A comparative analysis of MRI findings in endometrial cancer: differentiation between endometrioid adenocarcinoma, serous carcinoma, and clear cell carcinoma

• Published in: European radiology Vol. 32; no. 6; pp. 4128 - 4136
• Main Authors: Mori, Takayuki, Kato, Hiroki, Kawaguchi, Masaya, Hatano, Yuichiro, Ishihara, Takuma, Noda, Yoshifumi, Hyodo, Fuminori, Matsuo, Masayuki, Furui, Tatsuro, Morishige, Ken-ichirou
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2022; Springer Nature B.V
• Subjects: Adenocarcinoma; Adenocarcinoma, Clear Cell - diagnostic imaging; Adenocarcinoma, Clear Cell - pathology; Ascites; Cancer; Carcinoma, Endometrioid - diagnostic imaging; Carcinoma, Endometrioid - pathology; Comparative analysis; Diagnostic Radiology; Diffusion coefficient; Diffusion Magnetic Resonance Imaging - methods; Endometrial cancer; Endometrial Neoplasms - diagnostic imaging; Endometrial Neoplasms - pathology; Endometrium; Female; Gadolinium; Growth patterns; Humans; Hysterectomy; Image enhancement; Imaging; Internal Medicine; Interventional Radiology; Magnetic Resonance Imaging; Medical imaging; Medicine; Medicine & Public Health; Neuroradiology; Ovarian Neoplasms - pathology; Peritoneum; Radiology; Retrospective Studies; Tumors; Ultrasound; Urogenital; Endometrioid; Carcinoma; Magnetic resonance imaging; Endometrial neoplasms
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-08512-6

Objective To assess the magnetic resonance imaging (MRI) findings of endometrial cancers and to reveal the differences between endometrioid carcinoma (EC), serous carcinoma (SC), and clear cell carcinoma (CCC). Methods In this study, 274 consecutive patients with histopathologically confirmed endometrial cancer (231 ECs, 25 SCs, and 18 CCCs) who underwent MRI before hysterectomy were enrolled. MRI images were retrospectively reviewed and compared between the three pathologies. Results The maximum diameters (55.6 ± 34.7 vs. 39.3 ± 21.6 vs. 39.4 ± 26.8 mm) ( p  < 0.05) and apparent diffusion coefficient (ADC) values (1.11 ± 0.21 vs. 0.84 ± 0.17 vs. 0.86 ± 0.16 × 10 −3 mm 2 /s) ( p  < 0.01) were significantly greater in CCCs than in ECs and SCs, respectively. Infiltrative growth pattern (33% vs. 6%) ( p  < 0.01) was more frequent in CCCs than in ECs. Peritoneal dissemination (16% vs. 0%) ( p  < 0.01) and heterogeneous signal on diffusion-weighted (61% vs. 32%) ( p  < 0.05) images were more frequent in SCs than in ECs, respectively. Abnormal ascites (12% vs. 11% vs. 0%) and heterogeneous signal on T1-weighted (28% vs. 50% vs. 9%), T2-weighted (64% vs. 72% vs. 36%), and fat-suppressed gadolinium-enhanced T1-weighted (80% vs. 90% vs. 46%) images were more frequent in SCs and CCCs than in ECs, respectively ( p  < 0.05). Conclusions SCs frequently exhibited a heterogeneous signal with peritoneal dissemination and abnormal ascites. Alternatively, CCCs tended to have a larger tumor size and higher ADC values with an infiltrative growth pattern, heterogeneous signal, and abnormal ascites. Key Points • SCs tend to have a heterogeneous signal intensity with peritoneal dissemination and abnormal ascites compared to ECs. • CCCs tend to have a heterogeneous signal intensity with an infiltrative growth pattern and abnormal ascites compared to ECs. • CCCs have a larger tumor size and higher ADC values compared to ECs and SCs.