Role of Diffusion Weighted Imaging and Contrast-Enhanced MRI in the Evaluation of Intrapelvic Recurrence of Gynecological Malignant Tumor

• Published in: PloS one Vol. 10; no. 1; p. e0117411
• Main Authors: Kitajima, Kazuhiro, Tanaka, Utaru, Ueno, Yoshiko, Maeda, Tetsuo, Suenaga, Yuko, Takahashi, Satoru, Deguchi, Masashi, Miyahara, Yoshiya, Ebina, Yasuhiko, Yamada, Hideto, Tsurusaki, Masakatsu, Tamaki, Yukihisa, Sugimura, Kazuro
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.01.2015; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Cancer; Cancer therapies; Chemotherapy; Comparative analysis; Diagnosis; Diagnostic systems; Diffusion; Diffusion Magnetic Resonance Imaging - methods; Diseases; Driving while intoxicated; Evaluation; Female; Genital Neoplasms, Female - pathology; Gynecological cancer; Gynecology; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted; Lesions; Lymph; Lymph nodes; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medical imaging; Medical prognosis; Medicine; Metastases; Middle Aged; Neoplasm Recurrence, Local - pathology; NMR; Nuclear magnetic resonance; Obstetrics; Ovarian cancer; Patients; Pelvis - pathology; Peritoneum; Radiation therapy; Retrospective Studies; Sensitivity; Sensitivity and Specificity; Statistical analysis; Studies; Surgery; Tumors; University graduates
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0117411

To investigate the diagnostic performance of diffusion-weighted imaging (DWI) and contrast-enhanced imaging in combination with T2-weighted imaging (T2WI) for magnetic resonance imaging (MRI) evaluation of intrapelvic recurrence of gynecological malignancies. Sixty-two patients with suspected intrapelvic recurrence of gynecological malignancies underwent pelvic MRI including T2WI DWI, and contrast-enhanced imaging. Diagnostic performance for detection of local recurrence, pelvic lymph node and bone metastases, and peritoneal lesions was evaluated by consensus reading of two experienced radiologists using a 5-point scoring system, and compared among T2WI with unenhanced T1-weighted imaging (T1WI) (protocol A), a combination of protocol A and DWI (protocol B), and a combination of protocol B and contrast-enhanced imaging (protocol C). Final diagnoses were obtained by histopathological examinations, radiological imaging and clinical follow-up for at least 6 months. Receiver operating characteristic (ROC) analysis and McNemar test were employed for statistical analysis. Locally recurrent disease, lymph node recurrence, peritoneal dissemination and bone metastases were present in 48.4%, 29.0%, 16.1%, and 6.5% of the patients, respectively. The patient-based sensitivity, specificity, accuracy, and area under the ROC curve (AUC) for detection of intrapelvic recurrence were 55.0, 81.8, 64.5% and 0.753 for protocol A, 80.0, 77.3, 79.0% and 0.838 for protocol B, and 80.0, 90.9, 83.9% and 0.862 for protocol C, respectively. The sensitivity, accuracy, and AUC were significantly better for protocols B and C than for protocol A (p<0.001). There was no significant difference between protocols B and C. MRI using a combination of DWI and T2WI gives comparatively acceptable results for assessment of intrapelvic recurrence of gynecological malignancies.