PLoS ONE (Jan 2015)

Role of diffusion weighted imaging and contrast-enhanced MRI in the evaluation of intrapelvic recurrence of gynecological malignant tumor.

  • Kazuhiro Kitajima,
  • Utaru Tanaka,
  • Yoshiko Ueno,
  • Tetsuo Maeda,
  • Yuko Suenaga,
  • Satoru Takahashi,
  • Masashi Deguchi,
  • Yoshiya Miyahara,
  • Yasuhiko Ebina,
  • Hideto Yamada,
  • Masakatsu Tsurusaki,
  • Yukihisa Tamaki,
  • Kazuro Sugimura

DOI
https://doi.org/10.1371/journal.pone.0117411
Journal volume & issue
Vol. 10, no. 1
p. e0117411

Abstract

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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.