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Diffusion volume (DV) measurement in endometrial and cervical cancer: A new MRI parameter in the evaluation of the tumor grading and the risk classification
- Source :
- European journal of radiology. 85(1)
- Publication Year :
- 2015
-
Abstract
- A new MRI parameter representative of active tumor burden is proposed: diffusion volume (DV), defined as the sum of all the voxels within a tumor with apparent diffusion coefficient (ADC) values within a specific range. The aims of the study were: (a) to calculate DV on ADC maps in patients with cervical/endometrial cancer; (b) to correlate DV with histological grade (G) and risk classification; (c) to evaluate intra/inter-observer agreement of DV calculation.Fifty-three patients with endometrial (n=28) and cervical (n=25) cancers underwent pelvic MRI with DWI sequences. Both endometrial and cervical tumors were classified on the basis of G (G1/G2/G3) and FIGO staging (low/medium/high-risk). A semi-automated segmentation procedure was used to calculate the DV. A freehand closed ROI outlined the whole visible tumor on the most representative slice of ADC maps defined as the slice with the maximum diameter of the solid neoplastic component. Successively, two thresholds were generated on the basis of the mean and standard deviation (SD) of the ADC values: lower threshold (LT="mean minus three SD") and higher threshold (HT="mean plus one SD"). The closed ROI was expanded in 3D, including all the contiguous voxels with ADC values in the range LT-HT × 10-3mm(2)/s. A Kruskal-Wallis test was used to assess the differences in DV among G and risk groups. Intra-/inter-observer variability for DV measurement was analyzed according to the method of Bland and Altman and the intraclass-correlation-coefficient (ICC).DV values were significantly different among G and risk groups in both endometrial (p0.05) and cervical cancers (p ≤ 0.01). For endometrial cancer, DV of G1 (mean ± sd: 2.81 ± 3.21 cc) neoplasms were significantly lower than G2 (9.44 ± 9.58 cc) and G3 (11.96 ± 8.0 cc) ones; moreover, DV of low risk cancers (5.23 ± 8.0 cc) were significantly lower than medium (7.28 ± 4.3 cc) and high risk (14.7 ± 9.9 cc) ones. For cervical cancer, DV of G1 (0.31 ± 0.13 cc) neoplasms was significantly lower than G3 (40.68 ± 45.65 cc) ones; moreover, DV of low risk neoplasms (6.98 ± 8.08 cc) was significantly lower than medium (21.7 ± 17.13 cc) and high risk (62.9 ± 51.12 cc) ones and DV of medium risk neoplasms was significantly lower than high risk ones. The intra-/inter-observer variability for DV measurement showed an excellent correlation for both cancers (ICC ≥ 0.86).DV is an accurate index for the assessment of G and risk classification of cervical/endometrial cancers with low intra-/inter-observer variability.
- Subjects :
- Adult
Risk
medicine.medical_specialty
ADC map
MRI, DWI, ADC maps, Diffusion volume, Cervical Endometrial Cancera
Tumor burden
Uterine Cervical Neoplasms
DWI
computer.software_genre
Sensitivity and Specificity
Standard deviation
ADC maps
Cervical Endometrial Cancera
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Voxel
Image Interpretation, Computer-Assisted
Tumor Grading
Medicine
Effective diffusion coefficient
Humans
Radiology, Nuclear Medicine and imaging
Cancer
Aged
Cervical cancer
Observer Variation
Analysis of Variance
business.industry
Endometrial cancer
General Medicine
Middle Aged
Diffusion volume
medicine.disease
Endometrial Neoplasms
Tumor Burden
Diffusion Magnetic Resonance Imaging
030220 oncology & carcinogenesis
Cervical
Female
Radiology
Neoplasm Grading
business
Nuclear medicine
Risk classification
computer
Endometrial
MRI
Subjects
Details
- ISSN :
- 18727727
- Volume :
- 85
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- European journal of radiology
- Accession number :
- edsair.doi.dedup.....cf6f56393fa89c64b4c76f4d50992e01