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Utility of the relative apparent diffusion coefficient for preoperative assessment of low risk endometrial carcinoma

  • Yiqing Shen
    Affiliations
    Department of Radiology, the First Affiliated Hospital of Chongqing, Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China
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  • Fajin Lv
    Correspondence
    Corresponding author at: Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China.
    Affiliations
    Department of Radiology, the First Affiliated Hospital of Chongqing, Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China
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  • Zhibo Xiao
    Affiliations
    Department of Radiology, the First Affiliated Hospital of Chongqing, Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China
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  • Qiu Bi
    Affiliations
    Department of Radiology, the First Affiliated Hospital of Chongqing, Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China
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      Highlights

      • We use rADC values in predicting patients with low risk EC for the first time.
      • meanADC, minADC and rADC were significantly higher in the low risk EC than they were in the intermediate-high risk EC.
      • rADC values yield the best diagnostic efficiency.
      • ADC values aid in the selection of treatment strategies of stage I EC.

      Abstract

      Objectives

      Lymphadenectomy is not recommended for low risk stage I endometrial carcinoma (EC) patients. This study was to investigate the predictive value of apparent diffusion coefficient (ADC) values in predicting patients with low risk EC, and to identify an optimum ADC measurement for preoperative assessment.

      Materials and methods

      Eighty-one patients with stage I EC who underwent diffusion-weighted imaging (DWI) at 1.5T were included and divided into low group and intermediate-high risk group based on the ESMO-ESGO-ESTRO classification. Clinical indexes, conventional MRI parameters, minimum ADC values (minADC), mean ADC values (meanADC) and relative ADC values (rADC) were compared between those two groups. rADC was calculated using the equation ADC (cancer)/ADC (reference) with the obturator internus muscle as reference. The optimal ADC measurement and cut-off ADC value for low risk EC were calculated using the receiver operating characteristic (ROC) curve.

      Results

      The low risk group had significantly higher meanADC, minADC, and rADC values than did the intermediate-high risk group (1.095 vs. 0.902 × 10−3 mm2/s, 0.755 vs. 0.657 × 10−3 mm2/s, 0.754 vs. 0.603, respectively). In assessments of low risk EC patients, the area under the curve (AUC) values for meanADC, minADC, and rADC were 0.840 (95%CI, 0.749,0.931), 0.681 (95% CI: 0.561,0.800), and 0.876(95% CI: 0.798,0.954), respectively. The optimal cut-off rADC value for prediction was 0.669, the maximum Youden index, sensitivity, specificity, and accuracy values were 0.683, 81.8%, 86.5%, and 84.0%, respectively.

      Conclusions

      rADC is superior to minADC and meanADC for predicting patients with low risk EC, and could potentially aid to the surgical management of these patients in avoiding unnecessary lymphadenectomy.

      Keywords

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