Vol. 8, Issue 6, Part C (2022)

Abstract
Aim:1. To stage endometrial carcinoma on MR imaging.2. To assess the role of advanced MR imaging sequences (Dynamic Contrast Enhanced And Diffusion-Weighted Imaging) for evaluation of myometrial invasion in patients with endometrial carcinoma.Materials and Methods: This study was conducted on biopsy proven endometrial carcinoma patients referred for pelvic MRI to the Department of Radio-diagnosis and Modern imaging, Sardar Patel Medical College and Associated Group of Hospitals Bikaner over a period of one year. (from Nov. 2020 till Nov 2021).Method of collection of data: Thirty-six female patients with diagnosed endometrial carcinoma on histopathology were included in the study.MRI was performed after fulfilling the following inclusion and exclusion criteria.Inclusion Criteria• All patients with biopsy proven endometrial carcinoma.Exclusion Criteria: Any contraindications to MRI (cardiac pacemakers, prosthetic heart valves, cochlear implants, or claustrophobia).• Any contraindications to contrast administration (estimated glomerular filtration rate < 30 ml/min/1.73m2 in patients undergoing DCE MR Imaging).• Patients who do not consent to be a part of the study.Preparation of Patient: Written informed consent was obtained from each patient and relevant detailed history was elicited. Articles such as jewellery, keys, credit cards, watches, coins and other metallic objects were placed in the provided locker facility. The procedure was explained to the patient in her vernacular language to allay the fear and anxiety. Patient was placed in supine position and had a partially filled bladder. During the entire period of procedure, the patient was in contact with the technician/doctor by a two-way intercom system.Magnetic Resonance Imaging Protocol: All patients underwent a multiplanar, multi sequential MRI scan of the pelvis on a 3 Tesla MRI scanner by PHILIPS.All patients underwent axial T1-weighted, large FOV, axial T2-weighted and sagittal T2-weighted turbo spin echo (TSE) sequences. Thin slice (3mm) axial and coronal oblique T2 weighted TSE sequences (obtained in a plane perpendicular and parallel to the endometrial cavity) were then performed. Axial diffusion weighted images (DWI) were obtained with three b-values (50, 400, 800) and high b values (1400-1600) reconstructed using extrapolation. Dynamic contrast-enhanced study was performed after intravenous injection of gadolinium, 0.1 mmol/kg administered as a rapid bolus intravenous injection followed by a manual 20 mL saline flush. DCE images were acquired in the sagittal plane using three-dimensional gradient echo sequence, followed by axial oblique images using post-contrast turbo spin-echo sequence and a delayed sagittal T1 gradient echo sequence to assess the cervical invasion.Results: The purpose of this study was to stage the endometrial carcinoma on MR imaging with special focus on the depth of myometrial invasion and to further assess the role of advanced MR sequences (DWI and DCE) in comparison to conventional T2 weighted MR images. 36 cases of biopsy proven endometrial carcinoma were enrolled in our study with the age range of 35-88 years and mean age of 61 years. In our study, majority of the patients (n=33, 91.7%) were postmenopausal and the most common presenting symptom was postmenopausal bleeding (88.9%). Similar to this, in a study by Zandrino et al. 87% patients were post-menopausal and the most common presenting symptom was post-menopausal bleeding. In the present study, most common histopathological subtype was endometrioid carcinoma (n=29, 80.6%), out of which 51.7% were G1, 41.4% were G2 and 6.9% were G3. Other histological subtypes included 4 cases of carcinosarcoma, 2 cases of adenocarcinoma, NOS and 1 case of papillary adenocarcinoma. This was in concordance to study done by Hori et al. in which most of the cases (81.6%) had endometrioid histology, out of which 58.6% were G1, 27.6% were G2 and 13.8% were G3. In a study done by Zamani et al., 90.8% cases were of endometrioid variety with well-differentiated G1 tumors in 53.7% cases. The slight difference may be due to different sample sizes. The sensitivity, specificity, accuracy of T2WI, combined DWI + T2WI and combined DCE-MRI + T2WI in differentiating deep myometrial invasion from superficial myometrial invasion were 70.0%, 75.0%, 73.3%; 90.0%, 95.0%, 93.3%; and 90.0%, 90.0%, 90.0% respectively.