Role of Diffusion-Weighted Magnetic Resonance Imaging in Discrimination of Endometrial Carcinoma from Benign Diseases Affecting the Endometrium

Abstract Background: Evaluation of the role of diffusion-weighted imaging (DWI) in differentiation between endometrial carci-noma and benign diseases affecting the endometrium. Aim of Study: To assess the efficacy and the diagnostic accuracy of DWI in discrimination of endometrial carcinoma from benign endometrial and subendometrial diseases with pathologic correlation. Material and Methods: This study included 100 female patients with endometrial and subendometrial pathologies, their ages ranged from 20 to 85 years. Conventional T2- weighted, pre- and post contrast T1-weighted and DW-MRI images with b values 0, 500, 1000 s/mm2 were obtained. The mean ADC values of all lesions were recorded. Results were compared, correlated with final histopathological diagnosis reached by hysteroscopy, endometrial biopsy and surgical findings. Results: Patients were divided according to the final histopathological diagnosis into two categories (category I: included 40 patients with endometrial carcinoma and category II: included 60 patients with benign endometrial and suben-dometrial diseases). In DWI qualitative analysis; all studied cases with endometrial carcinoma displayed high signal intensity, however; there was overlap in DWI SI as regard benign diseases. The mean ADC value of endometrial cancer was 0.73±0.10 x10-3mm2/s which was significantly lower than that of benign diseases 1.36±0.32 x10-3 mm2/s (p<0.001). The cut off value for differentiation between endometrial cancer and benign diseases was 0.915 X10-3mm2/s with sensitivity, specificity and accuracy of 97.5%, 88.3% and 92.0% respectively. Conclusion: DWI combined with ADC measurement provides valuable information for evaluation of suspicious endometrial and subendometrial pathologies and is able to discriminate endometrial carcinoma from benign diseases affecting the endometrium with high diagnostic accuracy.