ABSTRACT ID NO: IRIA - 1085

ROLE OF DIFFUSION WEIGHTED IMAGING IN UTERINE AND CERVICAL LESIONS

Increasingly used in abdomen and pelvis since the last decade

DWI ADC(Apparent Diffusion Coefficient) Cellularity

Increased Cellularity Impeded diffusion

INTRODUCTION

REVIEW OF LITERATURE

Role of diffusion weighted imaging in the diagnosis of gynecological diseases : Tomohiro Namimoto,Kazuo Awai,Takeshi Nakaura,Yumi Yanaga :

European Society of Radiology 2008

Important cancer biomarker

Aids in superior lesion characterization, tumor staging, treatment planning, and disease follow-up of gynaecological tumors

Help predict and assess treatment response earlier than other techniques

Can detect residual / recurrent tumor

REVIEW OF LITERATURE

Diffusion-weighted Imaging of Gynecologic Tumors: Diagnostic Pearls and Potential Pitfalls : Sunita Dhanda, et al

Radiographics 2014 :34:1393–1416

To assess role of Diffusion weighted imaging (DWI) in differentiating benign from malignant lesions of uterus and cervix

AIM

24 patients with uterine and cervical lesions15 control patients with normal uterus and cervixDWI  with b value 800 as a part of routine MR imaging on 1.5T MRIApparent diffusion coefficient (ADC) calculated and correlated with histopathologyInclusion criteria: Patients with lesions of uterus and cervix who have undergone MRI and who have HPE follow up Exclusion criteria: Patients who have contraindications to MR imaging and who have no HPE follow up

MATERIALS AND METHODS

Name

Age

Hospital No

Date Of MRI Study

Clinical History

Previous USG,CT,MRI findings

Findings at MRI with special emphasis on DWI

Clinical Follow Up

HPE Diagnosis

PROFORMA

PATHOLOGIES

(n=2)

(n=12)

(n=5)

(n=5)

CARCINOMA ENDOMETRIUM

T2 WI

ADC :0.648x10-3mm2/s

DWIADC

F/65, Post menopausal bleeding

CARCINOMA ENDOMETRIUM

ADC 0.712 x10-3mm2/s

T2 WI

DWIADC

F/52, Menorrhagia

ADC :Normal Endometrium

S.NO. CONTROL ADC VALUES (X 10-3mm2/s)

1. 1.42

2. 1.29

3. 1.33

4. 1.43

5. 1.59

6. 1.45

7. 1.34

8. 1.46

9. 1.42

10. 1.42

11. 1.47

12. 1.59

13. 1.42

14. 1.49

15. 1.41

S.No ADC VALUES (X 10-3mm2/s)

1. 1.29

2. 0.712

3. 0.619

4. 0.94

5. 0.981

Range: 1.29 to 1.59 x 10-3mm2/sMean ADC : 1.44 x 10-3 mm2/s

Range :0.619 to 1.29 x 10-3mm2/s Mean ADC : 0.88 x 10-3mm2/s

ADC :Ca Endometrium

NPAR TESTSMANN-WHITNEY TEST

RANKS TEST STATISTICS

a. Grouping Variable: ANN

b. Not corrected for ties

CARCINOMA CERVIX

T2 WI

ADC:0.923x10-3mm2/s

DWI ADC

F/57Post menopausal bleeding

CARCINOMA CERVIX

ADC 0.977 x 103mm2/s

T2 WI

DWIADC

F/57 ,White discharge

ADC values of normal cervix

S.No CONTROL ADC VALUES X 10-3mm2/S

1 1.35

2 1.373 1.404 1.565 1.426 1.467 1.378 1.369 1.3410 1.3611 1.4312 1.3713 1.3614 1.3215 1.37

S.No ADC VALUES X 10-3mm2/S

1 0.618

2 1.104

3 0.886

4 1.012

5 0.977

Range :1.32 to 1.56 x10-3mm2/sMean ADC : 1.39 x10-3mm2/s

Range :0.618 to 1.012 x10-3mm2/sMean ADC :0.909 x10-3mm2/s

ADC values of Carcinoma cervix

NPAR TESTSMANN-WHITNEY TEST

RANKS TEST STATISTICS

b. Not corrected for ties.

a. Grouping Variable: ANN

LEIOMYOMA

T2 WI

ADC:1.616 x10-3mm2/s

DWIADC

F/43,Menorrhagia,dysmenorrhoea

LEIOMYOMAS

T2 WI

ADC: 1.256 x10-3mm2/s

DWIADC

F/43Menorrhagia

ADC values of normal myometrium

S.NO CONTROL ADC VALUES X 10-3mm2/s

1. 1.57

2. 1.39

3. 1.64

4. 1.68

5. 1.51

6. 1.54

7. 1.46

8. 1.54

9. 1.56

10. 1.52

11. 1.42

12. 1.54

13. 1.54

14. 1.53

15. 1.52

Range: 1.39 to 1.68 x10-3mm2/sMean ADC : 1.53 x10-3mm2/s

S.NO. ADC VALUES X 10-3mm2/s

1 2.27

2 1.77

3 1.59

4 1.53

5 1.54

6 1.206

7 1.828

8 2.059

9 1.616

10 1.256

11 2.1

12 1.41

ADC values of Leiomyoma

Range: 1.24 to 2.27 x10-3mm2/sMean ADC : 1.67x10-3mm2/s

STATISTICAL ANALYSIS :T-TEST

Independent Samples Test

Levene's Test for Equality of

Variances t-test for Equality of Means

F Sig. t dfSig. (2-tailed)

Mean Differe

nce

Std. Error

Difference

95% Confidence

Interval of the Difference

Lower UpperVALUES Equal

variances assumed

20.595 .000 -1.671 25 .107 -.14858

.08894 -.33176

.03459

Equal variances not assumed

-1.503 11.834 .159 -.14858

.09888 -.36436

.06720

STATISTICAL ANALYSIS (Cont…)

ADENOMYOSIS

ADC values of adenomyosis : 1.458 x 10-3mm/s and 1.506 x 10-3mm/s

T2 WI

DWIADC

F/40Dysmenorrhea,

ADC: 1.506 x10-3mm2/s

Significant reduction in ADC values of malignant lesions as compared to benign ones

Mean ADC of Ca Endometrium (0.88 x10-3mm2/s ) < Mean ADC of normal Endometrium (1.44 x10-3mm2/s )

Mean ADC of Ca Cervix (0.9 x10-3mm2/s) < Mean ADC of normal Cervix (1.39 x10-3mm2/s )

RESULTS

CONCLUSION

DWI with quantification of ADC values plays a major role in distinguishing benign and malignant lesions

DWI should be part of routine MR protocol when imaging the uterus and cervix

THANK YOU..