Perfusion and diffusion characteristics of endometrial malignancy based on intravoxel incoherent motion MRI at 3.0 T: comparison with normal endometrium.

BACKGROUND: There has been a growing need for a non-invasive imaging method for the accurate diagnosis and differentiation of endometrial malignancy (EM).
PURPOSE: To study tissue characteristics of EM using an intravoxel incoherent motion (IVIM) model and to assess their diagnostic potential.
MATERIAL AND METHODS: Sixty-eight EMs and 31 healthy participants were prospectively recruited for diffusion-weighted (13 b-values, b = 0-3,000 s/mm(2)) and standard magnetic resonance imaging (MRI). A bi-exponential analysis was performed to derive f (perfusion fraction), D* (pseudodiffusion coefficient), and D (true diffusion coefficient) in EM and normal endometrium (NE). Apparent diffusion coefficient (ADC) was calculated. Student's t test, the Mann-Whitney U test and a receiver operating characteristics (ROC) curve analysis were performed.
RESULTS: EM had lower f (37.809 ± 12.158%) and was significantly different from NE (P < 0.001). However, the EMs had higher D (0.503 ± 0.155 × 10(-3) mm(2)/s) and D* (19.796 ± 20.029 × 10(-3) mm(2)/s) and were all significantly different from NE (P < 0.001). D was significantly lower than ADC in NE (P < 0.001) but not in EM (P > 0.05). f ≤ 48.5%, D > 0.432 × 10(-3) mm(2)/s, D* > 4.94 × 10(-3) mm(2)/s, and ADC ≤ 0.542 × 10(-3) mm(2)/s could diagnose EM (AUC 0.786-0.961).
CONCLUSION: EM has distinctive IVIM perfusion and diffusion characteristics with promising potential for earlier non-invasive diagnosis. © The Foundation Acta Radiologica 2015.