ABSTRACT ID NO: IRIA - 1085

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ROLE OF DIFFUSION WEIGHTED IMAGING IN UTERINE AND
CERVICAL LESIONS

• ABSTRACT ID NO IRIA - 1085

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INTRODUCTION

• Increasingly used in abdomen and pelvis since the
  last decade
• DWI ? ADC(Apparent Diffusion Coefficient) ?
  Cellularity
• Increased Cellularity ? Impeded diffusion

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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
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REVIEW OF LITERATURE

• 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

Diffusion-weighted Imaging of Gynecologic Tumors
Diagnostic Pearls and Potential Pitfalls Sunita
Dhanda, et al Radiographics 2014 3413931416
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AIM

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

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MATERIALS AND METHODS

• 24 patients with uterine and cervical lesions
• 15 control patients with normal uterus and cervix
• DWI  with b value 800 as a part of routine MR
  imaging on 1.5T MRI
• Apparent diffusion coefficient (ADC) calculated
  and correlated with histopathology
• Inclusion 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

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PROFORMA

• 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

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PATHOLOGIES
(n2)
(n5)
(n12)
(n5)
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CARCINOMA ENDOMETRIUM
F/65, Post menopausal bleeding
T2 WI
ADC 0.648x10-3mm2/s
ADC
DWI
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CARCINOMA ENDOMETRIUM
F/52, Menorrhagia
T2 WI
ADC 0.712 x10-3mm2/s
DWI
ADC
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ADC Normal Endometrium
ADC Ca 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/s Mean 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
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NPAR TESTSMANN-WHITNEY TEST
RANKS
TEST STATISTICS
ANN ANN N Mean Rank Sum of Ranks
Endometrium ABNORMAL 5 3.10 15.50
Endometrium NORMAL 15 12.97 194.50
Endometrium Total 20    
  Endometrium
Mann-Whitney U .500
Wilcoxon W 15.500
Z -3.244
Asymp. Sig. (2-tailed) .001
Exact Sig. 2(1-tailed Sig.) .000b
a. Grouping Variable ANN
b. Not corrected for ties
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CARCINOMA CERVIX
F/57Post menopausal bleeding
T2 WI
ADC 0.923x10-3mm2/s
DWI
ADC
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CARCINOMA CERVIX
F/57 ,White discharge
T2 WI
ADC 0.977 x 103mm2/s
DWI
ADC
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ADC values of normal cervix
ADC values of Carcinoma cervix
S.No CONTROL ADC VALUES X 10-3mm2/S
1 1.35
2 1.37
3 1.40
4 1.56
5 1.42
6 1.46
7 1.37
8 1.36
9 1.34
10 1.36
11 1.43
12 1.37
13 1.36
14 1.32
15 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/s Mean ADC 1.39
x10-3mm2/s
Range 0.618 to 1.012 x10-3mm2/s Mean ADC 0.909
x10-3mm2/s
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NPAR TESTSMANN-WHITNEY TEST
TEST STATISTICS
RANKS
ANN ANN N Mean Rank Sum of Ranks
CERVIX ABNORMAL 5 3.0 15.00
CERVIX NORMAL 15 13.0 195.00
CERVIX Total 20    
  CERVIX
Mann-Whitney U 0.000
Wilcoxon W 15.000
Z -3.291
Asymp. Sig. (2-tailed) .001
Exact Sig. 2(1-tailed Sig.) .000b
a. Grouping Variable ANN
b. Not corrected for ties.
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LEIOMYOMA
F/43,Menorrhagia,dysmenorrhoea
T2 WI
ADC 1.616 x10-3mm2/s
ADC
DWI
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LEIOMYOMAS
F/43 Menorrhagia
T2 WI
ADC 1.256 x10-3mm2/s
ADC
DWI
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ADC values of normal myometrium
ADC values of Leiomyoma
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
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
Range 1.39 to 1.68 x10-3mm2/s Mean ADC 1.53
x10-3mm2/s
Range 1.24 to 2.27 x10-3mm2/s Mean ADC
1.67x10-3mm2/s
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STATISTICAL ANALYSIS T-TEST
Group Statistics Group Statistics Group Statistics Group Statistics Group Statistics Group Statistics
MF MF N Mean Std. Deviation Std. Error Mean
VALUES MYOMETRIUM 15 1.5313 .07308 .01887
VALUES FIBROID 12 1.6799 .33624 .09706
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STATISTICAL ANALYSIS (Cont)
Independent Samples Test Independent Samples Test Independent Samples Test Independent Samples Test Independent Samples Test Independent Samples Test Independent Samples Test Independent Samples Test Independent Samples Test Independent Samples Test Independent Samples Test
    Levene's Test for Equality of Variances Levene's Test for Equality of Variances t-test for Equality of Means t-test for Equality of Means t-test for Equality of Means t-test for Equality of Means t-test for Equality of Means t-test for Equality of Means t-test for Equality of Means
    F Sig. t df Sig. (2-tailed) Mean Difference Std. Error Difference 95 Confidence Interval of the Difference 95 Confidence Interval of the Difference
    F Sig. t df Sig. (2-tailed) Mean Difference Std. Error Difference Lower Upper
VALUES Equal variances assumed 20.595 .000 -1.671 25 .107 -.14858 .08894 -.33176 .03459
VALUES Equal variances not assumed     -1.503 11.834 .159 -.14858 .09888 -.36436 .06720
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ADENOMYOSIS
F/40 Dysmenorrhea,
T2 WI
ADC 1.506 x10-3mm2/s
DWI
ADC
ADC values of adenomyosis 1.458 x 10-3mm/s and
1.506 x 10-3mm/s
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RESULTS

• Significant reduction in ADC values of malignant
  lesions as compared to benign ones
• Mean ADC of Ca Endometrium (0.88 x10-3mm2/s ) lt
  Mean ADC of normal Endometrium (1.44 x10-3mm2/s )
• Mean ADC of Ca Cervix (0.9 x10-3mm2/s) lt Mean ADC
  of normal Cervix (1.39 x10-3mm2/s )

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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

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• THANK YOU..