Diffusion volume (DV) measurement in endometrial and cervical cancer: A new MRI parameter in the evaluation of the tumor grading and the risk classification

Pierpaolo Mainenti, Laura Micol Pizzuti, Sabrina Segreto, Marco Comerci, Simona De Fronzo, Federica Romano, Vincenzina Crisci, Michele Smaldone, Ettore Laccetti, Giovanni Storto, Bruno Alfano, S. Maurea, Marco Salvatore, L. Pace

Research output: Contribution to journalArticle

Abstract

Purpose A new MRI parameter representative of active tumor burden is proposed: diffusion volume (DV), defined as the sum of all the voxels within a tumor with apparent diffusion coefficient (ADC) values within a specific range. The aims of the study were: (a) to calculate DV on ADC maps in patients with cervical/endometrial cancer; (b) to correlate DV with histological grade (G) and risk classification; (c) to evaluate intra/inter-observer agreement of DV calculation. Materials and methods Fifty-three patients with endometrial (n = 28) and cervical (n = 25) cancers underwent pelvic MRI with DWI sequences. Both endometrial and cervical tumors were classified on the basis of G (G1/G2/G3) and FIGO staging (low/medium/high-risk). A semi-automated segmentation procedure was used to calculate the DV. A freehand closed ROI outlined the whole visible tumor on the most representative slice of ADC maps defined as the slice with the maximum diameter of the solid neoplastic component. Successively, two thresholds were generated on the basis of the mean and standard deviation (SD) of the ADC values: lower threshold (LT = "mean minus three SD") and higher threshold (HT = "mean plus one SD"). The closed ROI was expanded in 3D, including all the contiguous voxels with ADC values in the range LT-HT × 10-3 mm2/s. A Kruskal-Wallis test was used to assess the differences in DV among G and risk groups. Intra-/inter-observer variability for DV measurement was analyzed according to the method of Bland and Altman and the intraclass-correlation-coefficient (ICC). Results DV values were significantly different among G and risk groups in both endometrial (p <0.05) and cervical cancers (p ≤ 0.01). For endometrial cancer, DV of G1 (mean ± sd: 2.81 ± 3.21 cc) neoplasms were significantly lower than G2 (9.44 ± 9.58 cc) and G3 (11.96 ± 8.0 cc) ones; moreover, DV of low risk cancers (5.23 ± 8.0 cc) were significantly lower than medium (7.28 ± 4.3 cc) and high risk (14.7 ± 9.9 cc) ones. For cervical cancer, DV of G1 (0.31 ± 0.13 cc) neoplasms was significantly lower than G3 (40.68 ± 45.65 cc) ones; moreover, DV of low risk neoplasms (6.98 ± 8.08 cc) was significantly lower than medium (21.7 ± 17.13 cc) and high risk (62.9 ± 51.12 cc) ones and DV of medium risk neoplasms was significantly lower than high risk ones. The intra-/inter-observer variability for DV measurement showed an excellent correlation for both cancers (ICC ≥ 0.86). Conclusions DV is an accurate index for the assessment of G and risk classification of cervical/endometrial cancers with low intra-/inter-observer variability.

Original languageEnglish
Pages (from-to)113-124
Number of pages12
JournalEuropean Journal of Radiology
Volume85
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

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Neoplasm Grading
Endometrial Neoplasms
Uterine Cervical Neoplasms
Observer Variation
Neoplasms
Pelvic Neoplasms

Keywords

  • ADC maps
  • Cancer
  • Cervical
  • Diffusion volume
  • DWI
  • Endometrial
  • MRI

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Diffusion volume (DV) measurement in endometrial and cervical cancer : A new MRI parameter in the evaluation of the tumor grading and the risk classification. / Mainenti, Pierpaolo; Pizzuti, Laura Micol; Segreto, Sabrina; Comerci, Marco; Fronzo, Simona De; Romano, Federica; Crisci, Vincenzina; Smaldone, Michele; Laccetti, Ettore; Storto, Giovanni; Alfano, Bruno; Maurea, S.; Salvatore, Marco; Pace, L.

In: European Journal of Radiology, Vol. 85, No. 1, 01.01.2016, p. 113-124.

Research output: Contribution to journalArticle

Mainenti, P, Pizzuti, LM, Segreto, S, Comerci, M, Fronzo, SD, Romano, F, Crisci, V, Smaldone, M, Laccetti, E, Storto, G, Alfano, B, Maurea, S, Salvatore, M & Pace, L 2016, 'Diffusion volume (DV) measurement in endometrial and cervical cancer: A new MRI parameter in the evaluation of the tumor grading and the risk classification', European Journal of Radiology, vol. 85, no. 1, pp. 113-124. https://doi.org/10.1016/j.ejrad.2015.10.014
Mainenti, Pierpaolo ; Pizzuti, Laura Micol ; Segreto, Sabrina ; Comerci, Marco ; Fronzo, Simona De ; Romano, Federica ; Crisci, Vincenzina ; Smaldone, Michele ; Laccetti, Ettore ; Storto, Giovanni ; Alfano, Bruno ; Maurea, S. ; Salvatore, Marco ; Pace, L. / Diffusion volume (DV) measurement in endometrial and cervical cancer : A new MRI parameter in the evaluation of the tumor grading and the risk classification. In: European Journal of Radiology. 2016 ; Vol. 85, No. 1. pp. 113-124.
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TY - JOUR

T1 - Diffusion volume (DV) measurement in endometrial and cervical cancer

T2 - A new MRI parameter in the evaluation of the tumor grading and the risk classification

AU - Mainenti, Pierpaolo

AU - Pizzuti, Laura Micol

AU - Segreto, Sabrina

AU - Comerci, Marco

AU - Fronzo, Simona De

AU - Romano, Federica

AU - Crisci, Vincenzina

AU - Smaldone, Michele

AU - Laccetti, Ettore

AU - Storto, Giovanni

AU - Alfano, Bruno

AU - Maurea, S.

AU - Salvatore, Marco

AU - Pace, L.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Purpose A new MRI parameter representative of active tumor burden is proposed: diffusion volume (DV), defined as the sum of all the voxels within a tumor with apparent diffusion coefficient (ADC) values within a specific range. The aims of the study were: (a) to calculate DV on ADC maps in patients with cervical/endometrial cancer; (b) to correlate DV with histological grade (G) and risk classification; (c) to evaluate intra/inter-observer agreement of DV calculation. Materials and methods Fifty-three patients with endometrial (n = 28) and cervical (n = 25) cancers underwent pelvic MRI with DWI sequences. Both endometrial and cervical tumors were classified on the basis of G (G1/G2/G3) and FIGO staging (low/medium/high-risk). A semi-automated segmentation procedure was used to calculate the DV. A freehand closed ROI outlined the whole visible tumor on the most representative slice of ADC maps defined as the slice with the maximum diameter of the solid neoplastic component. Successively, two thresholds were generated on the basis of the mean and standard deviation (SD) of the ADC values: lower threshold (LT = "mean minus three SD") and higher threshold (HT = "mean plus one SD"). The closed ROI was expanded in 3D, including all the contiguous voxels with ADC values in the range LT-HT × 10-3 mm2/s. A Kruskal-Wallis test was used to assess the differences in DV among G and risk groups. Intra-/inter-observer variability for DV measurement was analyzed according to the method of Bland and Altman and the intraclass-correlation-coefficient (ICC). Results DV values were significantly different among G and risk groups in both endometrial (p <0.05) and cervical cancers (p ≤ 0.01). For endometrial cancer, DV of G1 (mean ± sd: 2.81 ± 3.21 cc) neoplasms were significantly lower than G2 (9.44 ± 9.58 cc) and G3 (11.96 ± 8.0 cc) ones; moreover, DV of low risk cancers (5.23 ± 8.0 cc) were significantly lower than medium (7.28 ± 4.3 cc) and high risk (14.7 ± 9.9 cc) ones. For cervical cancer, DV of G1 (0.31 ± 0.13 cc) neoplasms was significantly lower than G3 (40.68 ± 45.65 cc) ones; moreover, DV of low risk neoplasms (6.98 ± 8.08 cc) was significantly lower than medium (21.7 ± 17.13 cc) and high risk (62.9 ± 51.12 cc) ones and DV of medium risk neoplasms was significantly lower than high risk ones. The intra-/inter-observer variability for DV measurement showed an excellent correlation for both cancers (ICC ≥ 0.86). Conclusions DV is an accurate index for the assessment of G and risk classification of cervical/endometrial cancers with low intra-/inter-observer variability.

AB - Purpose A new MRI parameter representative of active tumor burden is proposed: diffusion volume (DV), defined as the sum of all the voxels within a tumor with apparent diffusion coefficient (ADC) values within a specific range. The aims of the study were: (a) to calculate DV on ADC maps in patients with cervical/endometrial cancer; (b) to correlate DV with histological grade (G) and risk classification; (c) to evaluate intra/inter-observer agreement of DV calculation. Materials and methods Fifty-three patients with endometrial (n = 28) and cervical (n = 25) cancers underwent pelvic MRI with DWI sequences. Both endometrial and cervical tumors were classified on the basis of G (G1/G2/G3) and FIGO staging (low/medium/high-risk). A semi-automated segmentation procedure was used to calculate the DV. A freehand closed ROI outlined the whole visible tumor on the most representative slice of ADC maps defined as the slice with the maximum diameter of the solid neoplastic component. Successively, two thresholds were generated on the basis of the mean and standard deviation (SD) of the ADC values: lower threshold (LT = "mean minus three SD") and higher threshold (HT = "mean plus one SD"). The closed ROI was expanded in 3D, including all the contiguous voxels with ADC values in the range LT-HT × 10-3 mm2/s. A Kruskal-Wallis test was used to assess the differences in DV among G and risk groups. Intra-/inter-observer variability for DV measurement was analyzed according to the method of Bland and Altman and the intraclass-correlation-coefficient (ICC). Results DV values were significantly different among G and risk groups in both endometrial (p <0.05) and cervical cancers (p ≤ 0.01). For endometrial cancer, DV of G1 (mean ± sd: 2.81 ± 3.21 cc) neoplasms were significantly lower than G2 (9.44 ± 9.58 cc) and G3 (11.96 ± 8.0 cc) ones; moreover, DV of low risk cancers (5.23 ± 8.0 cc) were significantly lower than medium (7.28 ± 4.3 cc) and high risk (14.7 ± 9.9 cc) ones. For cervical cancer, DV of G1 (0.31 ± 0.13 cc) neoplasms was significantly lower than G3 (40.68 ± 45.65 cc) ones; moreover, DV of low risk neoplasms (6.98 ± 8.08 cc) was significantly lower than medium (21.7 ± 17.13 cc) and high risk (62.9 ± 51.12 cc) ones and DV of medium risk neoplasms was significantly lower than high risk ones. The intra-/inter-observer variability for DV measurement showed an excellent correlation for both cancers (ICC ≥ 0.86). Conclusions DV is an accurate index for the assessment of G and risk classification of cervical/endometrial cancers with low intra-/inter-observer variability.

KW - ADC maps

KW - Cancer

KW - Cervical

KW - Diffusion volume

KW - DWI

KW - Endometrial

KW - MRI

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