The value of diffusion-weighted imaging in combination with conventional magnetic resonance imaging for improving tumor detection for early cervical carcinoma treated with fertility-sparing surgery

Abstract

Objective: This study aimed to investigate the value of diffusion-weighted imaging (DWI) in combination with conventional magnetic resonance imaging (MRI) for improving tumor detection in young patients treated with fertility-sparing surgery because of early cervical carcinoma. Methods: Fifty-four patients with stage Ia or Ib1 cervical carcinoma were enrolled into this study. Magnetic resonance examinations were performed for these patients using conventional MRI (including T1-weighted imaging, T2-weighted imaging, and dynamic contrast-enhanced MRI) and DWI. The apparent diffusion coefficient (ADC) values of cervical carcinoma were analyzed quantitatively and compared with that of adjacent epithelium. Sensitivity, positive predictive value, and accuracy of 2 sets of MRI sequences were calculated on the basis of histologic results, and the diagnostic ability of conventionalMRI/ DWI combinations was compared with that of conventional MRI. Results: The mean ADC value from cervical carcinoma (mean, 786 10j6 mm2/s T 100) was significantly lower than that from adjacent epithelium(mean, 1352 10j6 mm2/s T 147) (P = 0.01). When the threshold ADC value set as 1010 10j6 mm2/s, the sensitivity and specificity for differentiating cervical carcinoma from nontumor epithelium were 78.2% and 67.2%, respectively. The sensitivity and accuracy of conventional MRI for tumor detection were 76.0% and 70.4%, whereas the sensitivity and accuracy of conventional MRI/DWI combinations were 91.7% and 90.7%, respectively. ConventionalMRI/DWI combinations revealed a positive predictive value of 97.8% and only 4 false-negative findings. Conclusions: The addition of DWI to conventional MRI considerably improves the sensitivity and accuracy of tumor detection in young patients treated with fertility-sparing surgery, which supports the inclusion quantitative analysis of ADC value in routine MRI protocol before fertility-sparing surgery.