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Can reduced field-of-view diffusion sequence help assess microsatellite instability in FIGO stage 1 endometrial
Priya Bhosale1, Preetha Ramalingam2, Jingfei Ma3
1Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Purpose:
To determine if a reduced-field-of-view (rFOV) diffusion intravoxel incoherent motion (IVIM) sequence can differentiate the imaging characteristics of tumors with microsatellite instability (MSI) from those that are microsatellite stable (MSS) in patients with clinical FIGO stage IA endometrial cancer and if MRI can be used to determine MSI status.
Materials And Methods:
Sagittal rFOV diffusion-weighted images were obtained in 12 patients on a 3T scanner using six b-values (0, 50, 100, 150, 200, and 600). These images were used to derive apparent diffusion coefficient (ADC), true diffusion coefficient (Dt ), pseudodiffusion (D*), and perfusion fraction (f). Regions of interest (ROIs) were drawn on the dynamic contrast-enhanced magnetic resonance imaging (MRI) sequence on an Advantage Windows workstation and were copied to the same location on IVIM-derived images. The ROI mean of these images was recorded and compared with the microsatellite status. The depth of myometrial invasion and IVIM-derived parameters were tabulated by microsatellite status. The Wilcoxon rank sum test was used to compare T1 postcontrast images and IVIM-derived images and microsatellite status.
Results:
Six patients had MSS tumors and six had MSI tumors. MSS tumors had a significantly higher ADC value (P = 0.03) and Dt (P = 0.045) than the MSI tumors. There was no association between < and ≥ 50% depth of myometrial invasion (measured on pathology and MRI analysis) and MSI stability P > 0.99.
Conclusion:
IVIM, ADC and Dt may be able to determine microsatellite status noninvasively in patients with clinical FIGO stage I endometrial cancer.
Level Of Evidence:
1 J. Magn. Reson. Imaging 2017;45:1216-1224.
Insights
Reduced-field-of-view intravoxel incoherent motion (IVIM) MRI can differentiate microsatellite stable (MSS) from microsatellite unstable (MSI) endometrial tumors. Parameters like ADC and Dt may noninvasively determine MSI status in early-stage endometrial cancer.
Area of Science:
- Oncology
- Radiology
- Biomedical Imaging
Background:
- Endometrial cancer microsatellite instability (MSI) status impacts treatment decisions.
- Non-invasive methods to determine MSI status are needed.
Purpose of the Study:
- To assess if reduced-field-of-view (rFOV) diffusion intravoxel incoherent motion (IVIM) MRI can distinguish between MSI and microsatellite stable (MSS) tumors in early-stage endometrial cancer.
- To evaluate MRI's potential for non-invasively determining MSI status.
Main Methods:
- Sagittal rFOV diffusion-weighted images were acquired using a 3T scanner with six b-values.
- Apparent diffusion coefficient (ADC), true diffusion coefficient (Dt), pseudodiffusion (D*), and perfusion fraction (f) were derived.
- Regions of interest (ROIs) were analyzed for IVIM parameters and compared with microsatellite status.
Main Results:
- Microsatellite stable (MSS) tumors showed significantly higher ADC values (P=0.03) and Dt (P=0.045) compared to microsatellite unstable (MSI) tumors.
- No significant association was found between myometrial invasion depth and MSI status (P>0.99).
Conclusions:
- Intravoxel incoherent motion (IVIM) parameters, including ADC and Dt, show potential for non-invasively determining microsatellite status in FIGO stage I endometrial cancer.
- MRI may offer a non-invasive approach to assess MSI status, aiding in treatment stratification.
