Non-invasive staging of endometrial fibrosis using diffusion-weighted imaging: a feasibility study

Area of Science:

• Radiology
• Medical Imaging
• Gynecology

Background:

• Endometrial fibrosis impacts female reproductive health.
• Accurate staging of fibrosis is crucial for effective management.
• Current staging methods may have limitations.

Purpose of the Study:

• To evaluate the efficacy of diffusion-weighted imaging (DWI) in staging endometrial fibrosis.
• To determine if DWI parameters can differentiate between healthy endometrium and varying degrees of fibrosis.

Main Methods:

• Prospective study involving 41 healthy women, 30 with mild to moderate endometrial fibrosis (MMEF), and 102 with severe endometrial fibrosis (SEF).
• Measurement of endometrial thickness and DWI-derived apparent diffusion coefficient (ADC) parameters (mean intensity and standard deviation) using region of interest (ROI) and volume of interest (VOI).

Main Results:

• Significant differences in endometrial thickness and ADC values (ADC_VOI, ADC_ROI) were observed across healthy, MMEF, and SEF groups (all P < 0.001).
• Higher standard deviations of ADC values (ADC-SD_VOI, ADC-SD_ROI) were noted in SEF patients compared to healthy and MMEF groups (all P < 0.001).
• DWI parameters showed excellent accuracy (AUC > 0.800) in distinguishing between normal endometrium and different fibrosis stages, outperforming endometrial thickness measurements.

Conclusions:

• DWI is a highly effective tool for staging endometrial fibrosis.
• DWI accurately reflects microstructural changes associated with endometrial fibrosis.
• This imaging modality offers a promising approach for non-invasive fibrosis staging.