Preoperative risk assessment of endometrial cancer using histogram analysis of weighted and quantitative MRI images

The aim of this study was to evaluate the capability of histogram analysis of weighted and quantitative MRI images to improve preoperative endometrial cancer (EC) risk stratification by providing information about the histological properties of the tumours.

In this prospective study, 94 patients with biopsy verified endometrial carcinoma underwent a preoperative MRI examination performed according to the European Society of Urogenital Radiology (ESUR) guidelines with addition of synthetic MRI, dynamic contrast enhancement and diffusion weighted imaging (DWI) with high b-values. Quantitative relaxation maps, perfusion maps and diffusion kurtosis imaging (DKI) maps were generated from the additional sequences. Tumours were segmented on three adjacent slices and histogram properties were compared between tumours with low and high histological risk.

Significant differences were found between tumours with low and high histological risk in the histogram properties for the DKI derived apparent diffusion maps (D_app): mean (p = 0.048), median (p = 0.025), skewness (p < 0.001) and kurtosis (p = 0.003). No significant differences between the groups were observed in histogram properties of quantitative relaxation maps, acquired by synthetic MRI.

Histogram analysis of DKI shows better potential to discriminate between EC histological risk groups and histologically determined endometrioid tumour grades than regular DWI, relaxation maps from synthetic MR, perfusion maps and T1 or T2 weighted images.