Quantitative Time-Dependent Diffusion MRI for Diagnosis and Aggressiveness Assessment of Endometrial Cancer: A Prospective Study

Wenyi Yue ^1,2, Ruxue Han ³, Junzhong Xu ^4,5

¹Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
²Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
³Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
⁴Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA.
⁵Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
⁶Clinical & Technique Support, Philips Healthcare, Beijing, China.
⁷Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
⁸Department of Pathology, No. 984 Hospital of Chinese PLA Logistical Support Force, Beijing, China.
⁹Department of Gynecology Oncology, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹⁰Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. hual_gyn@163.com.
¹¹Laboratory for Clinical Medicine, Capital Medical University, Beijing, China. yangyangqiqi@gmail.com.

⁰Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

Korean Journal of Radiology +

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September 28, 2025

View abstract on PubMed

Summary

Time-dependent diffusion magnetic resonance imaging (TDD-MRI) effectively differentiates benign and malignant endometrial lesions. This advanced MRI technique also accurately identifies aggressive endometrial cancer types, aiding treatment decisions.

Area Of Science

Radiology and Oncologic Imaging
Biomedical Engineering
Gynecologic Pathology

Background

Accurate preoperative differentiation of endometrial lesions is vital for effective treatment planning.
Endometrial cancer (EC) requires precise histological typing to guide therapeutic strategies.
Time-dependent diffusion magnetic resonance imaging (TDD-MRI) offers potential for characterizing tissue microstructure noninvasively.

Purpose Of The Study

To assess TDD-MRI-derived microstructural parameters for distinguishing benign from malignant endometrial lesions.
To evaluate the capability of TDD-MRI in predicting aggressive histological subtypes of EC.
To explore the noninvasive diagnostic potential of TDD-MRI in gynecologic oncology.

Main Methods

Prospective study of 177 patients with suspected EC undergoing TDD-MRI.
Extraction of microstructural parameters including cellularity and cellularity index using the Imaging Microstructural Parameters Using Limited Spectrally Edited Diffusion method.
Diagnostic performance evaluated using receiver operating characteristic curve analysis and correlation with histopathology.

Main Results

Significant differences in microstructural parameters were observed between benign lesions and EC, and between nonaggressive and aggressive EC (P < 0.05).
Cellularity (AUC=0.86) and cellularity index (AUC=0.88) showed high diagnostic performance for differentiating lesion types.
TDD-MRI parameters strongly correlated with histopathological features (r=0.77-0.83, P < 0.001).

Conclusions

TDD-MRI-derived microstructural parameters demonstrate high accuracy in differentiating benign and malignant endometrial diseases.
The technique effectively identifies aggressive endometrial cancer subtypes, supporting its clinical utility.
TDD-MRI presents a promising noninvasive tool for preoperative assessment of endometrial lesions.

Keywords:

Endometrial cancer Histological types Magnetic resonance imaging Microstructural parameters Time-dependent diffusion MRI