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Quantitative T2 mapping of junctional zone alterations in endometrial fibrosis: comparison with diffusion-weighted
Huanhuan Liang1, Kaibo Sun1, Hui Zhu2
1Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Background:
Endometrial fibrosis can disrupt the uterine junctional zone and lead to infertility. Accurate and noninvasive evaluation of junctional zone alterations is important to clinical treatment. Although conventional T2-weighted imaging provides only qualitative information, quantitative techniques such as diffusion-weighted imaging (DWI) and T2 mapping may better capture fibrosis-related microstructural changes. This study aimed to use T2 mapping to quantitatively assess junctional zone alterations in endometrial fibrosis using, compare its performance with the apparent diffusion coefficient (ADC), and evaluate its diagnostic value and reproducibility.
Methods:
This prospective study included 86 patients with severe endometrial fibrosis (SEF), 40 patients with mild-to-moderate endometrial fibrosis (MMEF), and 55 healthy women. Junctional zone thickness (JZT), outer myometrial thickness (OMT), T2 relaxation times of the junctional zone (T2JZ) and outer myometrium (T2OM), and ADC values of the junctional zone (ADCJZ) and outer myometrium (ADCOM) were measured and analyzed. Statistical analyses included Kruskal-Wallis one-way analysis of variance, Spearman correlation analysis, binary logistic regression, receiver operating characteristic curves, and intraclass correlation coefficients.
Results:
JZT, T2JZ, and ADCJZ values were significantly higher in patients with SEF (6.0 mm, 81.3 ms, 1.04×10-3 mm2/s, respectively) and patients with MMEF (5.1 mm, 71.2 ms, and 0.98×10-3 mm2/s, respectively) than in healthy women (3.8 mm, 65.2 ms, and 0.81×10-3 mm2/s, respectively) (all P values <0.05). T2JZ was substantially elevated in patients with SEF compared with those with MMEF (P<0.001). OMT, T2OM, and ADCOM were significantly higher in patients with SEF compared to healthy women (all P values <0.05). T2JZ was strongly correlated with the degree of endometrial fibrosis (ρ=0.728), whereas JZT, ADCJZ, OMT, T2OM, and ADCOM showed weak-to -moderate correlations (ρ=0.254-0.550; all P values <0.05). Junctional zone and outer myometrial magnetic resonance imaging parameters and the multivariable model accurately distinguished patients with MMEF or those with SEF from healthy women (areas under the curve >0.600). The intra- and interobserver agreement for T2 values was excellent and higher than that for ADC values.
Conclusions:
T2 mapping is more effective than ADC in accurately assessing the junctional zone alterations associated with endometrial fibrosis.
