Diagnostic accuracy of dynamic contrast-enhanced diffusion-weighted MRI: Endometrial lesions

Abstract

Dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) magnetic resonance imaging are emerging as reliable non-invasive techniques for characterization of endometrial lesions. This prospective hospital-based study included 80 women with abnormal uterine bleeding who underwent pelvic MRI with DWI, ADC mapping and DCE sequences and findings were correlated with histopathology. Mean ADC values were significantly lower in endometrial cancer (0.86 ± 0.09 ×10⁻³ mm²/s) compared to normal endometrium (1.42 ± 0.15 ×10⁻³ mm²/s; p<0.001), with an optimal ADC cutoff ≤1.10 ×10⁻³ mm²/s yielding an AUC of 0.96. DCE-MRI demonstrated higher sensitivity (93.3%) and specificity (91.7%) than DWI alone and combined DCE+DWI analysis achieved diagnostic sensitivity of 95.2% for malignancy. Thus, data shows the ADC values showed significant inverse correlation with tumor grade, stage and lymph node involvement, indicating strong potential for non-invasive lesion characterization.