Use of Myometrium as an Internal Reference for Endometrial and Cervical Cancer on Multiphase Contrast-Enhanced MRI

BACKGROUND: Myometrial smooth muscle is normally within the field of view for the gynecological imaging. This study aimed to investigate the use of normal myometrium as an internal reference for endometrial and cervical cancer during multiphase contrast-enhanced magnetic resonance imaging (MCE-MRI) and to explore whether this information regarding tumor enhancement relative to the myometrium could be used to discriminate between endometrial and cervical cancer. METHODS: MRI images, before and after contrast enhancement, were analyzed in newly diagnosed cervical (n = 18) and endometrial cancer (n = 19) patients. Signal intensities (SIs) from tumor tissue and non-neoplastic myometrium were measured using imaging software. RESULTS: The relative signal for cervical cancer was approximately 30% higher than that of endometrial cancer after contrast administration. The area under receiver operating characteristic curve for SI, relative signal enhancement, and tumor to myometrium contrast ratio (as used to discriminate between cervical cancer and endometrial cancer) was 0.7807, 0.7456 and 0.7895, respectively. There was no difference in SI of the normal myometrium between endometrial and cervical cancer patients prior to and after contrast administration. Using non-tumorous myometrium as an internal reference, the tumor to myometrium contrast ratio was significantly higher in tumor tissue from cervical cancer compared with that from endometrial cancer at 25 s post contrast enhancement (p = 0.0016), with an optimal sensitivity of 72.22% and specificity of 84.21%. CONCLUSION: With SI normalized to baseline or normal myometrium, tumor tissue from cervical cancer patients showed significant hyperintensity compared with that of tumor tissue from endometrial cancer patients after contrast enhancement, yielding acceptable performance. The use of the myometrium as an internal reference may provide an alternative method to analyze MCE-MRI data.