Comparison of Diffusion Weighted Imaging and Dynamic Contrast Enhanced MRI for assessing the depth of myometrial invasion in endometrial cancer

Introduction Endometrial carcinoma is the fourth most common female cancer and the most common malignancy of the female reproductive tract. Incidence of the disease is increasing due to longevity and rising levels of obesity [1]. Endometrial cancer is staged with the FIGO system which was recently been modified and has incorporated MRI into the staging system [2]. The new FIGO staging system has amalgamated stage 1a and 1b into a new stage 1a, representing invasion of less than half of the myometrium, with the new 1b representing invasion of greater than one half of the myometrium but without extrauterine extension. There is little consensus in the literature regarding the best MRI technique for assessing myometrial invasion. We have previously published on the additional benefit of dynamic contrast enhanced (DCE) imaging in staging endometrial cancer and other approaches including diffusion weighted imaging (DWI) have shown promise in improving staging accuracy [3]. The aim of this study was to assess the diagnostic accuracy of DWI at assessing myometrial invasion in preoperative staging of endometrial cancer and to compare it to DCE imaging using surgical pathology as the reference standard.