Inner layers of the junctional zone typically enhance on arterial phase [24]. Demonstration of an undisrupted enhancing subendometrial line signifies lack of myometrial involvement [24]. This is a useful sign to rule-out myometrial invasion in postmenopausal patients whose junctional zone is otherwise not well discernible on T2WI [53]. In addition, absence of myometrial invasion as shown by an intact subendometrial line of enhancement is particularly relevant for women wishing to consider fertility-preserving treatment options. EC shows restricted diffusion and appears hyperintense on DWI relative to surrounding myometrium. One study showed that the apparent diffusion coefficient (ADC) value of the peritumoral tissue achieved an accuracy similar to the qualitative assessment by experienced readers, 83% versus 76%, respectively [54]. A meta-analysis revealed that the pooled sensitivity and specificity of DWI for detecting deep myometrial invasion were 80.9% and 85.9%, respectively [55]. It was also reported that the diagnostic capability of DWI for deep myometrial invasion improved when it was combined with T2WI (pooled sensitivity: 85.8%, pooled specificity: 94.7%). These results are comparable or superior to the contrast-enhanced MRI, thus DWI can be a potential alternative to patients with compromised kidney functions, in which contrast is contraindicated [46,47,56-61]. An erroneous MRI assessment in evaluating the depth of myometrial invasion can sometimes be caused by a polypoid tumor compressing the myometrium or in the presence of adenomyosis and leiomyomas. Evaluation and Follow-Up of Endometrial Cancer Studies have not shown any added advantage of using 3T versus 1.5T, and results are comparable for both 3T and 1.5T systems. Advantages of 3T imaging includes improved spectral separation as well as increased signal-to-noise ratios, which can be exploited to acquire images with a higher spatial resolution or decreased image acquisition times.
Pretreatment Evaluation and Follow Up of Endometrial Cancer. Inner layers of the junctional zone typically enhance on arterial phase [24]. Demonstration of an undisrupted enhancing subendometrial line signifies lack of myometrial involvement [24]. This is a useful sign to rule-out myometrial invasion in postmenopausal patients whose junctional zone is otherwise not well discernible on T2WI [53]. In addition, absence of myometrial invasion as shown by an intact subendometrial line of enhancement is particularly relevant for women wishing to consider fertility-preserving treatment options. EC shows restricted diffusion and appears hyperintense on DWI relative to surrounding myometrium. One study showed that the apparent diffusion coefficient (ADC) value of the peritumoral tissue achieved an accuracy similar to the qualitative assessment by experienced readers, 83% versus 76%, respectively [54]. A meta-analysis revealed that the pooled sensitivity and specificity of DWI for detecting deep myometrial invasion were 80.9% and 85.9%, respectively [55]. It was also reported that the diagnostic capability of DWI for deep myometrial invasion improved when it was combined with T2WI (pooled sensitivity: 85.8%, pooled specificity: 94.7%). These results are comparable or superior to the contrast-enhanced MRI, thus DWI can be a potential alternative to patients with compromised kidney functions, in which contrast is contraindicated [46,47,56-61]. An erroneous MRI assessment in evaluating the depth of myometrial invasion can sometimes be caused by a polypoid tumor compressing the myometrium or in the presence of adenomyosis and leiomyomas. Evaluation and Follow-Up of Endometrial Cancer Studies have not shown any added advantage of using 3T versus 1.5T, and results are comparable for both 3T and 1.5T systems. Advantages of 3T imaging includes improved spectral separation as well as increased signal-to-noise ratios, which can be exploited to acquire images with a higher spatial resolution or decreased image acquisition times.