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01.06.2014 | Magnetic Resonance | Ausgabe 6/2014

European Radiology 6/2014

MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis

European Radiology > Ausgabe 6/2014
Anita Andreano, Gilda Rechichi, Paola Rebora, Sandro Sironi, Maria Grazia Valsecchi, Stefania Galimberti
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00330-014-3139-4) contains supplementary material, which is available to authorized users.



To compare the diagnostic accuracy of dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MR imaging in detecting deep myometrial invasion in endometrial cancer, using surgical-pathological staging as reference standard.


After searching a wide range of electronic databases and screening titles/abstracts, we obtained full papers for potentially eligible studies and evaluated according to predefined inclusion criteria. Quality assessment was conducted by adapting the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist. From each study, we extracted information on diagnostic performance of DW and DCE sequences. After exploring heterogeneity, we adopted a bivariate generalized linear mixed model to compare the effect of the two MR sequences jointly on sensitivity and specificity.


Nine studies (442 patients) were considered. Significant evidence of heterogeneity was found only for specificity, both in DW and DCE imaging (I 2  = 70.8 % and 70.6 %). Pooled sensitivity of DW and DCE was 0.86 and specificity did not significantly differ (p = 0.16) between the two sequences (DW = 0.86 and DCE = 0.82). No difference was found between 3-T and 1.5-T MR. There was no evidence of publication bias.


MR diagnostic accuracy in presurgical detection of deep myometrial infiltration in endometrial cancer is high. DCE and DW imaging do not differ in sensitivity and specificity.

Key Points

Myometrial invasion is the most important morphological prognostic feature of endometrial cancer
MR diagnostic accuracy in presurgical detection of deep myometrial infiltration is high
MR examination including T2 and DCE imaging is considered the reference standard
DW imaging has been increasingly employed with heterogeneous results
This meta-analysis shows that DCE and DW do not differ in diagnostic accuracy

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