The value of diffusion-weighted imaging and semi-quantitative dynamic contrast-enhanced MRI in predicting the efficacy of medroxyprogesterone acetate treatment for atypical endometrial hyperplasia and endometrial carcinoma.

Abstract

Background: It will be important to noninvasively evaluate the efficacy of treatment for patients with atypical endometrial hyperplasia (AEH) and endometrial carcinoma (EC) who wish to have children. The study aimed to explore the feasibility of diffusion-weighted imaging (DWI) and semi-quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the efficacy of medroxyprogesterone acetate treatment for AEH and EC.

Methods: A retrospective analysis was conducted on the clinical-pathological data of 6 patients with AEH and 6 patients with EC. The treatment effects of medroxyprogesterone acetate were pathologically evaluated. Additionally, MRI examination was conducted at each follow-up at the 3rd and 6th month after treatment. Repeated measures variance analysis was used to compare statistically significant differences in the apparent diffusion coefficient (ADC) values and maximum signal difference (MSD) of the lesion and corresponding endometrial site before treatment, and at the 3rd and 6th month after treatment. Endometrial thickness was analyzed utilizing the Friedman test. Furthermore, Fisher's exact probability method was used to determine if there was a significant difference in the time-intensity curve (TIC).

Results: There was a statistically significant difference in endometrial thickness before treatment, and at the 3rd and 6th month after treatment for EC and AEH (P < 0.017). There was a statistically significant difference in the ADC values before treatment, and at the 3rd or 6th month after treatment for EC (P < 0.017). There was also a statistically significant difference in the type of TIC curve before and after treatment for EC (P < 0.001). However, the difference in MSD values was insignificant for EC and AEH before and after treatment (P > 0.05). No significant differences were noted in the ADC values, and type of TIC curve before and after treatment for AEH (P > 0.05).

Conclusions: Endometrial thickness can be imaging markers for predicting complete remission of EC and AEH with medroxyprogesterone acetate treatment. ADC values and TIC curve types can be imaging markers for predicting complete remission of EC.