Analysis of the Correlation between MRI Imaging Signs and Lymphovascular Space Invasion in Endometrial Cancer.

Background: Determination of LVSI is the recommended criterion for performing lymphatic drainage and is important for the preoperative clinical decisionmaking process; however, Intraoperative Frozen Section (IFS) has limitations for the analysis of LVSI, and there is an urgent need for other indirect methods to predict the presence of LVSI.

Aim: This study aimed to investigate the value of Magnetic Resonance Imaging (MRI) features in predicting Lymphovascular Space Invasion (LVSI) in endometrial cancer (EC).

Objective: The objective of this study was to analyze MRI features that may be associated with LVSI and to explore their association.

Methods: In this study, 179 patients who received treatment for EC confirmed by surgical pathology at two medical institutions from January 2017 to May 2024 were reviewed and grouped according to the presence or absence of vascular cancer embolism in the pathology. The MRI imaging features of the two groups were compared, including the maximum transverse diameter in the sagittal position, myometrial invasion, disruption of the uterine Junctional Zone (JZ), serosal surface, uterine appendages, cervical stromal invasion, lymph node enlargement, and its T2 value, and Diffusion- Weighted Imaging (DWI). The risk factors of the LVSI-positive group were determined by performing logistic regression analysis to analyze the correlation between Apparent Diffusion Coefficient (ADC) values and LVSI in EC.

Results: There were 34 cases in the LVSI-positive group and 145 cases in the negative group. The maximum transverse diameter in sagittal position, myometrial invasion, interruption of the uterine JZ, serous surface, uterine appendages, cervical stromal invasion, lymph node enlargement, and their DWI and ADC values were statistically significant between the two groups (P < 0.05). In multivariate logistic regression analysis, lymph node enlargement (P = 0.001) and ADC value (P = 0.041) were identified as independent risk factors for positive LVSI.

Conclusion: Lymph node enlargement and reduced ADC values (<0.767*10-3mm²/s) in MR imaging are of high value in predicting the occurrence of LVSI in patients with EC and can be used as an important reference for preoperative clinical diagnostic and therapeutic decisions for patients.