الفهرس 
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Abstract
Endometrial carcinoma is the commonest gynecological malignancy in developed countries. Histological grade and subtypes are important prognostic factors.
MRI is considered the most accurate imaging modality for the pretreatment local staging of EC secondary to its excellent soft tissue delineation. On MRI, EC is usually seen as a hypo-to-isointense mass on T1- weighted images (T1WI) with an intermediate signal intensity lower than the normal endometrium on T2-weighted images (T2WI). On dynamic post- contrast images, EC enhances less avidly than the myometrium.
So, this study aimed to evaluate the specificity of dynamic contrast enhanced MRI and MRI diffusion in diagnosis of endometrial carcinoma in patients with abnormal uterine bleeding.
This prospective study was performed on 40 patients suspected with endometrial carcinoma as decided by clinician and ultra-sonographic features referred from Gynecological department El Mynia university hospital to Radiology department of the El Mynia university hospital at a period from 2018 to 2020.
Our study patients had age ranged from 42 to 65 years (mean age was 52.4 years). 30 patients were married (about 75%) and 10 patients (about 25%) were unmarried. Most of patients were presented with irregular uterine bleeding was found in 35 patients (87.5%) and absent in 5 patients (12.5%). Other symptoms like lower abdominal pain and profuse watery vaginal discharge found in 10 patients (25%) and absent in 30 patients (75 %).
Regarding MRI morphology of endometrial lesion among the studied patients, Irregular mass lesion was found in 29 cases (72.5%) while regular mass lesion was found in 11 cases (27.5%). T2WI signal intensity of the lesion appeared compared with the signal intensity of the myometrium. Homogenous hyperintense signal in 17 cases (42.5%), Iso intense signal intensity in 5 cases (12.5%), Heterogenous signal intensity in 18 cases (45%). Areas of hemorrhage and necrosis seen in 10 cases (25%) and absent in 30 cases (75%).Regarding the diffusion weighted signal calculated at b value 1000 among studied patients, truly restricted diffusion (appearing hyperintense signal at DWI with corresponding low signal at ADC map) was found in 30 cases (75%) while facilitated diffusion (appearing hypo intense signal TDWI with corresponding hyperintense at ADC map) was found in 10 cases (25%).
The range of measured ADC map was 0.65 to 1.6 with its mean 1.07 .
Regarding post contrast T1WI among studied patients, we found about 29 cases (72.5%) showed less enhancement at early and late post contrast phases and 11 cases (27.5%) showed intense enhancement at early and late post contrast phases.
Regarding The depth of myometrial invasion that seen better at T2WI and DWI, 2 cases (5%) showed intact junctional zone (No myometrial invasion), 33 cases (82.5%) showed less than 50% myometrial invasion and 5 cases (12.5%) showed more than 50% myometrial invasion. Regarding histopathology of studied patients, 15 cases (37.5%) were negative for endometrial carcinoma while 25 cases (62.5%) were positive for endometrial carcinoma.
Describing the relation of age of studied patients to the histopathological finding, Regarding the negative cases for EC, we found the range of age was 42 to 65 years and the mean was 53.2 years however for positive cases for EC, we found the range was 43 to 63 years and the mean was 51.8. The P value was 0.5 statistically unsignificant.
Describing the relation of the marietal status to the histopathogical finding, Regarding the negative cases for EC, married women (80 %) and unmarried women (20 %). Otherwise for positive cases for EC, married women (72%) and unmarried women (28%). The P value was 0.5 statistically unsignificant.
Describing the relation of the BMI to the histopathogical finding, Regarding the negative cases for EC, Normal weight (33.3%), over weight (6.7%), and obese. However, for positive cases for EC, Normal weight (20%), over weight (36%) and obese (44%). The P value was 0.1 statistically unsignificant.
Describing the relation of the clinical data to the histopathogical finding, Regarding the negative cases for EC, Irregular uterine bleeding was present in (73.3%) and absent in (26.7) For other symptoms like lower abdominal pain or profuse watery vaginal discharges was present in (6.7%) and absent in (93.3). However, for positive cases for EC, Irregular uterine bleeding was present in (76%) and absent in (24) For other symptoms like lower abdominal pain or profuse watery vaginal discharges was present in (16%) and absent in (84%). The P value for irregular uterine bleeding was 0.8 while for other clinical data was 0.3 statistically unsignificant.
Describing the relation of the MRI morphological features of the endometrial lesion and histopathological finding. Regarding the negative cases for EC, the lesion appeared homogenous hyperintense T2 signal in (33.3%), isointense T2 signal in (20%) and heterogenous T2 signal in (46.7%) relative to the adjacent myometrium at T2WI. However, for positive cases for EC, it appeared homogenous hyperintense T2 signal in (48%), isointense T2 signal in (8%) and heterogenous T2 signal in (44%) relative to the adjacent myometrium at T2WI. The P value was 0.4 statistically unsignificant. Areas of hemorrhage and necrosis were present in (86.7%) and absent in (13.3%) in negative cases for EC however for positive cases for EC, they were present in (68%) and absent in (32%). The P value was 0.1 statistically unsignificant. Regarding the shape of the endometrial lesion. Irregular mass lesion was present in (53.3%) of negative cases and present in (84%) of positive cases however the regular mass lesion was present in (46.7%) of negative cases and present in (16 %) of positive cases. The P value was 0.03 statistically significant results.
Describing the relation between diffusion at b value 1000 and histopathology. Regarding the negative cases for EC truly restricted diffusion was present in (33.3%) and facilitated diffusion was present in (66.7%). For positive cases for EC, truly restricted diffusion was present in (100%) and facilitated diffusion was present in (0.0%). The P value was 0.001 statistically significant. Regarding the ADC map with measured area of interest (ROI) range about 0.14 (negative cases) and 0.31 (positive cases). for negative cases for EC Range 1.2 to 1.6 and mean 1.3 while for positive cases for EC, range 0.65 to 1.1 and mean 0.88. The P value was 0.001 statistically significant results.
Describing the relation between the post contrast T1 WI (early and delayed phases) to the histopathological finding. The degree of enhancement of the lesion compared with myometrial enhancement. Intense enhancement of the lesion was found in (73.3%) in negative cases for EC and (0.0%) in positive cases for EC while less enhanced lesion seen in (26.7%) in negative cases for EC and (100%) in positive cases for EC. P value was 0.001 statistically significant results.
Regarding the ROC curve (Recieiver operating characteristic curve) For ADC map as a predictor for malignancy (EC) by histopathology. The sensitivity was 84% and specificity was 100% at AUC (area under the curve) 0.9with cut off value more than 1 and accuracy was 90 %.
Diffusion at high b value 1000 sensitivity was 100%, specificity 66.7% and accuracy was 87.5%.
Regarding post contrast T1 as a predictor for malignancy (EC), sensitivity was 100%, specificity was 73.3% and accuracy was 90 %.
We conclude that DWI and DCE-MRI are both valuable diagnostic tools for the preoperative assessment of myometrial invasion.