Abstract

Background: Post-menopausal bleeding is problematic condition that occurs in old female patients. Diffusion weighted images with quantitative apparent diffusion coefficient value is considered one of the most helpful non-invasive, easiest procedures and not need contrast to differentiate malignant from benign conditions.
Aim of the study: This study aimed to detect the usefulness of diffusion-weighted magnetic resonance imaging (DWI) and(ADC)values in differentiating endometrial cancer from other benign endometrial lesions in females with thickened endometrium /endometrial mass and to detect a cut off value between benign and malignant endometrial lesions in females with PMB.
Patients and Methods: This prospective study included(60)postmenopausal female patients with thickened endometrium >6mm. All patients were examined first by ultrasound and then by MRI unit in Al Imamein AlKadhimein Medical city in Baghdad-Iraq during the period January-October 2021. T2-weighted, STIR, pre- and post-contrast vibe T1-weighted and diffusion weighted images were obtained with three b values (50-600-1000). Mean ADC values of all patients with endometrial pathologies were estimated after correlation with T2WI, DWI image study, then correlated with histopathological results.
Results: The results showed that 48(80%)of the lesions were benign, 12(20%) were endometrial cancers. The mean endometrial thickness among women with malignancy was significantly higher than those with benign lesions (40.08±18.59 vs 14.98±5.95) respectively. Subsequently, diffusion weighted image was restricted significantly to women with malignancy than those with benign lesions(100% vs. 2.1%)respectively. The mean ADC value(10–3 mm2/second) in malignant lesions was significantly lower than benign lesions(722.58±112.02 vs. 1483.408±275.03) respectively. The optimal ADC cutoff value for differentiation benign from malignant endometrial lesion was 0.8725 x10-3 downwards with 97.9% sensitivity and 100% specificity, and positive predictive value was 100%, negative predictive value was 92.30% while accuracy rate was 98.3%.
Conclusion: Quantitative ADC values differentiate between benign endometrial lesions and endometrial cancer in postmenopausal patients before interpretation with interventional managements.