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Title:	Developing and validating a multivariable prediction model to improve the diagnostic accuracy in determination of cervical versus endometrial origin of uterine adenocarcinomas: A prospective MR study combining diffusion-weighted imaging and spectroscopy
Authors:	Lin, GG;Lin, YC;Wu, RC;Yang, LY;Lu, HY;Tsai, SY;Huang, YT;Huang, YL;Lu, KY;Ng, KK;Yen, TC;Chao, A;Lai, CH;Hong, JH Tsai, Shang‐Yueh 蔡尚岳
Contributors:	應用物理所
Keywords:	cervical carcinoma;diffusion-weighted imaging;diagnostic accuracy;endometrial carcinoma;magnetic resonance imaging;magnetic resonance spectroscopy
Date:	2018-06
Issue Date:	2018-10-26 17:26:15 (UTC+8)
Abstract:	Background: A triage test to assist clinical decision-making on choosing primary chemoradiation for cervical carcinomas or primary surgery for endometrial carcinomas is important. Purpose or Hypothesis: To develop and validate a multiparametric prediction model based on MR imaging and spectroscopy in distinguishing adenocarcinomas of uterine cervical or endometrial origin. Study Type: Prospective diagnostic accuracy study. Population: Eighty-seven women: 25 cervical and 62 endometrial adenocarcinomas divided into training (n=43; cervical/endometrial adenocarcinomas=11/32) and validation (n=44; 14/30) datasets. Field Strength/Sequence: The 3T diffusion-weighted (DW) MR imaging and MR spectroscopy. Assessment: Morphology, volumetric DW MR imaging and spectroscopy (MDS) scoring system with total points 0-5, based on presence of the following MR features assessed independently by two radiologists: (a) epicenter at the cervix, (b) rim enhancement, (c) disrupted cervical stromal integrity, (d) mean volumetric apparent diffusion coefficient values (ADCmean) higher than 0.98 x 10-3 mm(2)/s, (e) fatty acyl delta 1.3 ppm more than 161.92mM. Histopathology as gold standard. Statistical Tests: Logistic regression and receiver operator characteristic (ROC) curves analysis. Results: For both the training and validation datasets, the MDS score achieved an accuracy of 93.0% and 84.1%, significantly higher than that of morphology (88.4% and 79.5%), ADC value (74.4% and 68.2%), and spectroscopy (81.4% and 68.2%; P<0.05 for all). The performances of the scoring were superior to the morphology in the training dataset (areas under the receiver operating characteristics curve [AUC]=0.95 vs. 0.89; P=0.046), but not in the validation dataset (AUC=0.90 vs. 0.85; P=0.289). Data Conclusion: MDS score has potentials to improve distinguishing adenocarcinomas of cervical or endometrial origin, and warrants large-scale studies for further validation. Technical Efficacy: Stage 3
Relation:	JOURNAL OF MAGNETIC RESONANCE IMAGING, 47(6), 1654-1666
Data Type:	article
DOI link:	http://dx.doi.org/10.1002/jmri.25899
DOI:	10.1002/jmri.25899
Appears in Collections:	[Graduate Institute of Applied Physics] Periodical Articles

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