Volume 31, Issue 1 (3-2024)
RJMS 2024, 31(1): 1-14 |
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Shahnazari R, Saghafian Larijani S, Mirfakhraee H, Mazloomi M, Emtiazi N. Role of Dynamic Contrast-Enhanced and Diffusion-Weighted Magnetic Resonance Imaging in Evaluating Endometrial Lesions: A Systematic Review and Meta-analysis Study. RJMS 2024; 31 (1) :1-14
URL: http://rjms.iums.ac.ir/article-1-8633-en.html
URL: http://rjms.iums.ac.ir/article-1-8633-en.html
Razieh Shahnazari 
, Samaneh Saghafian Larijani , Hosna Mirfakhraee , Maryam Mazloomi , Nikoo Emtiazi
, Samaneh Saghafian Larijani , Hosna Mirfakhraee , Maryam Mazloomi , Nikoo Emtiazi
Iran University of Medical Sciences , fjmk7789@gmail.com
Abstract: (356 Views)
Background & Aims: The endometrium, the inner lining of the uterus, is a place for the formation and growth of various lesions that can be detected by medical imaging. Accurate and timely diagnosis of endometritis is essential because these lesions may cause serious complications such as infertility and severe pain. In this context, medical imaging plays a very important role in the diagnosis and evaluation of endometrial lesions. An abnormal appearance of the endometrium is possible. On magnetic resonance imaging (MRI) of the pelvis, it can be identified as an incidental finding in the absence of associated symptoms. However, characterizing an endometrial abnormality on MRI as benign or malignant is challenging. It is a variable secondary to imaging of both benign lesions such as endometrial polyps, hyperplasia, and intracavitary fibroids, and malignant lesions including endometrial adenocarcinoma, carcinosarcoma, and endometrial stromal sarcoma. Magnetic resonance imaging with dynamic contrast (DCE-MRI) and diffusion-weighted imaging (DW-MRI) as two advanced methods in the field of medical imaging, are of great importance in the evaluation of endometrial lesions. These two imaging methods, by providing detailed and comprehensive information on the morphological and physiological characteristics of the lesions, allow doctors to make better decisions regarding diagnosis, determining the clinical stage, and managing patients with abnormal endometrium and related lesions. This review aims to investigate the role of DCE-MRI and DW-MRI in the evaluation of endometrial lesions, highlighting their strengths, limitations, and clinical applications in the field of gynecological imaging.
Methods: The present study was conducted based on the checklist of selected reporting items for systematic reviews and meta-analyses (PRISMA). International databases (Web of Science, PubMed, Scopus, and Embase) were searched and studies that examined the role of DWI-MRI and DCE-MRI in the evaluation of endometrial lesions were extracted. After removing duplicate studies, the titles and abstracts of the remaining articles were reviewed to find eligible studies based on the following inclusion and exclusion criteria. Inclusion criteria include: 1- Case-control studies on the role of DCE-MRI and DW-MRI in the evaluation of endometrial lesions with extractable data, 2- Studies with similar objectives and statistical methods, as well as sufficient published data to estimate the odds ratio. (OR) and the confidence interval was 95%. Exclusion criteria included review articles, meta-analyses, congress abstracts, and studies in languages other than English. Eligible studies were selected by two authors and reviewed and approved by all authors. Data were extracted from selected studies by two different authors and included author name, location, publication date, sample size, age, study design, and sensitivity, characteristics of DCE and DWI methods. The Newcastle-Ottawa scale was used to evaluate the methodology and quality of the studies (9). Articles with scores of 0-3, 4-6, and 7-9 were considered as low, medium, and high quality. None of the studies scored <4. Begg's plots and Egger's test were used to evaluate data publication bias, and P values less than 0.05 were considered significant. Effect sizes and 95% confidence intervals (CI) were calculated using Stata version 15. We measured the heterogeneity of each group using the index of incompatibility (I2). I2 greater than 50% or a P-value less than 0.05 is considered significant heterogeneity. If heterogeneity was high, a random effect model was used to calculate the pooled effect and 95% CI. Otherwise, the fixed effect was used. The diagnostic value of dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging in the evaluation of endometrial lesions was determined by calculating specificity, sensitivity, PPV, NPV, and accuracy, with a 95% confidence interval (CI).
Results: After removing duplicate and irrelevant studies, finally, 16 articles aligned with the inclusion criteria, published between 2014 and 2022, were included in the study. This meta-analysis includes six prospective articles, eight retrospective articles, and two cross-sectional articles. A total of 754 people were examined. The mean ± standard deviation of the age of the subjects was 58.10 ± 3 years. The results showed that the sensitivity of DWI-MRI in evaluating endometrial lesions was83% (79% to 86%), the specificity was 87% (84% to 90%) and the accuracy was 88% (83% to 94%). Similarly, DCE-MRI sensitivity was 86% (80% to 91%), specificity was 87% (83% to 90%) and accuracy was 85% (80% to 90%). The publication bias was shown symmetrically in the funnel plot and the P-value was calculated as 0.092, which means there is a publication bias.
Conclusion: In summary, the results of this study support the use of DWI-MRI and DCE-MRI as valuable tools in diagnostic techniques to evaluate endometrial lesions. The demonstrated sensitivity, specificity, and accuracy emphasize their potential to aid clinical decision-making and patient management in the field of endometrial pathology.
Methods: The present study was conducted based on the checklist of selected reporting items for systematic reviews and meta-analyses (PRISMA). International databases (Web of Science, PubMed, Scopus, and Embase) were searched and studies that examined the role of DWI-MRI and DCE-MRI in the evaluation of endometrial lesions were extracted. After removing duplicate studies, the titles and abstracts of the remaining articles were reviewed to find eligible studies based on the following inclusion and exclusion criteria. Inclusion criteria include: 1- Case-control studies on the role of DCE-MRI and DW-MRI in the evaluation of endometrial lesions with extractable data, 2- Studies with similar objectives and statistical methods, as well as sufficient published data to estimate the odds ratio. (OR) and the confidence interval was 95%. Exclusion criteria included review articles, meta-analyses, congress abstracts, and studies in languages other than English. Eligible studies were selected by two authors and reviewed and approved by all authors. Data were extracted from selected studies by two different authors and included author name, location, publication date, sample size, age, study design, and sensitivity, characteristics of DCE and DWI methods. The Newcastle-Ottawa scale was used to evaluate the methodology and quality of the studies (9). Articles with scores of 0-3, 4-6, and 7-9 were considered as low, medium, and high quality. None of the studies scored <4. Begg's plots and Egger's test were used to evaluate data publication bias, and P values less than 0.05 were considered significant. Effect sizes and 95% confidence intervals (CI) were calculated using Stata version 15. We measured the heterogeneity of each group using the index of incompatibility (I2). I2 greater than 50% or a P-value less than 0.05 is considered significant heterogeneity. If heterogeneity was high, a random effect model was used to calculate the pooled effect and 95% CI. Otherwise, the fixed effect was used. The diagnostic value of dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging in the evaluation of endometrial lesions was determined by calculating specificity, sensitivity, PPV, NPV, and accuracy, with a 95% confidence interval (CI).
Results: After removing duplicate and irrelevant studies, finally, 16 articles aligned with the inclusion criteria, published between 2014 and 2022, were included in the study. This meta-analysis includes six prospective articles, eight retrospective articles, and two cross-sectional articles. A total of 754 people were examined. The mean ± standard deviation of the age of the subjects was 58.10 ± 3 years. The results showed that the sensitivity of DWI-MRI in evaluating endometrial lesions was83% (79% to 86%), the specificity was 87% (84% to 90%) and the accuracy was 88% (83% to 94%). Similarly, DCE-MRI sensitivity was 86% (80% to 91%), specificity was 87% (83% to 90%) and accuracy was 85% (80% to 90%). The publication bias was shown symmetrically in the funnel plot and the P-value was calculated as 0.092, which means there is a publication bias.
Conclusion: In summary, the results of this study support the use of DWI-MRI and DCE-MRI as valuable tools in diagnostic techniques to evaluate endometrial lesions. The demonstrated sensitivity, specificity, and accuracy emphasize their potential to aid clinical decision-making and patient management in the field of endometrial pathology.
Keywords: Magnetic Resonance Imaging, Diagnostic Imaging, Endometrial Neoplasms, Sensitivity, Specificity
Type of Study: review article |
Subject:
Radiology
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