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

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 × 10‐3 mm 2 /s, (e) fatty acyl δ 1.3 ppm more than 161.92 mM. 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. Level of Evidence: 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1654–1666.