Feasibility of magnetic resonance imaging compilation (MAGIC) for evaluating the depth of myometrial invasion and predicting the pathological subtypes of endometrial cancer: A comparison with high resolution T2WI and DWI

Purpose To investigate the feasibility of MAGiC (sy-T2WI; T1, T2 and PD maps) for evaluating the depth of myometrial invasion (DMI) and predicting the pathological subtypes of endometrial cancer (EC) in comparison to hr-T2WI and DWI. Methods 68 out of 131 consecutive EC patients were prospectively recruited to perform MAGiC, hr-T2WI and DWI on 3.0T MRI before surgery. DMI (DMI-: < 50%, DMI-II: ≥ 50%) and histologic subtypes (type-I and type-II) were confirmed by operation and as the reference standard. For DMI, the diagnostic performance was assessed and compared across imaging protocols (sy-T2WI vs. hr-T2WI; sy-T2WI + DWI vs. hr-T2WI + DWI). For histologic typing, the predictive performance of T1, T2, PD maps and their combinations was evaluated against ADC values using area under the curve (AUC). Results For DMI, the diagnostic accuracy, sensitivity and specificity were 77.9%, 66.7% and 81.1% for sy-T2WI, 79.4%, 80.0% and 79.2% for hr-T2WI; 82.2%, 86.7% and 88.7% for sy-T2WI + DWI, and 91.2%, 86.7% and 92.5% for hr-T2WI + DWI. No statistically significant differences were observed between sy-T2WI vs. hr-T2WI or between their combinations with DWI (P > 0.05). For histologic subtypes, the combination of T2 and PD maps outperformed ADC alone (AUC: 0.873 vs. 0.778; p = 0.003), although T2 and PD showed similar AUC to ADC (both p > 0.05). Conclusions MAGiC provides a comparable or superior performance to conventional hr-T2WI and DWI both DMI evaluation and histologic subtypes prediction in EC, highlighting its potential as a robust non-contrast MR protocol in clinical practice.