1. ABSTRACT ID NO: IRIA - 1085 ROLE OF DIFFUSION WEIGHTED IMAGING IN UTERINE AND CERVICAL LESIONS

2. Increasingly used in abdomen and pelvis since the last decade DWI  ADC(Apparent Diffusion Coefficient)  Cellularity Increased Cellularity  Impeded diffusion INTRODUCTION

3. REVIEW OF LITERATURE Role of diffusion weighted imaging in the diagnosis of gynecological diseases : Tomohiro Namimoto,Kazuo Awai,Takeshi Nakaura,Yumi Yanaga : European Society of Radiology 2008

4. Important cancer biomarker Aids in superior lesion characterization, tumor staging, treatment planning, and disease follow-up of gynaecological tumors Help predict and assess treatment response earlier than other techniques Can detect residual / recurrent tumor REVIEW OF LITERATURE Diffusion-weighted Imaging of Gynecologic Tumors: Diagnostic Pearls and Potential Pitfalls : Sunita Dhanda, et al Radiographics 2014 :34:1393–1416

5. To assess role of Diffusion weighted imaging (DWI) in differentiating benign from malignant lesions of uterus and cervix AIM

6. 24 patients with uterine and cervical lesions 15 control patients with normal uterus and cervix DWI with b value 800 as a part of routine MR imaging on 1.5T MRI Apparent diffusion coefficient (ADC) calculated and correlated with histopathology Inclusion criteria: Patients with lesions of uterus and cervix who have undergone MRI and who have HPE follow up Exclusion criteria: Patients who have contraindications to MR imaging and who have no HPE follow up MATERIALS AND METHODS

7. Name Age Hospital No Date Of MRI Study Clinical History Previous USG,CT,MRI findings Findings at MRI with special emphasis on DWI Clinical Follow Up HPE Diagnosis PROFORMA

8. PATHOLOGIES (n=2) (n=12) (n=5)

9. CARCINOMA ENDOMETRIUM T2 WI ADC : 0.648x10 -3 mm 2 /s DWI ADC F/65, Post menopausal bleeding

10. CARCINOMA ENDOMETRIUM ADC 0.712 x10 -3 mm 2 /s T2 WI DWI ADC F/52, Menorrhagia

11. ADC :Normal Endometrium S.NO.CONTROL ADC VALUES (X 10 -3 mm 2 /s) 1.1.42 2.1.29 3.1.33 4.1.43 5.1.59 6.1.45 7.1.34 8.1.46 9.1.42 10.1.42 11.1.47 12.1.59 13.1.42 14.1.49 15.1.41 S.NoADC VALUES (X 10 -3 mm 2 /s) 1.1.29 2.0.712 3.0.619 4.0.94 5.0.981 Range: 1.29 to 1.59 x 10 -3 mm 2 /s Mean ADC : 1.44 x 10 -3 mm 2 /s Range :0.619 to 1.29 x 10 -3 mm 2 /s Mean ADC : 0.88 x 10 -3 mm 2 /s ADC :Ca Endometrium

12. NPAR TESTS MANN-WHITNEY TEST RANKS TEST STATISTICS a. Grouping Variable: ANN b. Not corrected for ties

13. CARCINOMA CERVIX T2 WI ADC: 0.923x10 -3 mm 2 /s DWI ADC F/57Post menopausal bleeding

14. CARCINOMA CERVIX ADC 0.977 x 10 3 mm 2 /s T2 WI DWI ADC F/57,White discharge

15. ADC values of normal cervix S.NoCONTROL ADC VALUES X 10 -3 mm 2 /S 11.35 2 1.37 3 1.40 4 1.56 5 1.42 6 1.46 7 1.37 8 1.36 9 1.34 10 1.36 11 1.43 12 1.37 13 1.36 14 1.32 15 1.37 S.NoADC VALUES X 10 -3 mm 2 /S 10.618 21.104 30.886 41.012 50.977 Range :1.32 to 1.56 x10 -3 mm 2 /s Mean ADC : 1.39 x10 -3 mm 2 /s Range :0.618 to 1.012 x10 -3 mm 2 /s Mean ADC :0.909 x10 -3 mm 2 /s ADC values of Carcinoma cervix

16. NPAR TESTS MANN-WHITNEY TEST RANKS TEST STATISTICS b. Not corrected for ties. a. Grouping Variable: ANN

17. LEIOMYOMA T2 WI ADC: 1.616 x10 -3 mm 2 /s DWI ADC F/43,Menorrhagia, dysmenorrhoea

18. LEIOMYOMAS T2 WI ADC: 1.256 x10 -3 mm 2 /s DWI ADC F/43 Menorrhagia

19. ADC values of normal myometrium S.NOCONTROL ADC VALUES X 10 -3 mm 2 /s 1.1.57 2.1.39 3.1.64 4.1.68 5.1.51 6.1.54 7.1.46 8.1.54 9.1.56 10.1.52 11.1.42 12.1.54 13.1.54 14.1.53 15.1.52 Range: 1.39 to 1.68 x10 -3 mm 2 /s Mean ADC : 1.53 x10 -3 mm 2 /s S.NO.ADC VALUES X 10 -3 mm 2 /s 12.27 21.77 31.59 41.53 51.54 61.206 71.828 82.059 91.616 101.256 112.1 121.41 ADC values of Leiomyoma Range: 1.24 to 2.27 x10 -3 mm 2 /s Mean ADC : 1.67x10 -3 mm 2 /s

20. STATISTICAL ANALYSIS :T-TEST

21. Independent Samples Test Levene's Test for Equality of Variancest-test for Equality of Means FSig.tdf Sig. (2- tailed) Mean Differe nce Std. Error Differe nce 95% Confidence Interval of the Difference LowerUpper VALUESEqual variances assumed 20.595.000-1.67125.107-.14858.08894-.33176.03459 Equal variances not assumed -1.50311.834.159-.14858.09888-.36436.06720 STATISTICAL ANALYSIS (Cont…)

22. ADENOMYOSIS ADC values of adenomyosis : 1.458 x 10 -3 mm/s and 1.506 x 10 -3 mm/s T2 WI DWIADC F/40 Dysmenorrhea, ADC: 1.506 x10 -3 mm 2 /s

23. Significant reduction in ADC values of malignant lesions as compared to benign ones Mean ADC of Ca Endometrium (0.88 x10 -3 mm 2 /s ) < Mean ADC of normal Endometrium (1.44 x10 -3 mm 2 /s ) Mean ADC of Ca Cervix (0.9 x10 -3 mm 2 /s) < Mean ADC of normal Cervix (1.39 x10 -3 mm 2 /s ) RESULTS

24. CONCLUSION DWI with quantification of ADC values plays a major role in distinguishing benign and malignant lesions DWI should be part of routine MR protocol when imaging the uterus and cervix

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