**3.1 Pathological findings and MRI features**

## **3.1.1 Pathological findings**

Pathologically, 16 tumors were adenocarcinoma, 5 were adenosquamous cell carcinoma, 1 was serous adenocarcinoma, 1 was papillary adenocarcinoma, and 1 was clear cell carcinoma. In addition, 12 of the 24 tumors were well differentiated and the other 12 were poorly differentiated.

#### **3.1.2 Features of MRI**

#### **3.1.2.1 General types**

Nineteen tumors exhibited diffuse type with the endometrial thickness of 1.12 ~ 10.35 cm (4.68 ± 0.33 cm in average). Five tumors exhibited focal type with the maximum diameter of 0.94 ~ 6.17 cm (3.27 ± 0.42 cm in average).

#### **3.1.2.2 Depth of invasion**

Fifteen tumors showed no invasion or superficial myometrial invasion, and the other 9 tumors showed deep myometrial invasion.

#### **3.1.2.3 Cervical involvement**

Nine tumors had no involvement of the cervix and 15 tumors invaded the cervix.

#### **3.1.2.4 Infiltration width**

There were 20 tumors without peripheral invasion, 1 tumor with parametrial invasion, 1 tumor with right sacral metastasis, and 2 tumors with lymph node metastasis.

#### **3.2 DCE TIC types**

All 24 tumors were enhanced at 16 s after contrast agent injection. Of them, 17 tumors showed lower or similar enhancement and the other 7 tumors showed significantly higher enhancement compared with the adjacent normal myometrium tissues. On TIC, 23 tumors exhibited continued enhancement in the late phase, and only 1 tumor exhibited decreased enhancement (Figures 1-4). Based on the TIC types, we found type I in 12 tumors (12/24), type II in 6 tumors (6 / 24), type III in 3 tumors (3 / 24), and type IV in 3 tumors (3 / 24). Types I and II curves with an early peak were observed in 18 tumors (18/24). ARSI% ≥ 60% in types I and III curves was observed in 15 tumors (15/24) (Figures 5-8).

without operative treatment were staged comprehensively based on the clinical information, mainly the gynecological specialized examination, B-mode ultrasound, cystoscopy, and

Statistical analysis was performed with the SPSS 11.5 statistical software package. Paired ttest was used to compare the signal intensity in different DCE phases between cancer lesions and adjacent myometrial tissues. Two independent samples t-test was used to compare the differences of ARSI%, MRSI%, and SER% among groups. P < 0.05 was

Pathologically, 16 tumors were adenocarcinoma, 5 were adenosquamous cell carcinoma, 1 was serous adenocarcinoma, 1 was papillary adenocarcinoma, and 1 was clear cell carcinoma. In addition, 12 of the 24 tumors were well differentiated and the other 12 were

Nineteen tumors exhibited diffuse type with the endometrial thickness of 1.12 ~ 10.35 cm (4.68 ± 0.33 cm in average). Five tumors exhibited focal type with the maximum diameter of

Fifteen tumors showed no invasion or superficial myometrial invasion, and the other 9

There were 20 tumors without peripheral invasion, 1 tumor with parametrial invasion, 1

All 24 tumors were enhanced at 16 s after contrast agent injection. Of them, 17 tumors showed lower or similar enhancement and the other 7 tumors showed significantly higher enhancement compared with the adjacent normal myometrium tissues. On TIC, 23 tumors exhibited continued enhancement in the late phase, and only 1 tumor exhibited decreased enhancement (Figures 1-4). Based on the TIC types, we found type I in 12 tumors (12/24), type II in 6 tumors (6 / 24), type III in 3 tumors (3 / 24), and type IV in 3 tumors (3 / 24). Types I and II curves with an early peak were observed in 18 tumors (18/24). ARSI% ≥ 60%

Nine tumors had no involvement of the cervix and 15 tumors invaded the cervix.

tumor with right sacral metastasis, and 2 tumors with lymph node metastasis.

in types I and III curves was observed in 15 tumors (15/24) (Figures 5-8).

colonoscopy【7】.

**3. Results** 

**2.4 Statistical analysis** 

considered to be significant.

**3.1.1 Pathological findings** 

poorly differentiated.

**3.1.2 Features of MRI 3.1.2.1 General types** 

**3.1.2.2 Depth of invasion** 

**3.1.2.3 Cervical involvement** 

**3.1.2.4 Infiltration width** 

**3.2 DCE TIC types** 

**3.1 Pathological findings and MRI features** 

0.94 ~ 6.17 cm (3.27 ± 0.42 cm in average).

tumors showed deep myometrial invasion.

Fig. 1 to 4 female, 61 years old, endometrial adenocarcinoma. Figure 1 showed 0 s after the contrast agent injection, endometrial cancer lesions showed slightly lower signal, such as uterine tissue showed equal signal; Figure 2-4 16 s, 32 s and 64 s after the contrast agent injection, endometrial cancer lesions showed moderate enhancement, and normal uterine tissue was significantly enhanced, contrast between them was clear. Figure 5-12 Dynamic enhancement curves (TIC) type. Figure 5 endometrial cancer lesions (curve 1)was type I, ARSI% ≥ 60%, reached peak in early dynamic contrast-enhanced; normal tissue (curve 2) showed type III, ARSI% ≥ 60%, continuing to strengthen and enhance level higher than lesion; Figure 6 endometrial cancer lesions (curve 1) showed type II, ARSI% <60%, also reached its peak in the early dynamics; normal tissue (curve 2) showed type I, strengthening was higher than the lesion; Figure 7 endometrial cancer lesions (curve 1) showed type II curve, normal tissue (curve 2) showed type IV, ARSI% <60%, degree of enhancement was similar with lesions; Figure 8 endometrial cancer lesions (curve 1) showed type III, normal tissue (curve 2) showed type IV, the degree of enhancement below the lesion.

Fig. 1 to 4 female, 61 years old, endometrial adenocarcinoma. Figure 1 showed 0 s after the contrast agent injection, endometrial cancer lesions showed slightly lower signal, such as uterine tissue showed equal signal; Figure 2-4 16 s, 32 s and 64 s after the contrast agent injection, endometrial cancer lesions showed moderate enhancement, and normal uterine tissue was significantly enhanced, contrast between them was clear. Figure 5-12 Dynamic enhancement curves (TIC) type. Figure 5 endometrial cancer lesions (curve 1)was type I, ARSI% ≥ 60%, reached peak in early dynamic contrast-enhanced; normal tissue (curve 2) showed type III, ARSI% ≥ 60%, continuing to strengthen and enhance level higher than lesion; Figure 6 endometrial cancer lesions (curve 1) showed type II, ARSI% <60%, also reached its peak in the early dynamics; normal tissue (curve 2) showed type I, strengthening was higher than the lesion; Figure 7 endometrial cancer lesions (curve 1) showed type II curve, normal tissue (curve 2) showed type IV, ARSI% <60%, degree of enhancement was similar with lesions; Figure 8 endometrial cancer lesions (curve 1) showed type III, normal

tissue (curve 2) showed type IV, the degree of enhancement below the lesion.

The signal intensities of the tumors in the early phase (16 s), delayed phase (300 s), or the curve peak were significantly lower than those of the adjacent normal tissue. The signal intensity in tumors was significantly higher in the delayed phase than in the early phase (Table 2). Also, the mean values were all significantly higher for SER% in the menopausal group than in the non-menopausal group, for ARSI% in the poorly differentiated group than in well differentiated group, and for ARSI% in the deep myometrial invasion group than in the superficial or no myometrial invasion group (all P < 0.05 ) (Table 3).


Table 2. Comparison of the signal intensity in the early and delayed phases between normal tissues and endometrial carcinoma (%,±s).


Note: ARSI%: arterial phase relative signal increase; MRSI%: maximal relative signal increase; SER%: signal enhancement ratio.

Table 3. Comparison of the ARSI%, MRSI%, and SER% between designated groups (%,).
