Intra- and Peri-tumoral Analysis with Multimodal Functional MRI for Preoperative Detection of Aggressive Endometrial Carcinoma in FIGO 2023

Motivation: Preoperative detection of aggressive endometrial carcinoma (EC) in the new 2023 FIGO system is essential for guiding surgical and fertility-preserving strategies, whereas pre‐ and postoperative tumor histological inconsistencies occur. Goal(s): Our goal was to determine if multimodal functional MRI could detect aggressive from non-aggressive subtype of EC as defined in FIGO 2023. Approach: We analyzed intra- and peritumoral parameters derived from intravoxel incoherent motion diffusion-weighted imaging, diffusion kurtosis imaging, and dynamic contrast-enhanced MRI between the two EC subtypes. Results: A comprehensive multiparametric MRI protocol, incorporating clinical data, morphological features, and quantitative MRI parameters, performed well in detecting aggressive subtype EC preoperatively. Impact: Multiparametric MRI, incorporating advanced quantitative sequences and conventional MRI features, could help effectively predict aggressive subtype EC in the FIGO 2023 system preoperatively, enhancing preoperative risk stratification and treatment planning in EC management.