This study evaluated the magnetic resonance imaging (MRI) findings of endometrial cancer (EC) patients and identified differences based on risk group and molecular classification. The study involved a total of 175 EC patients. The MRI data were retrospectively reviewed and compared based on the risk of recurrence. Additionally, the associations between imaging phenotypes and genomic signatures were assessed. The low-risk and non-low-risk groups (intermediate, high-intermediate, high, metastatic) showed significant differences in tumor diameter (p< 0.001), signal intensity and heterogeneity on diffusion-weighted imaging (DWI) (p= 0.003), deep myometrial invasion (involvement of more than 50% of the myometrium), cervical invasion (p< 0.001), extrauterine extension (p= 0.002), and lymphadenopathy (p= 0.003). Greater diffusion restriction and more heterogeneity on DWI were exhibited in the non-low-risk group than in the low-risk group. Deep myometrial invasion, cervical invasion, extrauterine extension, lymphadenopathy, recurrence, and stage discrepancy were more common in the non-low-risk group (p< 0.001). A significant difference in microsatellite stability status was observed in the heterogeneity of the contrast-enhanced T1-weighted images (p= 0.027). However, no significant differences were found in MRI parameters related to TP53 mutation. MRI features can be valuable predictors for differentiating risk groups in patients with EC. However, further investigations are needed to explore the imaging markers based on molecular classification.
本研究评估了子宫内膜癌（EC）患者的磁共振成像（MRI）表现，并根据风险组别和分子分型识别其差异。研究共纳入175名EC患者。回顾性分析MRI数据，并基于复发风险进行比较。此外，评估了影像表型与基因组特征之间的关联。低风险组与非低风险组（中危、中高危、高危、转移性）在肿瘤直径（p<0.001）、弥散加权成像（DWI）信号强度及异质性（p=0.003）、深肌层浸润（肌层侵犯超过50%）、宫颈侵犯（p<0.001）、子宫外侵犯（p=0.002）及淋巴结肿大（p=0.003）方面存在显著差异。非低风险组较低风险组表现出更强的弥散受限及更高的DWI异质性。深肌层浸润、宫颈侵犯、子宫外侵犯、淋巴结肿大、复发及分期差异在非低风险组中更为常见（p<0.001）。对比增强T1加权图像的异质性与微卫星稳定性状态存在显著差异（p=0.027）。然而，与TP53突变相关的MRI参数未见显著差异。MRI特征可作为区分EC患者风险组别的重要预测指标，但基于分子分型的影像标志物仍需进一步研究探索。
肿瘤(癌症)患者之家