Amide Proton Transfer-Weighted Imaging Combined with ZOOMit Diffusion Kurtosis Imaging in Predicting Lymph Node Metastasis of Cervical Cancer

Background: The aim of this study is to investigate the feasibility of amide proton transfer-weighted (APTw) imaging combined with ZOOMit diffusion kurtosis imaging (DKI) in predicting lymph node metastasis (LNM) in cervical cancer (CC). Materials and Methods: Sixty-one participants with pathologically confirmed CC were included in this retrospective study. The APTw MRI and ZOOMit diffusion-weighted imaging (DWI) were acquired. The mean values of APTw and DKI parameters including mean kurtosis (MK) and mean diffusivity (MD) of the primary tumors were calculated. The parameters were compared between the LNM and non-LNM groups using the Student’s t-test or Mann–Whitney U test. Binary logistic regression analysis was performed to determine the association between the LNM status and the risk factors. The diagnostic performance of these quantitative parameters and their combinations for predicting the LNM was assessed with receiver operating characteristic (ROC) curve analysis. Results: Patients were divided into the LNM group (n = 17) and the non-LNM group (n = 44). The LNM group presented significantly higher APTw (3.7 ± 1.1% vs. 2.4 ± 1.0%, p < 0.001), MK (1.065 ± 0.185 vs. 0.909 ± 0.189, p = 0.005) and lower MD (0.989 ± 0.195 × 10−3 mm2/s vs. 1.193 ± 0.337 ×10−3 mm2/s, p = 0.035) than the non-LNM group. APTw was an independent predictor (OR = 3.115, p = 0.039) for evaluating the lymph node status through multivariate analysis. The area under the curve (AUC) of APTw (0.807) was higher than those of MK (AUC, 0.715) and MD (AUC, 0.675) for discriminating LNM from non-LNM, but the differences were not significant (all p > 0.05). Moreover, the combination of APTw, MK, and MD yielded the highest AUC (0.864), with the corresponding sensitivity of 76.5% and specificity of 88.6%. Conclusion: APTw and ZOOMit DKI parameters may serve as potential noninvasive biomarkers in predicting LNM of CC.

[1]  S. Tian,et al.  APTw combined with mDixon−Quant imaging to distinguish the differentiation degree of cervical squamous carcinoma , 2023, Frontiers in Oncology.

[2]  I. Kamel,et al.  WHO/ISUP grade and pathological T stage of clear cell renal cell carcinoma: value of ZOOMit diffusion kurtosis imaging and chemical exchange saturation transfer imaging , 2022, European Radiology.

[3]  Ying Lin,et al.  Amide Proton Transfer-weighted MRI in Predicting Histologic Grade of Bladder Cancer. , 2022, Radiology.

[4]  Mengyan Hou,et al.  Comparative analysis of the value of amide proton transfer-weighted imaging and diffusion kurtosis imaging in evaluating the histological grade of cervical squamous carcinoma , 2022, BMC Cancer.

[5]  Yan Bai,et al.  Evaluation of amide proton transfer-weighted imaging for endometrial carcinoma histological features: a comparative study with diffusion kurtosis imaging , 2021, European Radiology.

[6]  M. Washington,et al.  The new (Version 9) American Joint Committee on Cancer tumor, node, metastasis staging for cervical cancer , 2021, CA: a cancer journal for clinicians.

[7]  D. Hu,et al.  Comparison of reduced field-of-view diffusion-weighted imaging (DWI) and conventional DWI techniques in the assessment of Cervical carcinoma at 3.0T: Image quality and FIGO staging. , 2021, European journal of radiology.

[8]  Kai Liu,et al.  Prediction of muscle invasion of bladder cancer: A comparison between DKI and conventional DWI. , 2021, European journal of radiology.

[9]  Bo Liu,et al.  Three-dimension amide proton transfer MRI of rectal adenocarcinoma: correlation with pathologic prognostic factors and comparison with diffusion kurtosis imaging , 2020, European Radiology.

[10]  Yi Zhang,et al.  Frequency‐stabilized chemical exchange saturation transfer imaging with real‐time free‐induction‐decay readout , 2020, Magnetic resonance in medicine.

[11]  Yan Bai,et al.  A comparative study of the value of amide proton transfer-weighted imaging and diffusion kurtosis imaging in the diagnosis and evaluation of breast cancer , 2020, European Radiology.

[12]  I. Yamada,et al.  Uterine Cervical Carcinoma: Evaluation Using Non-Gaussian Diffusion Kurtosis Imaging and Its Correlation With Histopathological Findings. , 2020, Journal of computer assisted tomography.

[13]  Meiyun Wang,et al.  Application of the amide proton transfer-weighted imaging and diffusion kurtosis imaging in the study of cervical cancer , 2020, European Radiology.

[14]  H. Hricak,et al.  Diagnostic performance of conventional and advanced imaging modalities for assessing newly diagnosed cervical cancer: systematic review and meta-analysis , 2020, European Radiology.

[15]  S. Park,et al.  Identification of Early Response to Anti-Angiogenic Therapy in Recurrent Glioblastoma: Amide Proton Transfer-weighted and Perfusion-weighted MRI compared with Diffusion-weighted MRI. , 2020, Radiology.

[16]  J. Qiang,et al.  Diagnostic performance of MR imaging in evaluating prognostic factors in patients with cervical cancer: a meta-analysis , 2019, European Radiology.

[17]  Xiaoqi Wang,et al.  Three‐dimensional turbo‐spin‐echo amide proton transfer‐weighted mri for cervical cancer: A preliminary study , 2019, Journal of magnetic resonance imaging : JMRI.

[18]  W. Dou,et al.  Chemical exchange saturation transfer magnetic resonance imaging and its main and potential applications in pre-clinical and clinical studies. , 2019, Quantitative imaging in medicine and surgery.

[19]  Hongzan Sun,et al.  The utility of APT and IVIM in the diagnosis and differentiation of squamous cell carcinoma of the cervix: A pilot study. , 2019, Magnetic resonance imaging.

[20]  I. Haldorsen,et al.  What Is the Role of Imaging at Primary Diagnostic Work-Up in Uterine Cervical Cancer? , 2019, Current Oncology Reports.

[21]  Jinyuan Zhou,et al.  Improved chemical exchange saturation transfer imaging with real‐time frequency drift correction , 2019, Magnetic resonance in medicine.

[22]  I. Yamada,et al.  Diffusion kurtosis imaging of endometrial carcinoma: Correlation with histopathological findings. , 2019, Magnetic resonance imaging.

[23]  Kathleen R. Cho,et al.  Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. , 2019, Journal of the National Comprehensive Cancer Network : JNCCN.

[24]  Hongzan Sun,et al.  Amide proton transfer imaging to evaluate the grading of squamous cell carcinoma of the cervix: A comparative study using 18F FDG PET , 2018, Journal of magnetic resonance imaging : JMRI.

[25]  A. Jemal,et al.  Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries , 2018, CA: a cancer journal for clinicians.

[26]  O. Togao,et al.  Amide proton transfer imaging can predict tumor grade in rectal cancer. , 2018, Magnetic resonance imaging.

[27]  O. Togao,et al.  Amide Proton Transfer MR Imaging of Endometrioid Endometrial Adenocarcinoma: Association with Histologic Grade. , 2017, Radiology.

[28]  F. Piludu,et al.  Correlation study between DKI and conventional DWI in brain and head and neck tumors. , 2017, Magnetic resonance imaging.

[29]  Jan Sijbers,et al.  Gliomas: diffusion kurtosis MR imaging in grading. , 2012, Radiology.

[30]  Jinyuan Zhou,et al.  Amide proton transfer MR imaging of prostate cancer: A preliminary study , 2011, Journal of magnetic resonance imaging : JMRI.

[31]  J. Helpern,et al.  MRI quantification of non‐Gaussian water diffusion by kurtosis analysis , 2010, NMR in biomedicine.

[32]  I. Narabayashi,et al.  Detection and Evaluation of Pelvic Lymph Nodes in Patients With Gynecologic Malignancies Using Body Diffusion-Weighted Magnetic Resonance Imaging , 2008, Journal of computer assisted tomography.

[33]  T. Yen,et al.  Detection of lymph node metastasis in cervical and uterine cancers by diffusion‐weighted magnetic resonance imaging at 3T , 2008, Journal of magnetic resonance imaging : JMRI.

[34]  J. Helpern,et al.  Diffusional kurtosis imaging: The quantification of non‐gaussian water diffusion by means of magnetic resonance imaging , 2005, Magnetic resonance in medicine.

[35]  F. Landoni,et al.  Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer , 1997, The Lancet.