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. 2022 Sep 12:12:916846.
doi: 10.3389/fonc.2022.916846. eCollection 2022.

Amide proton transfer weighted imaging combined with dynamic contrast-enhanced MRI in predicting lymphovascular space invasion and deep stromal invasion of IB1-IIA1 cervical cancer

Qingling Song  1 , Shifeng Tian  1 , Changjun Ma  1 , Xing Meng  2 , Lihua Chen  1 , Nan Wang  1 , Liangjie Lin  3 , Jiazheng Wang  3 , Qingwei Song  1 , Ailian Liu  1
Affiliations

Amide proton transfer weighted imaging combined with dynamic contrast-enhanced MRI in predicting lymphovascular space invasion and deep stromal invasion of IB1-IIA1 cervical cancer

Qingling Song et al. Front Oncol. .

Abstract

Objectives: To investigate the value of amide proton transfer weighted (APTw) imaging combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting intermediate-risk factors of deep stromal invasion (DSI) and lymphovascular vascular space invasion (LVSI) in cervical cancer.

Methods: Seventy patients with cervical cancer who underwent MRI before operation from July 2019 to February 2022 were retrospectively included in this study. Clinical information including age, histologic subtype etc. were recorded for patients. ATPw imaging parameter APTmean and DCE-MRI parameters Ktrans, Kep and Ve were measured and analyzed. The independent-sample t-test, Mann-Whitney U test, or Chi-square test was used to compare the differences of parameters between DSI/LVSI positive and negative groups. Logistic analysis was used to develop a combined predictive model. The receiver operating characteristic curve was for predictive performance. ANOVA and Kruskal-Wallis test were used to compare the differences of consecutive parameters among multiple groups.

Results: Ktrans and SCC-Ag were independent factors in predicting DSI; Ktrans+SCC-Ag had the highest AUC 0.819 with sensitivity and specificity of 71.74% and 91.67%, respectively. APTmean and Ktrans were independent factors in predicting LVSI; APTmean+Ktrans had the highest AUC 0.874 with sensitivity and specificity of 92.86% and 75.00%, respectively. Ktrans and Ve could discriminate coexistence of DSI and LVSI from presence of single one, APTmean could discriminate the presence of DSI or LVSI from no risk factor presence.

Conclusion: The combination of APTw and DCE-MRI is valuable in predicting intermediate-risk factors of DSI and LVSI in cervical cancer.

Keywords: MRI; amide proton transfer; cervical cancer; deep stromal invasion; dynamic contrast-enhanced; lymphovascular space invasion.

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Conflict of interest statement

Authors LL and JW were employed by Philips Healthcare. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The study flow diagram, including the patient selection process.
Figure 2
Figure 2
A 68-year-old patient with poor differentiation squamous cell cervical cancer with LVSI and DSI. (A) The T2WI and the arrow show the lesion. (B) The fusion image of APT pseudo color image and T2WI. The ROI was manually placed along the edge of the largest area of the tumor by referring to the T2WI, avoiding the necrotic area. (C) The DCE-MRI image; the ROI was manually placed by referring to the T2WI. (D) Hematoxylin-eosin (×200) showing LVSI positive.
Figure 3
Figure 3
(A, B) The boxplot showing the difference of Ktrans and Ve between the DSI positive and DSI negative groups. (C-E) Boxplots showing the difference of APTmean, Ktrans, and Ve between the LVSI positive group and LVSI negative group.
Figure 4
Figure 4
(A) ROC of Ktrans, Ve, SCC-Ag and combined values (SCC-Ag+Ktrans) for the prediction of DSI. (B) ROC of SCC-Ag, APTmean, Ktrans, Ve and combined values (APTmean+Ktrans) for the prediction of LVSI. The combined values for DSI and LVSI both show the highest AUC.
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