Amide Proton Transfer-Weighted Imaging and Multiple Models Diffusion-Weighted Imaging Facilitates Preoperative Risk Stratification of Early-Stage Endometrial Carcinoma.

Abstract

BACKGROUND:

Endometrial carcinoma (EC) risk stratification is generally based on histological assessment. It would be beneficial to perform risk stratification noninvasively by MRI.

PURPOSE:

To investigate the application of amide proton transfer-weighted imaging (APTWI), monoexponential, biexponential, and stretched exponential intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) for the evaluation of risk stratification in early-stage EC.

STUDY TYPE:

Prospective.

POPULATION:

Eighty patients with early-stage EC (47 classified as low risk, 20 as medium risk, and 13 as high risk by histological grade and International Federation of Gynecology and Obstetrics stage).

FIELD STRENGTH/SEQUENCE:

T1-weighted imaging, T2-weighted imaging, IVIM, APTWI, and DKI MRI at 3 T.

ASSESSMENT:

The magnetization transfer ratio asymmetry (MTRasym [3.5 ppm]), apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), distributed diffusion coefficient (DDC), water molecular diffusion heterogeneity index (α), mean kurtosis (MK), and mean diffusivity (MD) were calculated and compared between low-risk and non-low-risk groups.

STATISTICAL TESTS:

Individual sample t test, analysis of variance, and logistic regression. A P-value <0.05 was considered statistically significant.

RESULTS:

The α, ADC, D, DDC, and MD were significantly higher and the f, MK, and MTRasym (3.5 ppm) were significantly lower in the low-risk group than in the non-low-risk group. The difference in D* between the two groups was not significant (P = 0.289). MTRasym (3.5 ppm), D, and MK were independent predictors of risk stratification. The combination of these three parameters was better able to identify low- and non-low-risk groups than each individual parameter.

DATA CONCLUSION:

The IVIM, DKI, and APTWI parameters have potential as imaging markers for risk stratification in early-stage EC.

LEVEL OF EVIDENCE:

2 TECHNICAL EFFICACY: Stage 3.

• Authors: Nan Meng, Ting Fang, Pengyang Feng, Zhun Huang, Jing Sun, Xuejia Wang, Jie Shang, Kaiyu Wang, Dongming Han, Meiyun Wang
• Journal: Journal of magnetic resonance imaging : JMRI (J Magn Reson Imaging) Vol. 54 Issue 4 Pg. 1200-1211 (10 2021) ISSN: 1522-2586 [Electronic] United States
• PMID: 33991377 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 International Society for Magnetic Resonance in Medicine.

Chemical References

• Amides
• Protons

Topics

• Amides
• Diffusion Magnetic Resonance Imaging
• Endometrial Neoplasms (diagnostic imaging)
• Female
• Humans
• Prospective Studies
• Protons
• Risk Assessment