Nan Meng1,2, Xuejia Wang3, Jing Sun4, Zhun Huang5, Zhen Yang4, Jie Shang6, Yan Bai1,2, Wei Wei1,2, Dongming Han3, Hui Han7, Kaiyu Wang8, Fengmin Shao9, Meiyun Wang10,11. 1. Department of Medical Imaging, Zhengzhou University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, Henan, China. 2. Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China. 3. Department of MR, The First Affiliated Hospital, Xinxiang Medical University, Weihui, China. 4. Department of Pediatrics, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China. 5. Department of Medical Imaging, Henan University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, Henan, China. 6. Department of Pathology, The First Affiliated Hospital, Xinxiang Medical University, Weihui, China. 7. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 8. MR Research China, GE Healthcare, Beijing, China. 9. Department of Nephrology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, Henan, China. fengminshao@126.com. 10. Department of Medical Imaging, Zhengzhou University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, Henan, China. mywang@ha.edu.cn. 11. Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China. mywang@ha.edu.cn.
Abstract
OBJECTIVES: To investigate whether amide proton transfer-weighted imaging (APTWI) and diffusion kurtosis imaging (DKI) can be used to evaluate endometrial carcinoma (EC) in terms of clinical type, histological grade, subtype, and Ki-67 index. METHODS: Eighty-eight patients with EC underwent pelvic DKI and APTWI. The non-Gaussian diffusion coefficient (Dapp), apparent kurtosis coefficient (Kapp), and magnetization transfer ratio asymmetry (MTRasym (3.5 ppm)) were calculated and compared based on the clinical type (type I, II), histological grade (high- and low-grade), and subtype (endometrioid adenocarcinoma (EA) and non-EA). Correlation coefficients were calculated for each parameter with histological grades and the Ki-67 index. RESULTS: The MTRasym (3.5 ppm) and Kapp values were higher in the type II group and high-grade group than in the type I and low-grade groups, respectively, while the Dapp values were lower in the type I and low-grade groups, respectively (all p < 0.05). The Kapp value was higher in the EA group than in the non-EA group (p = 0.022). The Kapp value was the only independent predictor for the histological grade of EA and the clinical type of EC. The AUC (DKI) was higher than the AUC (APTWI) in the identification of type I and II EC and high- and low-grade EA (Z = 2.042, 2.013, p = 0.041, 0.044), while in the identification of EA and non-EA, only the difference in Kapp was statistically significant. Moreover, the Kapp and MTRasym (3.5 ppm) values and Dapp values correlated positively and negatively, respectively, with histological grade (r = 0.759, 0.555, 0.624, and 0.462, all p < 0.05) and Ki-67 index (r = -0.704, -0.507, all p < 0.05). CONCLUSION: Both DKI- and APTWI-related parameters have potential as imaging markers in estimating the histological features of EC, while DKI shows better performance than APTWI in this study. KEY POINTS: • DKI and APTWI can be used to preliminarily evaluate the histological characteristics of endometrial carcinoma (EC). • The Kapp was the only independent predictor for the histological grade of EA and the clinical type of EC. • The Kapp, MTRasym (3.5 ppm), and Dapp correlated positively and negatively, respectively, with histological grade and Ki-67 index.
OBJECTIVES: To investigate whether amide proton transfer-weighted imaging (APTWI) and diffusion kurtosis imaging (DKI) can be used to evaluate endometrial carcinoma (EC) in terms of clinical type, histological grade, subtype, and Ki-67 index. METHODS: Eighty-eight patients with EC underwent pelvic DKI and APTWI. The non-Gaussian diffusion coefficient (Dapp), apparent kurtosis coefficient (Kapp), and magnetization transfer ratio asymmetry (MTRasym (3.5 ppm)) were calculated and compared based on the clinical type (type I, II), histological grade (high- and low-grade), and subtype (endometrioid adenocarcinoma (EA) and non-EA). Correlation coefficients were calculated for each parameter with histological grades and the Ki-67 index. RESULTS: The MTRasym (3.5 ppm) and Kapp values were higher in the type II group and high-grade group than in the type I and low-grade groups, respectively, while the Dapp values were lower in the type I and low-grade groups, respectively (all p < 0.05). The Kapp value was higher in the EA group than in the non-EA group (p = 0.022). The Kapp value was the only independent predictor for the histological grade of EA and the clinical type of EC. The AUC (DKI) was higher than the AUC (APTWI) in the identification of type I and II EC and high- and low-grade EA (Z = 2.042, 2.013, p = 0.041, 0.044), while in the identification of EA and non-EA, only the difference in Kapp was statistically significant. Moreover, the Kapp and MTRasym (3.5 ppm) values and Dapp values correlated positively and negatively, respectively, with histological grade (r = 0.759, 0.555, 0.624, and 0.462, all p < 0.05) and Ki-67 index (r = -0.704, -0.507, all p < 0.05). CONCLUSION: Both DKI- and APTWI-related parameters have potential as imaging markers in estimating the histological features of EC, while DKI shows better performance than APTWI in this study. KEY POINTS: • DKI and APTWI can be used to preliminarily evaluate the histological characteristics of endometrial carcinoma (EC). • The Kapp was the only independent predictor for the histological grade of EA and the clinical type of EC. • The Kapp, MTRasym (3.5 ppm), and Dapp correlated positively and negatively, respectively, with histological grade and Ki-67 index.
Entities:
Keywords:
Diffusion magnetic resonance imaging; Endometrial neoplasms; Magnetization transfer contrast imaging