Nan Meng1,2, Ting Fang1,2, Pengyang Feng3, Zhun Huang3, Jing Sun4, Xuejia Wang5, Jie Shang6, Kaiyu Wang7, Dongming Han5, Meiyun Wang1,2. 1. Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China. 2. Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China. 3. Department of Medical Imaging, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China. 4. Department of Pediatrics, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, China. 5. Department of MR, the First Affiliated Hospital, Xinxiang Medical University, Weihui, China. 6. Department of Pathology, the First Affiliated Hospital, Xinxiang Medical University, Weihui, China. 7. MR Research China, GE Healthcare, Beijing, China.
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.
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.