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

Meng, Nan; Fang, Ting; Feng, Pengyang; Huang, Zhun; Sun, Jiayuan; Wang, Xuejia; Shang, Jie; Wang, Kaiyu; Han, Dongming; Wang, Meiyun

doi:10.1002/jmri.27684

Cited by 31 publications

(47 citation statements)

References 40 publications

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“…Meng et al. used the average ADC and MD based on the total tumor volume for stage I EC risk stratification assessment, and the results showed that these values decreased with the increase in risk stratification; significant differences in the ADC and MD between the low-risk and non-low-risk groups were observed ( 19 ). In the present study, the ADC and MD were lower in the non-adenocarcinoma, stage IB, high-grade, and non-low-risk groups than those in the adenocarcinoma, stage IA, non-high-grade, and low-risk groups (all p < 0.05), which was generally consistent with the above findings.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Amide Proton Transfer-Weighted Imaging for Risk Factors in Stage I Endometrial Cancer: A Comparison With Diffusion-Weighted Imaging and Diffusion Kurtosis Imaging

Jin

Yan

et al. 2022

Front. Oncol.

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BackgroundEndometrial cancer (EC) is one of the most common gynecologic malignancies in clinical practice. This study aimed to compare the value of diffusion-weighted imaging (DWI), diffusion kurtosis imaging (DKI), and amide proton transfer-weighted imaging (APTWI) in the assessment of risk stratification factors for stage I EC including histological subtype, grade, stage, and lymphovascular space invasion (LVSI).MethodsA total of 72 patients with stage I EC underwent pelvic MRI. The apparent diffusion coefficient (ADC), mean diffusivity (MD), mean kurtosis (MK), and magnetization transfer ratio asymmetry (MTRasym at 3.5 ppm) were calculated and compared in risk groups with the Mann–Whitney U test or independent samples t-test. Spearman’s rank correlation was applied to depict the correlation of each parameter with risk stratification. The diagnostic efficacy was evaluated with receiver operating characteristic (ROC) curve analysis and compared using the DeLong test. A multivariate logistic regression was conducted to explore the optimal model for risk prediction.ResultsThere were significantly greater MTRasym (3.5 ppm) and MK and significantly lower ADC and MD in the non-adenocarcinoma, stage IB, LVSI-positive, high-grade, and non-low-risk groups (all p < 0.05). The MK and MTRasym (3.5 ppm) were moderately positively correlated with risk stratification as assessed by the European Society for Medical Oncology (EMSO) clinical practice guidelines (r = 0.640 and 0.502, respectively), while ADC and MD were mildly negatively correlated with risk stratification (r = −0.358 and −0.438, respectively). MTRasym (3.5 ppm), MD, and MK were identified as independent risk predictors in stage I EC, and optimal predictive performance was obtained with their combinations (AUC = 0.906, sensitivity = 70.97%, specificity = 92.68%). The results of the validation model were consistent with the above results, and the calibration curve showed good accuracy and consistency.ConclusionsAlthough similar performance was obtained with each individual parameter of APTWI, DWI, and DKI for the noninvasive assessment of aggressive behavior in stage I EC, the combination of MD, MK, and MTRasym (3.5 ppm) provided improved predictive power for non-low-risk stage I EC and may serve as a superior imaging marker.

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Section: Discussionmentioning

confidence: 99%

“…A few studies have briefly reported the role of these techniques in stage I EC risk stratification ( 18 , 19 ). However, these studies either explored the application of only a single imaging technique or assessed only risk stratification without evaluating the risk stratification factors.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Amide Proton Transfer-Weighted Imaging for Risk Factors in Stage I Endometrial Cancer: A Comparison With Diffusion-Weighted Imaging and Diffusion Kurtosis Imaging

Jin

Yan

et al. 2022

Front. Oncol.

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“…APT values changed with cancer type [ 56 ], histology grade [ 60 ], proliferation, as well as menstrual cycle. The APT method was co-studied with other fMRI methods [ 57 ].…”

Section: Applicationsmentioning

confidence: 99%

“…Meng et al also studied endometrial carcinoma (EC) by using APT and the other methods [ 57 ]. The authors found that the APT values were significantly less in low-risk cases compared to those of higher risk, and moreover, that the APT values, diffusion coefficient (D), and mean kurtosis (MK) were independent predictors of risk stratification.…”

Section: Applicationsmentioning

confidence: 99%

A Brief History and Future Prospects of CEST MRI in Clinical Non-Brain Tumor Imaging

Gao

Zou

et al. 2021

IJMS

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Chemical exchange saturation transfer (CEST) MRI is a promising molecular imaging tool which allows the specific detection of metabolites that contain exchangeable amide, amine, and hydroxyl protons. Decades of development have progressed CEST imaging from an initial concept to a clinical imaging tool that is used to assess tumor metabolism. The first translation efforts involved brain imaging, but this has now progressed to imaging other body tissues. In this review, we summarize studies using CEST MRI to image a range of tumor types, including breast cancer, pelvic tumors, digestive tumors, and lung cancer. Approximately two thirds of the published studies involved breast or pelvic tumors which are sites that are less affected by body motion. Most studies conclude that CEST shows good potential for the differentiation of malignant from benign lesions with a number of reports now extending to compare different histological classifications along with the effects of anti-cancer treatments. Despite CEST being a unique ‘label-free’ approach with a higher sensitivity than MR spectroscopy, there are still some obstacles for implementing its clinical use. Future research is now focused on overcoming these challenges. Vigorous ongoing development and further clinical trials are expected to see CEST technology become more widely implemented as a mainstream imaging technology.

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“…In this seminal report, APTw signal intensities were significantly higher for grade 3 EEA than for grade 1 EEA [ 27 ]. Recently, this imaging marker was proven valuable in estimating histological features and risk stratification in early-stage EC [ 28 ]. In 2021, Li et al first reported the feasibility of using three-dimensional (3D) APTw imaging for identifying endometrial adenocarcinoma, that its APTw values were significantly higher than that of benign uterine lesions, and also found APTw values exhibited a moderate positive correlation with Ki-67 proliferation status [ 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Using amide proton transfer-weighted MRI to non-invasively differentiate mismatch repair deficient and proficient tumors in endometrioid endometrial adenocarcinoma

Liu

Wang

et al. 2021

Insights Imaging

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Objectives To investigate the utility of three-dimensional (3D) amide proton transfer-weighted (APTw) imaging to differentiate mismatch repair deficient (dMMR) and mismatch repair proficient (pMMR) tumors in endometrioid endometrial adenocarcinoma (EEA). Methods Forty-nine patients with EEA underwent T1-weighted imaging, T2-weighted imaging, 3D APTw imaging, and diffusion-weighted imaging at 3 T MRI. Image quality and measurement confidence of APTw images were evaluated on a 5-point Likert scale. APTw and apparent diffusion coefficient (ADC) values were calculated and compared between the dMMR and pMMR groups and among the three EEA histologic grades based on the Federation of Gynecology and Obstetrics (FIGO) grading system criteria. Student’s t-test, analysis of variance with Scheffe post hoc test, and receiver operating characteristic analysis were performed. Statistical significance was set at p < 0.05. Results Thirty-five EEA patients (9 with dMMR tumors and 26 with pMMR tumors) with good image quality were enrolled in quantitative analysis. APTw values were significantly higher in the dMMR group than in the pMMR group (3.2 ± 0.3% and 2.8 ± 0.5%, respectively; p = 0.019). ADC values of the dMMR and pMMR groups were 0.874 ± 0.104 × 10−3 mm2/s and 0.903 ± 0.100 × 10−3 mm2/s, respectively. No significant between-group difference was noted (p = 0.476). No statistically significant differences were observed in APTw values or ADC values among the three histologic grades (p = 0.766 and p = 0.295, respectively). Conclusions APTw values may be used as potential imaging markers to differentiate dMMR from pMMR tumors in EEA.

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

Cited by 31 publications

References 40 publications

Evaluation of Amide Proton Transfer-Weighted Imaging for Risk Factors in Stage I Endometrial Cancer: A Comparison With Diffusion-Weighted Imaging and Diffusion Kurtosis Imaging

Evaluation of Amide Proton Transfer-Weighted Imaging for Risk Factors in Stage I Endometrial Cancer: A Comparison With Diffusion-Weighted Imaging and Diffusion Kurtosis Imaging

A Brief History and Future Prospects of CEST MRI in Clinical Non-Brain Tumor Imaging

Using amide proton transfer-weighted MRI to non-invasively differentiate mismatch repair deficient and proficient tumors in endometrioid endometrial adenocarcinoma

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