Diagnostic Value of Combined Intravoxel Incoherent Motion Diffusion-Weighted Magnetic Resonance Imaging with Diffusion Tensor Imaging in Predicting Parametrial Infiltration in Cervical Cancer

Abstract

Objective. This study sought to determine the diagnostic value of combined intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) in predicting parametrial infiltration (PMI) in patients with cervical cancer. Materials and Methods. We enrolled 65 patients with cervical cancer confirmed by radical hysterectomy (25 PMI-negative and 40 PMI-positive) who underwent IVIM and DTI pretreatment. The parameters of IVIM (ADC, D, D ∗ , and f) and DTI (average diffusion coefficient (DCavg) and fractional anisotropy (FA)) were recorded by two observers. All parameter differences were tested, and the receiver operating characteristic (ROC) curves were generated to estimate the diagnostic performance of significant metrics and their combinations. Results. Compared to the PMI-negative group, the PMI-positive group had significantly lower D (0.632 ± 0.017 vs. 0.773 ± 0.024, p < 0.001 ) and lower FA (0.073 ± 0.002 vs. 0.085 ± 0.003, p = 0.003 ). The area under the ROC curve (AUC) of D and FA was 0.801 and 0.726, respectively, and the combination of D and FA improved the AUC to 0.931, with a sensitivity and specificity of 80.0% and 97.5%, respectively. Conclusion. D and FA values could be used to help diagnose PMI in patients with cervical cancer. The combination of IVIM and DTI was more valuable than either option alone.

Imaging in translational cancer research

“…Because water diffusion in biological tissue is often anisotropic, and not isotropic, i.e., equal in all directions, the concept of a diffusion tensor captures and quantifies this (fractional) anisotropy, thus enabling investigation of preferred tracts of diffusion, e.g., along neuronal fibers in brain tissue or peripheral nerves 66 , 67 . Although used primarily in neuro-oncology 68 , this method has also been shown to be beneficial in determining the histological grade of oral carcinoma 69 ; discriminating between small-cell lung cancer and non-small cell lung cancer brain metastases 70 ; correlating with Gleason scores in prostate cancer 71 ; or predicting parametrial infiltration in cervical cancer 72 .…”