Identification of histological features of endometrioid adenocarcinoma based on amide proton transfer-weighted imaging and multimodel diffusion-weighted imaging

Abstract

Background: Noninvasive identification of the histological features of endometrioid adenocarcinoma is necessary. This study aimed to investigate whether amide proton transfer-weighted imaging (APTWI) and multimodel (monoexponential, biexponential, and stretched exponential) diffusion-weighted imaging (DWI) could predict the histological grade of endometrial adenocarcinoma (EA). In addition, we analyzed the correlation between each parameter and the Ki-67 index.Methods: A total of 90 EA patients who received pelvic magnetic resonance imaging (MRI) were enrolled.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), and water molecular diffusion heterogeneity index (α) were measured and compared.Correlation coefficients between each parameter and histological grade and the Ki-67 index were calculated.Statistical methods included the independent samples t test, Spearman's correlation, and logistic regression. Results: MTRasym (3.5 ppm) [(3.72%±0.31%) vs. (3.27%±0.48%)], f [(3.15%±0.36%) vs. (2.69%±0.83%)], and α [(0.89±0.05) vs. (0.81±0.09)] were higher and ADC [(0.82±0.08) vs. (0.89±0.10) ×10 −3 mm 2 /s], D [(0.67±0.09) vs. (0.81±0.11) ×10 −3 mm 2 /s], and DDC [(1.04±0.09) vs.(1.13±0.13) ×10 −3 mm 2 /s] were lower in high-grade EA than in low-grade EA (P<0.05). MTRasym (3.5 ppm) and D were independent predictors for the histological grade of EA. The combination of MTRasym (3.5 ppm) and D were better able to identify high-and low-grade EA than was each parameter. MTRasym (3.5 ppm) and α were moderately and weakly positively correlated, respectively, with histological grade and the r=0.514, r=0.395, and r=0.367; P<0.05). D was moderately negatively correlated with histological grade and the Ki-67 index (r=-0.540 and r=-0.529; P<0.05). DDC was weakly and moderately negatively correlated with histological grade and the Ki-67 index, respectively (r=-0.473 and r=-0.515; P<0.05). ADC was weakly negatively correlated with histological grade and the Ki-67 index (r=-0.417 and r=-0.427; P<0.05). f was weakly positively correlated with histological grade and the Ki-67 index (r=0.294 and r=0.355; P<0.05).

Use of biexponential and stretched exponential models of intravoxel incoherent motion and dynamic contrast-enhanced magnetic resonance imaging to assess the proliferation of endometrial carcinoma

“…The stretched exponential model IVIM generates α, a parameter reflecting the complexity of the tissue. Previous studies have found that due to the higher level of intravoxel microscopic necrotic foci, heterogeneous cellularity, and heterogeneous cellularity, the tissue complexity of highproliferation lesions tends to be higher than that of lowproliferation lesions, and therefore α tends to decrease in high-proliferation lesions (38,39). These results are consistent with those of the present study, suggesting that α can play an important role in the assessment of EC proliferation.…”

Quantitative dynamic contrast-enhanced parameters and intravoxel incoherent motion facilitate the prediction of TP53 status and risk stratification of early-stage endometrial carcinoma

“…13 Previous publications have demonstrated that D* values with poor stability and repeatability could not effectively evaluate histopathological information of earlystage EC due to the influence of the scanning parameters, the ROI determination method, the signal-to-noise ratio (SNR), and other factors. [17][18][19][20] In this study, there was no statistically significant difference in D* between the TP53-mutant and TP53wild groups, and the low-risk and the non-low-risk groups, which was consistent with the above research, further proving that the D* value was unable to play a role in the assessment of TP53 status and risk stratification in early-stage EC.…”

“…17,19 The reason may be that there were differences in histological grade, FIGO stage, and lymph node metastasis between the low-risk and non-low-risk early-stage EC, resulting in different degrees of influence on the diffusion of water molecules and ultimately leading to significant differences in D values between the two groups. 18,20 D* was a perfusion parameter of IVIM that is mainly correlated with the velocity of blood flow within the microcirculation. 13 Previous publications have demonstrated that D* values with poor stability and repeatability could not effectively evaluate histopathological information of earlystage EC due to the influence of the scanning parameters, the ROI determination method, the signal-to-noise ratio (SNR), and other factors.…”

“…For example, Satta et tures of EC and showed that some of the derived parameters helped to identify the histopathological features of EC. 17,18 19,20 , while Ye et al 12 used DCE-MRI for the preoperative risk assessment of EC, and their results showed that some parameters of DCE-MRI or IVIM could play a positive role in the risk stratification prediction of EC. However, not only did none of these studies address TP53 status but also risk stratification was assessed either by applying only one of the IVIM or DCE-MRI techniques or the subjects were not early-stage EC.…”

Amide Proton Transfer‐Weighted Imaging Combined With Intravoxel Incoherent Motion for Evaluating Microsatellite Instability in Endometrial Cancer

“…This is because the size of the f value is not only related to the microvessel density and blood flow velocity but also to the overall motion of the water molecules in the tissue, the pressure of the blood vessel wall, and the difference in the b-value. [35][36][37][38] Previous reports 39,40 have shown that the choice of b value varies, and the size of f value also varies. For instance, an IVIM study 39 on prostate cancer showed that when the b values were within a range of 0-750 sec/mm 2 , the f value of the tumor tissue increases, but when the maximum b value exceeds 750 sec/mm 2 , the f value of the tumor tissue decreases significantly, making it indistinguishable from normal tissue.…”