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Guo L, Zhang R, Xu Y, Wu W, Zheng Q, Li J, Wang J, Niu J. Predicting the status of lymphovascular space invasion using quantitative parameters from synthetic MRI in cervical squamous cell carcinoma without lymphatic metastasis. Front Oncol 2024; 14:1304793. [PMID: 38380361 PMCID: PMC10876895 DOI: 10.3389/fonc.2024.1304793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose To investigate the value of quantitative longitudinal relaxation time (T1), transverse relaxation time (T2), and proton density (PD) maps derived from synthetic magnetic resonance imaging (MRI) for evaluating the status of lymphovascular space invasion (LVSI) in cervical squamous cell carcinoma (CSCC) without lymph node metastasis (LNM). Material and methods Patients with suspected cervical cancer who visited our hospital from May 2020 to March 2023 were collected. All patients underwent preoperative MRI, including routine sequences and synthetic MRI. Patients with pathologically confirmed CSCC without lymphatic metastasis were included in this study. The subjects were divided into negative- and positive-LVSI groups based on the status of LVSI. Quantitative parameters of T1, T2, and PD values derived from synthetic MRI were compared between the two groups using independent samples t-test. Receiver operating characteristic curves were used to determine the diagnostic efficacy of the parameters. Results 59 patients were enrolled in this study and were classified as positive (n = 32) and negative LVSI groups (n = 27). T1 and T2 values showed significant differences in differentiating negative-LVSI from positive-LVSI CSCC (1307.39 ± 122.02 vs. 1193.03 ± 107.86, P<0.0001; 88.42 ± 7.24 vs. 80.99 ± 5.50, P<0.0001, respectively). The area under the curve (AUC) for T1, T2 values and a combination of T1 and T2 values were 0.756, 0.799, 0.834 respectively, and there is no statistically significant difference in the diagnostic efficacy between individual and combined diagnosis of each parameter. Conclusions Quantitative parameters derived from synthetic MRI can be used to evaluate the LVSI status in patients with CSCC without LNM.
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Affiliation(s)
| | | | | | | | | | | | | | - Jinliang Niu
- Department of Radiology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Xu Q, Song Q, Wang Y, Lin L, Tian S, Wang N, Wang J, Liu A. Amide proton transfer weighted combined with diffusion kurtosis imaging for predicting lymph node metastasis in cervical cancer. Magn Reson Imaging 2024; 106:85-90. [PMID: 38101652 DOI: 10.1016/j.mri.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To investigate the value of amide proton transfer weighted (APTw) combined with diffusion kurtosis imaging (DKI) in quantitative prediction of lymph node metastasis (LNM) in cervical carcinoma (CC). METHODS Data of 19 LNM(+) and 50 LNM(-) patients with CC were retrospectively analyzed. 3.0 T MRI scan was performed before the operation, including APTw and DKI. After post-processing, quantitative magnetization transfer ratio asymmetric at 3.5 ppm [MTRasym (3.5 ppm)], mean kurtosis (MK), and mean diffusivity (MD) maps were obtained. The MTRasym(3.5 ppm), MK, and MD values were respectively measured by two observers, and intra-class correlation coefficients (ICC) were used to test the consistency of the results. The independent samples t-test or Mann-Whitney U test was used to compare the differences in the values of each parameter. The ROC curve was used to analyze the predictive performance of parameters with significant differences and their combination parameter. RESULTS The two observers had good agreement in the measurement of each data (ICC > 0.75). The MTRasym(3.5 ppm) and MK values of the LNM(+) group(3.260 ± 0.538% and 0.531 ± 0.202) were higher than those of the LNM(-) group(2.698 ± 0.597% and 0.401 ± 0.148) (P < 0.05), while there was no significant difference in MD values between the two groups(P > 0.05). The area under the curves (AUCs) of MTRasym(3.5 ppm), MK value, and MTRasym(3.5 ppm) + MK value were 0.763, 0.716, and 0.813, respectively, when predicting LNM status of CC. CONCLUSION APTw and DKI can quantitatively predict LNM status of CC, which is of importance in clinical diagnosis and treatment.
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Affiliation(s)
- Qihao Xu
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian,China
| | - Qingling Song
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian,China
| | - Yue Wang
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian,China
| | - Liangjie Lin
- Clinical and Technical Support, Philips Healthcare, Beijing, China
| | - Shifeng Tian
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian,China
| | - Nan Wang
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian,China
| | - Jiazheng Wang
- Clinical and Technical Support, Philips Healthcare, Beijing, China
| | - Ailian Liu
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian,China; Dalian Medical Imaging Artificial Intelligence Engineering Technology Research Center, Dalian, China.
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Zheng Y, Han N, Huang W, Jiang Y, Zhang J. Evaluating Mediastinal Lymph Node Metastasis of Non-Small Cell Lung Cancer Using Mono-exponential, Bi-exponential, and Stretched-exponential Models of Diffusion-weighted Imaging. J Thorac Imaging 2023:00005382-990000000-00119. [PMID: 38153288 DOI: 10.1097/rti.0000000000000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
PURPOSE To explore and compare the diagnostic values of mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted imaging (DWI) parameters of primary lesions and lymph nodes (LNs) to predict mediastinal LN metastasis in patients with non-small cell lung cancer. PATIENTS AND METHODS Sixty-one patients with non-small cell lung cancer underwent preoperative magnetic resonance imaging, including multiple b-value DWI. The DWI parameters, including apparent diffusion coefficient (ADC) from a mono-exponential model, true diffusion (D) coefficient, pseudo-diffusion (D*) coefficient, and perfusion fraction (f) from a bi-exponential model, distributed diffusion coefficient (DDC) and intravoxel diffusion heterogeneity index (α) from a stretched-exponential model of primary tumors and LNs and the size characteristics of LNs, were measured and compared. Multivariate logistic regression analysis was used to establish models for predicting mediastinal LN metastasis. Receiver operating characteristic analysis was applied to evaluate diagnostic performances. RESULTS The DWI parameters of primary tumors showed no statistical significance between LN metastasis-positive and LN metastasis-negative groups. Nonmetastatic LNs had significantly higher ADC, D, DDC, and α values compared with metastatic LNs (all P < 0.05). The short-dimension, long-dimension, and short-long dimension ratio of metastatic LNs was significantly larger than those of nonmetastatic ones (all P < 0.05). The D value showed the best diagnostic performance among all DWI-derived single parameters, and the short dimension of LNs performed the same among all the size variables. Furthermore, the combination of DWI parameters (ADC and D) and the short dimension of LNs can significantly improve diagnostic efficiency. CONCLUSIONS The ADC, D, DDC, and α from the mono-exponential, bi-exponential, and stretched-exponential models were demonstrated efficient in differentiating benign from metastatic LNs, and the combination of ADC, D, and short dimension of LNs may have a better diagnostic performance than DWI or size-derived parameters either in combination or individually.
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Affiliation(s)
- Yu Zheng
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Na Han
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Wenjing Huang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Yanli Jiang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
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Ren J, Li Y, Liu XY, Zhao J, He YL, Jin ZY, Xue HD. Diagnostic performance of ADC values and MRI-based radiomics analysis for detecting lymph node metastasis in patients with cervical cancer: A systematic review and meta-analysis. Eur J Radiol 2022; 156:110504. [PMID: 36108474 DOI: 10.1016/j.ejrad.2022.110504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate and compare the diagnostic performance of apparent diffusion coefficient (ADC) values and MRI-based radiomics analysis for lymph node metastasis (LNM) detection in patients with cervical cancer (CC). METHODS We searched relevant databases for studies on ADC values and MRI-based radiomics analysis for LNM detection in CC between January 2001 and December 2021. Methodological quality assessment of risk of bias using Quality Assessment of Diagnostic Accuracy Studies 2 and radiomics quality score (RQS) of the studies was conducted. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated. Diagnostic performance was compared between the two quantitative analyses using a two-sample Z-test. RESULTS In total, 22 studies including 2314 patients were included. Unclear risk of bias was observed in 4.5-36.4% of the studies. The 8 radiomics studies exhibited a median (interquartile range) RQS of 13.5 (5.5-15.75). The pooled sensitivity, specificity, LR+, LR-, DOR, and AUC of the ADC values vs radiomics analysis were 0.86 vs 0.84, 0.85 vs 0.73, 5.7 vs 3.1, 0.17 vs 0.22, 34 vs 14, and 0.91 vs 0.86, respectively. There was no threshold effect or publication bias, but significant heterogeneity existed among the studies. No significant difference was detected in the diagnostic performance of the two quantitative analyses using the Z-test. CONCLUSION ADC values are more clinically promising because they are more easily accessible and widely applied, and exhibit a non-statistically significant trend to outperform radiomics analysis.
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Affiliation(s)
- Jing Ren
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
| | - Yuan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, PR China.
| | - Xin-Yu Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
| | - Jia Zhao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
| | - Yong-Lan He
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
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Zhang Y, Zhang KY, Jia HD, Fang X, Lin TT, Wei C, Qian LT, Dong JN. Feasibility of Predicting Pelvic Lymph Node Metastasis Based on IVIM-DWI and Texture Parameters of the Primary Lesion and Lymph Nodes in Patients with Cervical Cancer. Acad Radiol 2022; 29:1048-1057. [PMID: 34654623 DOI: 10.1016/j.acra.2021.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/22/2021] [Accepted: 08/27/2021] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the feasibility and value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and texture parameters of primary lesions and lymph nodes for predicting pelvic lymph node metastasis in patients with cervical cancer. MATERIALS AND METHODS A total of 143 patients with cervical cancer confirmed by surgical pathology were analyzed retrospectively and 125 patients were enrolled in primary lesions study, 83 patients and 134 lymph nodes were enrolled in lymph nodes study. Patients and lymph nodes were randomly divided into training group and test group at a ratio of 2: 1. The IVIM-DWI parameters and 3D texture features of primary lesions and lymph nodes of all patients were measured. The least absolute shrinkage and selection operator algorithm, spearman's correlation analysis, independent two-sample t-test and Mann-Whitney U-test were used to select texture parameters. Multivariate Logistic regression analysis and receiver operating characteristic curves were used to model and evaluate diagnostic performances. RESULTS In primary lesions study, model 1 was constructed by combining f value, original_shape_Sphericity and original_firstorder_Mean of primary lesions. In lymph nodes study, model 2 was constructed by combining short diameter, circular enhancement and rough margin of lymph nodes. Model 3 was constructed by combining ADC, f value and original_glszm_Small Area Emphasis of lymph nodes. The areas under curve of model 1, 2 and 3 in training group and test group were 0.882, 0.798, 0.907 and 0.862, 0.771, 0.937 respectively. CONCLUSION Models based on IVIM-DWI and texture parameters of primary lesions and lymph nodes both performed well in diagnosing pelvic lymph node metastasis of cervical cancer and were superior to morphological features of lymph nodes. Especially, parameters of lymph nodes showed higher diagnostic efficiency and clinical significance.
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Malek M, Rahmani M, Pourashraf M, Amanpour-Gharaei B, Zamani N, Farsi M, Ahmadinejad N, Raminfard S. Prediction of lymphovascular space invasion in cervical carcinoma using diffusion kurtosis imaging. Cancer Treat Res Commun 2022; 31:100559. [PMID: 35460974 DOI: 10.1016/j.ctarc.2022.100559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study aimed to investigate the potential relationship between diffusion kurtosis imaging (DKI)- derived parameters and lymphovascular space invasion (LVSI) in patients with cervical carcinoma. PATIENTS AND METHODS This prospective study included 30 patients with cervical carcinoma. The patients underwent MRI, diffusion-weighted imaging (DWI), and DKI prior to surgery. The surgical pathology results were accepted as the reference standard for determining the LVSI status. The DKI-derived parameters, including mean diffusivity (MD) and mean kurtosis (MK), were measured. The apparent diffusion coefficient (ADC) value was also assessed. RESULTS The MD value of LVSI positive cervical carcinomas was significantly lower than LVSI negative carcinomas (p-value = 0.01). MK value was significantly higher in LVSI positive tumors (p-value = 0.01). However, the ADC value did not show a significant difference between LVSI positive and LVSI negative tumors (p-value = 0.2). MD and MK parameters showed similar diagnostic accuracy in identifying the LVSI status, with the area under the curve of 0.77 and 0.78, respectively. CONCLUSION In this study, DKI-derived parameters were associated with the LVSI status in cervical carcinomas. Further studies with larger sample size are required to confirm these results.
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Affiliation(s)
- Mahrooz Malek
- Department of Radiology, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Rahmani
- Department of Radiology, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Pourashraf
- Department of Radiology, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Behzad Amanpour-Gharaei
- Omid Institute for Advanced Biomodels, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Narges Zamani
- Department of Gynecology Oncology, Vali-e-Asr Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Farsi
- Medical Imaging Center, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Nasrin Ahmadinejad
- Department of Radiology, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Samira Raminfard
- Department of Neuroimaging and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Liu L, Wang S, Yu T, Bai H, Liu J, Wang D, Luo Y. Value of diffusion-weighted imaging in preoperative evaluation and prediction of postoperative supplementary therapy for patients with cervical cancer. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:120. [PMID: 35282103 PMCID: PMC8848374 DOI: 10.21037/atm-21-5319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022]
Abstract
Background With the continuous progress of medical imaging technology, evaluation of cervical cancer is increasingly dependent on imaging methods. Diffusion-weighted imaging (DWI) plays an important role, and apparent diffusion coefficient (ADC) value is a unique quantitative parameter in the research of cervical cancer. Methods In this prospective study, a total of 273 patients diagnosed with stage IB1 to IIIC1 cervical cancer based on the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging guidelines who underwent pelvic 3.0T magnetic resonance imaging (MRI), including MRI and DWI, were enrolled, and the diagnostic value of preoperative staging of cervical cancer was compared between the MRI and DWI groups. The DWI group was used to explore the potential association of mean ADC (ADCmean) with different pathological characteristics and receiver operating characteristic (ROC) curves of ADCmean generated to predict the appropriate postoperative supplementary therapy. Results The diagnostic coincidence rate of DWI was higher than that of MRI in preoperative staging of cervical cancer (χ2, P<0.05) and determined as stages IB1 + IB2 + IIA1 (90.91%), IB3 + IIA2 (93.48%), and IIIC1p (95.16%). The DWI staging results were consistent with postoperative pathological staging (Kappa value =0.865, P<0.001). We observed significant differences in ADCmean values in relation to pathological type, histological grade, depth of stromal infiltration, tumor diameter, lymphovascular invasion, and pelvic lymph node metastasis of cervical cancer (all P<0.05). The area under the ROC curve (AUC) was 0.815, with the best predictive value for postoperative supplementary therapy in cervical cancer (sensitivity 80.0%, specificity 74.0%) at ADCmean of 0.910×10-3 mm2/s. Conclusions The DWI is a useful tool for preoperative evaluation of cervical cancer. In local cervical lesions, ADCmean varies in relation to different clinicopathological characteristics and a reference index of <0.910×10-3 mm2/s can be effectively applied to predict the need for postoperative supplementary therapy.
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Affiliation(s)
- Liying Liu
- Department of Gynecology, Cancer Hospital of China Medical University, Shenyang, China
| | - Shuo Wang
- Department of Gynecology, Cancer Hospital of China Medical University, Shenyang, China
| | - Tao Yu
- Department of Radiology and Nuclear Medicine, Cancer Hospital of China Medical University, Shenyang, China
| | - Haoyan Bai
- Department of Radiology and Nuclear Medicine, Cancer Hospital of China Medical University, Shenyang, China
| | - Jingyu Liu
- Department of Radiology and Nuclear Medicine, Cancer Hospital of China Medical University, Shenyang, China
| | - Danbo Wang
- Department of Gynecology, Cancer Hospital of China Medical University, Shenyang, China.,Liaoning Cancer Institute, Shenyang, China
| | - Yahong Luo
- Department of Radiology and Nuclear Medicine, Cancer Hospital of China Medical University, Shenyang, China
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