Preliminary Study Of Diffusion Kurtosis Imaging In Diagnosis Of Uterine Neoplastic Lesions

Part1 Diagnostic value of magnetic resonance diffusion kurtosis imaging in different pathological types of uterine fibroidsObjective:To investigate the diagnostic value of quantitative parameters of diffusion kurtosis imaging(DKI)and diffusion weighted imaging(DWI)in differentiating uterine fibroids of different pathological types.Methods: A total of 60 lesions from 48 patients with uterine fibroids who were surgically pathologically confirmed at our hospital,from November 2019 to February2021 were collected and divided into 3 groups according to the different pathological types: 31 cases of ordinary leiomyomas,13 cases of cellular leiomyomas,16 cases of degenerated leiomyomas,an additional 30 normal uteri were collected as a control group.All patients underwent pelvic MRI at our hospital preoperatively,including MRI conventional and enhanced examination,as well as DWI and DKI sequence scans,and the MK,MD,and ADC values obtained from the postprocessing were measured and recorded by two radiologists.Using the intraclass correlation coefficient(ICC)to assess the agreement of the two physicians in measuring each parameter,and if the consistency was good,the mean of the two was used for subsequent analysis.Comparison of parameter values between multiple groups was performed by one-way ANOVA,and LSD-t test was used for pairwise comparison between groups.Receiver operating characteristic(ROC)curves were generated to calculate the sensitivity,specificity and optimal diagnostic threshold of each parameter value in discriminating different pathological types of uterine fibroids,and the diagnostic efficacy of each parameter value was assessed according to the area under the ROC curve(AUC).Results: Good concordance was obtained between the two radiologists in measuring the MK,MD,and ADC values.The MK,MD,and ADC values of the uterine fibroids in the cellular leiomyomas group were not statistically different from ordinary leiomyomas group(P>0.05),and the differences of pairwise comparison in the remaining groups were statistically significant(P<0.05).The MD and ADC values of degenerated leiomyomas were higher than those of ordinary eiomyomas(P=0.001,0.000,respectively)and cellular leiomyomas(P=0.024,0.001,respectively),lower than control group(P = 0.003,0.014,respectively).The K value of the degenerated leiomyomas were lower than those of ordinary leiomyomas(P=0.000)and cellular leiomyomas(P=0.000),higher than control group(P=0.044).The AUC of the ROC curve for discriminating between the degenerated leiomyomas and the ordinary leiomyomas was approximately similar(0.926,0.938,respectively),and higher than the AUC of the ADC value.The AUC of the MK and MD values in diagnosing degenerated leiomyomas and cellular leiomyomas(0.944、0.997,respectively)were higher than ADC values(0.926).The AUC of the of the combination of MK and MD values in diagnosing degenerated leiomyomas and ordinary leiomyomas increased to0.965,and the AUC of the combination of MK and MD values in degenerated leiomyomas and cellular leiomyomas increased to 0.994,which were all significantly higher than the AUC of the ADC value.Conclusions: Both DKI and DWI parameters are capable of noninvasively quantifying the differences between different pathological types of uterine fibroids,and MK and MD values of DKI have higher diagnostic efficacy compared with ADC value of DWI.Part 2 Diagnostic value of magnetic resonance diffusion kurtosis imaging in cervical cancerObjective: To investigate the diagnostic value of quantitative parameters of diffusion kurtosis imaging(DKI)compared with diffusion weighted imaging(DWI)in cervical cancer.Methods: 15 cervical cancer patients who were pathologically confirmed in our hospital from November 2019 to February 2021,all underwent pelvic MRI in our hospital preoperatively,including MRI conventional and enhanced examination,as well as DWI and DKI sequence scans.Cervical cancer foci versus normal myometrial parameter values were measured on post processed MK,MD and ADC maps by two imaging diagnosticians.Intraclass correlation coefficient(ICC)was employed to evaluate the consistency of each parameter measured by two physicians.If parameters met normal distribution with homogeneous variance,independent samples t-test was used for comparison between groups,otherwise the Mann Whitney U test was employed.ROC curves were drawn to analyze the diagnostic efficacy of each parameter value in differentiating cervical cancer from normal myometrium,and the corresponding sensitivity,specificity,and optimal diagnostic threshold of each parameter were determined according to the Youden index.Results: Good concordance was obtained between the two physicians in measuring MK,MD,ADC values(ICC = 0.992,0.998,0.997,respectively).The MD and ADC values of cervical cancer were lower than those of normal myometrium(P = 0.000,0.000,respectively),while the MK value was higher than those of normal myometrium(P = 0.000).The area under the ROC curve AUC for MK value(1.000)in differentiating cervical cancer from normal myometrium was the largest,followed by MD value(0.960),ADC value(0.951).Conclusions: Both DWI and DKI can effectively differentiate cervical cancer from normal myometrium,and DKI has a reliable application value in cervical cancer diagnosis and its diagnostic value is superior to that of conventional DWI.