The Diagnostic Value Of 3.0T Magnetic Resonance Diffusion Kurtosis Imaging For Cervical Cancer

Objective:To use 3.0T magnetic resonance DKI and DWI sequence scans for cervical cancer（CC）patients,using DWI quantitative parameters as a reference,to explore the application value of DKI quantitative parameters in the histopathological type,pathological grade and clinical FIGO staging diagnosis of cervical cancer.Materials and methods:From October 2019 to November 2020,a retrospective analysis of 42 cases of CC patients confirmed by pathological results in the MRI room of our hospital.According to histopathological type,the patients were divided into 2 groups:adenocarcinoma of the cervix（ACA）group（13 cases）,cervical squamous cell carcinoma（SCC）group（29 cases）;according to pathological classification,the patients were divided into2 groups:well-moderately（G1-G2）differentiated group and poorly（G3）differentiated group,the number of cases was 32,10 respectively;according to the 2018 FIGO staging standard（FIGOI-IV）,the patients were divided into 2 groups:early（FIGOI-IIa）cervical cancer group and advanced（FIGOIIb-IV）cervical cancer group,the number of cases was 22,20 respectively.The 3.0T magnetic resonance scanning equipment（Discovery MR750）of GE Healthcare in the United States was used to perform MR routine,DKI（b=0,1000,2000 s/mm²）and DWI（b=0,800 s/mm²）sequence scans for all patients.Import the DKI quantitative parameters（MK,MD）and DWI quantitative parameters（ADC,eADC）into the GE workstation（ADW4.6）,click the Functool function key,and find the corresponding software to process the obtained data.Combining with conventional MRI plain scan images,select the solid part of the tumor,and draw a region of interest（ROI）on its edge.Measure and record in detail two parts of data in the ROI area:the first part was the DKI quantitative parameters,including the average kurtosis（MK）,the average diffusion coefficient（MD）;the second part was the DWI parameters,including the average apparent diffusion coefficient（ADC）,exponential apparent coefficient（eADC）.Analyze and compare the differences of these four quantitative parameters in different pathological grades of CC,clinical FIGO staging,and histopathological types.For the parameters with significant differences,use Med Calc15.2.2.0software to establish ROC curve to evaluate the diagnostic efficacy of identifying CC.Inaddition,Spearman rank correlation was used to calculate the correlation degree of the above four parameters with different pathological grades of CC and clinical FIGO staging.Results:1.DKI quantitative parameter MD:cervical ACA group was higher than SCC group,the difference was significant（Z=-2.027,P<0.05）,the area under the ROC curve was 0.698,and the diagnostic threshold was0.96(×10^-3mm²/s),the sensitivity was 41.38%and the specificity was 92.31%.2.DKI quantitative parameter MK:there was no significant difference between the cervical ACA group and the SCC group（Z=-1.075,P>0.05）.3.DWI quantitative parameters averageADC:cervical ACA group was higher than SCC group,the difference was significant（Z=-1.959,P<0.05）,the area under the ROC curve was 0.691,and the diagnostic threshold was 1.01(×10^-3mm²/s),the sensitivity was 55.17%,and the specificity was 92.31%.4.DWI quantitative parameter average eADC:cervical ACA group was lower than SCC group,the difference was significant（Z=-2.095,P<0.05）,the area under the ROC curve was 0.704,the diagnostic threshold was 0.45,the sensitivity was 55.17%,and the specificity was 92.31%.5.The quantitative parameters MD,MK,averageADC and eADC of DKI and DWI were not statistically different between the well-moderately differentiated and poorly differentiated cervical cancer groups（P>0.05）,and they were not significantly correlated with CC pathological grade（r_s were-0.134,0.175,-0.009,-0.014,respectively,P>0.05）.6.The quantitative parameters MD,MK,averageADC and eADC of DKI and DWI were not statistically different between the early cervical cancer group and the advanced cervical cancer group（P>0.05）,and they were not significantly correlated with the CC clinical FIGO staging（r_s were 0.208,-0.118,0.175,-0.151,respectively,P>0.05）.Conclusions:1.The quantitative parameters MD,ADC,and eADC of magnetic resonance DKI and DWI were significantly different in cervical squamous（SCC）and adenocarcinoma（ACA）,which was helpful to evaluate the histopathological type of CC and was also a non-invasive evaluation.The histopathological types of cervical cancer provided a new idea to assist in choosing the best clinical treatment plan.However,compared with the averageADC and eADC of DWI,the MD of DKI had similar diagnostic efficiency in distinguishing different histopathological types of CC.Therefore,compared with DWI,DKI did not show significant additional value.2.The quantitative parameters MD,MK,averageADC,and eADC of DKI and DWI had limited diagnostic efficacy in assessing the pathological grading and clinical FIGO staging of cervical cancer.Their value remained to be further explored in order to provide clinicians with more accurate and comprehensive information.