Application Of Amide Proton Transfer-weighted Imaging In The Diagnosis Of Cervical Cancer Grading And Parametrial Invasion

Objective:To investigate the diagnostic value of Amide proton transfer-weighted imaging(APTw)in evaluating cervical cancer grade and parametrial invasion(PMI).Methods:Seventy-five patients who underwent radical hysterectomy at The Second Hospital of Jilin University from March 2021 to October 2022 and were definitively diagnosed with cervical cancer by pathology were collected and finally divided into PMI group(18 patients)and Non-PMI group(57 patients)based on pathological findings;43 patients with squamous cell carcinoma of the cervix containing complete differentiation information were divided into low differentiation group(12 patients)and intermediate/high differentiation group(31 patients).All patients underwent preoperative MRI(including APTw sequences)on a 3.0T scanner(Ingenia CX,Philips Healthcare,the Netherlands),and clinical,pathological and APTw data were collected from all patients.Post-processing was performed using ISP software(Intellispace Portal;Version 10.1;Philips Healthcare,Best,the Netherlands)to obtain APTw values of tumors in the PMI and Non-PMI groups,APTw values of paracancerous tissues;tumors in the low and intermediate/high differentiation groups APTw values were analyzed,and the results of preoperative conventional MRI plain+enhanced,APTw imaging parameters for the assessment of PMI and APTw imaging parameters for the assessment of differentiation were compared with postoperative pathological results.Statistical methods were used to analyze the intra-class correlation coefficients(ICC)for the consistency of the mean values of APTw obtained from two observers using a double-blind method with multiple measurements.Independent samples t-test(for normally distributed data)or rank sum test(for non-normally distributed data)was used to compare the differences between the different parameter values between the groups,and the subject operating characteristic curve(ROC)was plotted to evaluate the diagnostic efficacy of each parameter value and to derive the optimal diagnostic threshold,and the corresponding sensitivity and specificity of each parameter value was determined based on the maximum Jorden index.P < 0.05 differences were statistically significant.Results:1.The APTw values of tumor were statistically analyzed,and the APTw values of the low differentiation group(3.65 ± 0.20)% were higher than those of the intermediate/high differentiation group(3.40 ± 0.23)%,and the difference was statistically significant(P < 0.05).The results of ROC curve analysis showed that the AUC of APTw value in the diagnosis of low,intermediate/high differentiation of cervical cancer was 0.802,and the sensitivity and specificity were 83.30% and77.40%,respectively.There were no significant differences in the clinical data(age,menopausal status,WBC,RBC,PLT and ALP)between the low differentiation and intermediate/high differentiation groups(P > 0.05).2.Independent sample t-test analysis of tumor APTw values and paracancerous tissue APTw values showed that tumor APTw values were higher in the PMI group(3.80 ± 0.33)% than in the Non-PMI group(3.43 ± 0.28)%,with a statistically significant difference(P<0.001).The APTw value of paracancerous tissue was higher in the PMI group(2.73 ± 0.09)% than in the Non-PMI group(2.13 ± 0.40)%,and the difference was statistically significant(P<0.001).the differences in clinical data(age,menopausal status,WBC,RBC,PLT and ALP)between the PMI and Non-PMI groups were not statistically significant,except for WBC statistically significant(P>0.05).3.According to the pathological results,PMI was present in 18 of 75 patients(24%);among the 18 patients with PMI,MRI plain + enhanced diagnosed PMI in 14 of them.the ROC curve analysis showed that the area under the curve(AUC)for MRI plain + enhanced diagnosis of PMI was 0.889,with an accuracy of 89.33%,sensitivity of 77.78%,and the specificity was 92.98%.In contrast,the AUC of tumor APTw values to diagnose PMI was 0.816,with sensitivity and specificity of 83.30% and70.02%,respectively;the AUC of paracancerous tissue APTw values to diagnose PMI was 0.856,with sensitivity and specificity of 100.00% and 82.50%,respectively;compared with tumor APTw values and paracancerous tissue APTw value alone to predict PMI,tumor The AUC of combined paracancerous tissue APTw value for PMI diagnosis increased to 0.920,the sensitivity remained 100%(P=0.000),and the specificity was 77.20%.In contrast,the AUC increased to 0.990,the sensitivity remained at 100.00%,and the specificity increased to 91.20%(P=0.000)when combining tumor APTw value,paracancerous tissue APTw value,and conventional MRI plain + enhanced to diagnose PMI.Conclusion:Amide proton transfer-weighted imaging(APTw)can effectively evaluate the grade and PMI of cervical cancer,and provide important imaging information for preoperative prediction of cervical cancer grade and PMI,and then assist clinical decision-making.