Cervical cancer evaluated with integrated (18)F-FDG PET/MR

The current study aimed to evaluate the correlation between maximum standardized uptake value (SUV(max)) and minimum apparent diffusion coefficient (ADC(min)) of cervical cancer using an integrated (18)F-fluorodeoxyglucose positron emission tomography/magnetic resonance (PET/MR) imaging system, and to determine the association with pathological prognostic factors. A total of 46 patients were pathologically diagnosed with cervical cancer and underwent PET/MR prior to surgery, including total hysterectomy, bilateral pelvic lymph node dissection or paraaortic lymph node dissection. The imaging biomarkers included the SUV(max) and ADC(min.) The pathological prognostic factors were as follows: Tumor size, histological grade, International Federation of Gynecology and Obstetrics (FIGO) stage and lymph node metastasis. Pearson's correlation analysis was used to evaluate the correlation between imaging biomarkers and the tumor size and the Mann-Whitney U test analysis was used to evaluate the association between imaging biomarkers and pathological factors. The mean SUV(max) was 11.1±8.7 (range, 3.16–51.6) and the mean ADC(min) was 0.76±0.15×10(−3) mm(2)/s (range, 0.47–1.04×10(−3) mm(2)/s). The SUV(max) had a significant negative correlation with the ADC(min) (r=−0.700; P<0.001). The SUV(max) was significantly increased in patients with poorly differentiated tumors (P=0.001), patients with FIGO stage IIB (P=0.005) and the patients with lymph node metastasis (P=0.040). The ADC(min) was significantly decreased in patients with poorly differentiated tumors (P<0.001) and patients with FIGO stage IIB (P=0.017). Statistical analysis revealed no significant correlation between the tumor size and the SUV(max) (r=0.286;P=0.054), or between the tumor size and the ADC(min) (r=−0.231; P=0.122). Area under the curve (AUC) analysis revealed that SUV(max) had a higher diagnostic value for lymph node metastasis (AUC=0.681) and FIGO staging (AUC=0.837) compared with ADC(min), whereas ADC(min) had a higher diagnostic value for the grade of pathological differentiation (AUC=0.816) compared with SUV(max) (AUC=0.788). The results of the current study demonstrated that there was a significant negative correlation between SUV(max) and ADC(min), which were associated with prognostic factors.