Amide proton transfer weighted imaging combined with dynamic contrast-enhanced MRI in predicting lymphovascular space invasion and deep stromal invasion of IB1-IIA1 cervical cancer

OBJECTIVES: To investigate the value of amide proton transfer weighted (APTw) imaging combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting intermediate-risk factors of deep stromal invasion (DSI) and lymphovascular vascular space invasion (LVSI) in cervical cancer. METHODS: Seventy patients with cervical cancer who underwent MRI before operation from July 2019 to February 2022 were retrospectively included in this study. Clinical information including age, histologic subtype etc. were recorded for patients. ATPw imaging parameter APT(mean) and DCE-MRI parameters K(trans), K(ep) and V(e) were measured and analyzed. The independent-sample t-test, Mann-Whitney U test, or Chi-square test was used to compare the differences of parameters between DSI/LVSI positive and negative groups. Logistic analysis was used to develop a combined predictive model. The receiver operating characteristic curve was for predictive performance. ANOVA and Kruskal-Wallis test were used to compare the differences of consecutive parameters among multiple groups. RESULTS: K(trans) and SCC-Ag were independent factors in predicting DSI; K(trans)+SCC-Ag had the highest AUC 0.819 with sensitivity and specificity of 71.74% and 91.67%, respectively. APT(mean) and K(trans) were independent factors in predicting LVSI; APT(mean)+K(trans) had the highest AUC 0.874 with sensitivity and specificity of 92.86% and 75.00%, respectively. K(trans) and Ve could discriminate coexistence of DSI and LVSI from presence of single one, APT(mean) could discriminate the presence of DSI or LVSI from no risk factor presence. CONCLUSION: The combination of APTw and DCE-MRI is valuable in predicting intermediate-risk factors of DSI and LVSI in cervical cancer.