The Value of Time-dependent Diffusion MRI and Macromolecular Proton Fraction Imaging in Assessing Pathological Grade in Cervical Cancer.

RATIONALE AND

OBJECTIVES

To investigate the value of time-dependent diffusion MRI (Td-dMRI) and macromolecular proton fraction (MPF) imaging in assessing the pathological grade of cervical cancer (CC).

MATERIALS AND

METHODS

A total of 92 CC patients, comprising 35 with high-grade (grade III) cancer and 57 with low-grade (grade I/II) cancer, who underwent Td-dMRI and MPF, were prospectively enrolled. Td-dMRI derived parameters including cellularity (cell density), diameter (tumor cell size), Dex (extracellular diffusivity), Vin (intracellular volume fraction), and three apparent diffusion coefficients (ADCPGSE, ADC17 Hz, ADC33Hz) and MPF derived parameter MPF (tissue macromolecular) were calculated and compared. Diagnostic performance was assessed via area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and decision curve analysis (DCA); internal validation was performed using 1000 bootstrap resamples to mitigate model optimism. Multiple pairwise AUC comparisons were adjusted using the DeLong test.

RESULTS

Cellularity, Vin, and MPF were higher and diameter, Dex, ADCPGSE, ADC17 Hz, and ADC33 Hz were lower in high-grade group than in low-grade group (all P < 0.05). Cellularity, Vin, and MPF were independent predictors and their combination achieved optimal diagnostic efficacy (AUC = 0.960; 95% CI: 0.897-0.990; sensitivity = 97.14%; specificity = 82.46%), which was significantly higher than any individual parameter (AUC range: 0.685-0.923; all P < 0.05 after Bonferroni correction). Internal validation confirmed stable performance (AUC = 0.955; 95% CI: 0.939-0.960), and DCA demonstrated higher net benefit for patients. Vin strongly correlated with pathological nuclear fraction (r = 0.752, P < 0.001).

CONCLUSION

Td-dMRI and MPF were effective methods of predicting pathological grade in CC, and the combination of cellularity, Vin, and MPF has the potential to serve as a new imaging marker, facilitating preoperative grading and personalized treatment.