The Relationship Between DKI And Pathological Features Of Cervical Cancer:A Preliminary Study

Objective To evaluate and contrast diffusion-weighted imaging(DWI) and diffusion kurtosis imaging(DKI) in differentiating cervical pathological type and degree of differentiation.Methods Collecting 39 patients diagnosed with carcinoma of uterine cervix according to surgery or biopsy. In the 39 patients, 31 are diagnosed with cervical squamous cell cancer,including 7 high differentiation cervical squamous cell cancer, 19 medium differentiation cervical squamous cell cancer and 7 low differentiation cervical squamous cell cancer, and the remaining 8patients were diagnosed with cervical adenocarcinoma. Everyone underwent cervical magnetic resonance imaging(MRI) examination before treatment, the sequence includes conventional axial T1-weighted image(T1 weighted imaging, TIWI), axial T2-weighted images(T2 weighted imaging, T2WI), sagittal T2-weighted images(T2WI), coronal T2-weighted images(T2WI), axial DWI(b=0s/mm2, 800s/mm2) and DKI(b=0s/mm2, 500s/mm2, 1000s/mm2, 1500s/mm2, 2000s/mm2,30 uniform distribution different directions for the diffusion sensitizing gradients.).Values for apparent diffusion coefficient(ADC), mean kurtosis(MK) and mean diffusivity(MD) were calculated and compared by pathological type and degree of differentiation after processing the collected raw image. Compared value of ADC, MK and MD of cervical squamous cell cancer, cervical adenocarcinoma and high, medium and low differentiation cervical squamous cell cancer. Evaluate the discriminability of ADC, MK and MD in cervical squamous cell cancer,cervical adenocarcinoma and high, medium and low differentiation cervical squamous cell cancer by Receiver operating characteristics(ROC) curves, then seek out the optimal threshold value.Results 1. Application of DWI and DKI in differentiating cervical pathological typeThe values of ADC in cervical squamous cell carcinoma is(0.82±0.08)×10-3mm2/s, and in adenocarcinoma it is(0.99±0.10)×10-3mm2/s; The values of MK in cervical squamous cell carcinoma is 0.71±0.11, and in adenocarcinoma it is 0.50±0.06; The values of MD in cervical squamous cell carcinoma is(1.71±0.12)×10-3mm2/s, and in adenocarcinoma it is(1.95±0.09)×10-3mm2/s. The values of ADC, MD were lower in cervical squamous cell carcinoma contrast to those in adenocarcinoma(P<0.001), but the values of MK in cervical squamous cell carcinoma were higher contrast to those in adenocarcinoma(P<0.001). When differentiatingcervical squamous cell carcinoma from cervical adenocarcinoma, value of MK posses a biggest AUC(0.968)(P<0.001), follows MD(0.940, P<0.001) and ADC(0.915, P<0.001). When regard MK=0.53, MD=1.84×10-3mm2/s, ADC=0.89×10-3mm2/s as threshold value of differentiating cervical squamous cell carcinoma from cervical adenocarcinoma, the yuoden index were MK(0.843), MD(0.714) and ADC(0.681), the sensitivity and specificity were MK(87.5%, 96.8%),MD(87.5%, 83.9 %) and ADC(87.5%, 80.6%) seperated.2. Application of DWI and DKI in differentiating degree of differentiation of cervical squamous cell carcinomaIn different differentiated degree differentiation cervical squamous cell carcinoma, the values of ADC in high differentiated squamous cell carcinoma is(0.91±0.08)×10-3mm2/s, in medium differentiated squamous cell carcinoma is(0.81±0.06)×10-3mm2/s and in low differentiated squamous cell carcinoma is(0.73±0.05)×10-3mm2/s, the values of ADC between any differentiated degree differentiation cervical squamous cell carcinoma has obvious difference(P<0.001); the values of MK in high differentiated squamous cell carcinoma is 0.58±0.06, in medium differentiated squamous cell carcinoma is 0.73±0.07 and in low differentiated squamous cell carcinoma is 0.84±0.07, the values of MK between any differentiated degree differentiation cervical squamous cell carcinoma has obvious difference(P<0.001); the values of MD in high differentiated squamous cell carcinoma is(1.84±0.08)×10-3mm2/s, in medium differentiated squamous cell carcinoma is(1.70±0.10)×10-3mm2/s and in low differentiated squamous cell carcinoma is(1.57±0.06)×10-3mm2/s, the values of MD between any differentiated degree differentiation cervical squamous cell carcinoma has obvious difference(P<0.001). When differentiating poorly from medium differentiated squamous cell carcinoma, the value of MK had best ability with a largest AUC(0.905)(P=0.003), follows MD(AUC=0.884, P=0.009) and ADC(AUC=0.853, P=0.012), When regard MK=0.82, MD=1.64×10-3mm2/s,ADC=0.76×10-3mm2/s as threshold value of differentiating poorly from medium differentiated squamous cell carcinoma, the yuoden index were MK(0.747), MD(0.737) and ADC(0.589), the sensitivity and specificity were MK(80.0%, 94.7%), MD(100%, 73.7%) and ADC(80%,78.9%)seperated; besides, MK also had a largest AUC(0.940)(P<0.001) on differentiating medium from high differentiated squamous cell carcinoma, follows MD(AUC=0.887,P=0.002) and ADC(AUC=0.842, P=0.003), When regard MK=0.65, MD=1.84×10-3mm2/s,ADC=0.84×10-3mm2/s as threshold value of differentiating high from medium differentiated squamous cell carcinoma, the yuoden index were MK(0.752), MD(0.594) and ADC(0.541), the sensitivity and specificity were MK(85.7%, 89.5%), MD(85.7%, 73.7%) and ADC(85.7%, 68.4%)seperated. ADC and MD are negatively correlated with the degree of differentiation of cervicalsquamous cell carcinoma, MK is positively correlated with the degree of differentiation of cervical squamous cell carcinoma.Conclusion1. DKI is better than DWI on discriminating cervical carcinoma pathological type and degree of differentiation of cervical squamous carcinoma.2. On discriminating cervical carcinoma pathological type, the ability of MK and MD was superior to that of ADC, and MK has the best ability of differentiation of cervical squamous cell carcinoma and adenocarcinoma.3. On discriminating cervical squamous cell carcinoma degree of differentiation, the ability of MK and MD was superior to that of ADC, and MK has the best ability of differentiation of high,medium and low differentiated subtypes of cervical squamous cell carcinoma, besides, MK is positively correlated with the degree of differentiation of cervical squamous cell carcinoma, ADC and MD are negatively correlated with the degree of differentiation of cervical squamous cell carcinoma.