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Value of integrated PET-IVIM MRI in predicting lymphovascular space invasion in cervical cancer without lymphatic metastasis

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Abstract

Purpose

To evaluate the contributory value of positron emission tomography (PET)-intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in the prediction of lymphovascular space invasion (LVSI) in patients with cervical cancer without lymphatic metastasis.

Materials and methods

A total of 90 patients with cervical cancer without signs of lymph node metastasis on PET/MRI were enrolled in this study. The tumours were classified into LVSI-positive (n = 25) and LVSI-negative (n = 65) groups according to postoperative pathology. The PET-derived parameters (SUVmax, SUVmean, metabolic tumour volume (MTV) and total lesion glycolysis (TLG)) and IVIM-derived parameters (ADCmean, ADCmin, Dmean, Dmin, f, D* and gross tumour volume (GTV)) between the two groups were evaluated using a Student’s t test (Mann-Whitney U test for variables with a nonnormal distribution) and receiver operating characteristic (ROC) curves. The optimal combination of PET/MR parameters for predicting LVSI was investigated using univariate and multivariate logistic regression models and evaluated by ROC curves. The optimal cutoff threshold values corresponded to the maximal values of the Youden index. A control model was established using 1000 bootstrapped samples, for which the performance was validated using calibration curves and ROC curves.

Results

PET-derived parameters (SUVmax, SUVmean, MTV, TLG) and IVIM MRI-derived parameters (Dmin, ADCmin, GTV) were significantly different between patients with and without LVSI (P < 0.05). Logistic analyses showed that a combination of TLG and Dmin had the strongest predictive value for LVSI diagnosis (area under the curve (AUC), 0.861; sensitivity, 80.00; specificity, 86.15; P < 0.001). The optimal cutoff threshold values for Dmin and TLG were 0.58 × 10−3 mm2/s and 66.68 g/cm3, respectively. The verification model showed the combination of TLG and Dmin had the strongest predictive value, and its ROC curve and calibration curve showed good accuracy (AUC, 0.878) and consistency.

Conclusions

The combination of TLG and Dmin may be the best indicator for predicting LVSI in cervical cancer without lymphatic metastasis.

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Data availability

The datasets used and analysed of the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank the native English-speaking scientists of BioMed Proofreading Company and Springer Nature Proofreading Company for editing our manuscript.

Funding

This study was funded by the LIAONING Science & Technology Project (2017225012), LIAONING Science Natural Science Foundation (2019-MS-373) and 345 Talent Project.

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Authors and Affiliations

  1. Department of Radiology, Shengjing Hospital of China Medical University, 36# Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China

    Chen Xu, Yang Yu, Xiaoran Li & Hongzan Sun

  2. Liaoning Provincial Key Laboratory of Medical Imaging, 36# Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China

    Chen Xu & Hongzan Sun

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Contributions

Conceptualisation: Chen Xu, Hongzan Sun; methodology: Chen Xu, Xiaoran Li; formal analysis: Chen Xu; investigation: Yang Yu; resources: Chen Xu, Hongzan Sun; data curation: Chen Xu; writing-original draft preparation: Chen Xu; writing - review and editing: Chen Xu; supervision: Hongzan Sun; project administration: Hongzan Sun; and funding acquisition: Hongzan Sun. All authors read and approved the final manuscript.

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Correspondence to Hongzan Sun.

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The present study was approved by the Shengjing Hospital of China Medical University Technology ethics committees.

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This article is part of the Topical Collection on Oncology – Genitourinary

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Xu, C., Yu, Y., Li, X. et al. Value of integrated PET-IVIM MRI in predicting lymphovascular space invasion in cervical cancer without lymphatic metastasis. Eur J Nucl Med Mol Imaging 48, 2990–3000 (2021). https://doi.org/10.1007/s00259-021-05208-3

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