The value of amide proton transfer imaging in predicting parametrial invasion and lymph-vascular space invasion of cervical cancer

Objective: To explore the value of amide proton transfer (APT) imaging in assessing parametrial invasion (PMI) and lymph-vascular space invasion (LVSI) of cervical cancer.

Materials and methods: We retrospectively analyzed the clinical and imaging data of cervical cancer patients diagnosed pathologically at our hospital from January 2021 to June 2024. All patients underwent routine magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and APT imaging before treatment. Apparent diffusion coefficient (ADC) and APT values were measured. Based on the pathological results, patients were categorized into LVSI (+) and LVSI (-) groups, and PMI (+) and PMI (-) groups. Independent sample t-tests were used to compare the ADC and APT values between these groups. Receiver operating characteristic (ROC) curves were used to assess the sensitivity, specificity, and area under the curve (AUC) of ADC, APT, and ADC + APT in predicting PMI and LVSI. The Delong test was employed to compare the diagnostic performance among these measures.

Results: A total of 83 patients were included, with 56 in the LVSI (-) group, 27 in the LVSI (+) group, 35 in the PMI (-) group, and 16 in the PMI (+) group. The ADC values for the LVSI (+) and PMI (+) groups were significantly lower than those for the LVSI (-) and PMI (-) groups (P < 0.01). The APT values for the LVSI (+) and PMI (+) groups were significantly higher than those for the LVSI (-) and PMI (-) groups (P < 0.01). The AUC values for ADC, APT, and the combination of ADC + APT in predicting LVSI were 0.839, 0.788, and 0.880, respectively, and in predicting PMI were 0.770, 0.764, and 0.796, respectively. There were no statistically significant differences in the diagnostic performance of ADC, APT, and ADC + APT in predicting PMI. However, the diagnostic performance of ADC + APT in predicting LVSI was significantly better than that of ADC and APT alone (P < 0.01).

Conclusion: APT imaging can predict LVSI and PMI status in cervical cancer before surgery. When combined with ADC, its diagnostic accuracy for predicting LVSI is higher than that of APT or ADC alone. This suggests a novel approach for assessing LVSI in cervical cancer.