Amide proton transfer imaging in differentiation of type II and type I endometrial carcinoma: a pilot study

Ryoya Ochiai,Shinya Sato,Tetsuro Oishi,Shinichiro Kitao,Shinya Fujii,Hiroto Yunaga,Atsushi Nozaki,Naoko Mukuda,Mitsuharu Miyoshi,Kyohei Okuda

doi:10.1007/s11604-021-01197-3

Ryoya Ochiai, Shinya Sato + Show 8 more

Open Access

https://doi.org/10.1007/s11604-021-01197-3

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Journal: Radiation medicine	Publication Date: Sep 15, 2021
Citations: 11	License type: open-access

Affiliation: Tottori University, Tottori University Hospital

Abstract

PurposeThis study aimed at evaluating the efficacy of amide proton transfer (APT) imaging in differentiation of type II and type I uterine endometrial carcinoma.Materials and methodsThirty-three patients diagnosed with uterine endometrial carcinoma, including 24 with type I and 9 with type II carcinomas, underwent APT imaging. Two readers evaluated the magnetization transfer ratio at 3.5 ppm [MTRasym (3.5 ppm)] in each type of carcinoma. The average MTRasym (APTmean) and the maximum MTRasym (APTmax) were analyzed. The receiver operating characteristic (ROC) curve analysis was performed.ResultsThe APTmax was significantly higher in type II carcinomas than in type I carcinomas (reader1, p = 0.004; reader 2, p = 0.014; respectively). However, APTmean showed no significant difference between type I and II carcinomas. Based on the results reported by reader 1, the area under the curve (AUC) pertaining to the APTmax for distinguishing type I from type II carcinomas was 0.826, with a cut-off, sensitivity, and specificity of 9.90%, 66.7%, and 91.3%, respectively. Moreover, based on the results reported by reader 2, the AUC was 0.750, with a cut-off, sensitivity, and specificity of 9.80%, 62.5%, and 87.5%, respectively.ConclusionAPT imaging has the potential to determine the type of endometrial cancer.

Highlights

Endometrial cancer is the most common malignancy of the female reproductive organs in developed countries, including the United States and Europe
The present study demonstrated that type II endometrial carcinoma has a higher APTmax than type I endometrial carcinoma, there were no significant differences between type I and type II carcinomas with regard to the APTmean
Nuclear atypia is another possible factor related to increased amide proton transfer (APT) signals, owing to interactions with hydrophobic cell membranes and macromolecules [22,23,24]

Summary

Introduction

Endometrial cancer is the most common malignancy of the female reproductive organs in developed countries, including the United States and Europe. Type I carcinoma, comprising well or moderately differentiated endometrial carcinoma, accounts for 80–90% of all. The classification of poorly differentiated endometrioid carcinoma as either type varies from report to report [8,9,10,11,12]. The National Comprehensive Cancer Network 2020 Guidelines [13] revealed that the combined use of pelvic and aortic lymphadenectomy may be considered in the management of type II carcinoma, owing to the high frequency of lymph node metastases. The guidelines state that fertility preservation is not recommended, even though the cancer is confined to the uterus in type II carcinoma cases. The preoperative differentiation of type II from type I carcinoma is very important to formulate a surgical treatment plan

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