Diagnosis of Cervical Cancer With Parametrial Invasion on Whole-Tumor Dynamic Contrast-Enhanced Magnetic Resonance Imaging Combined With Whole-Lesion Texture Analysis Based on T2- Weighted Images.

Xin-Xiang Li,Ting-Ting Lin,Wei Wei,Bin Liu

doi:10.3389/fbioe.2020.00590

Abstract

Purpose: To evaluate the diagnostic value of the combination of whole-tumor dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and whole-lesion texture features based on T2–weighted images for cervical cancer with parametrial invasion.Materials and Methods: Sixty-two patients with cervical cancer (27 with parametrial invasion and 35 without invasion) preoperatively underwent routine MRI and DCE-MRI examinations. DCE-MRI parameters (Ktrans, Kep, and Ve) and texture features (mean, skewness, kurtosis, uniformity, energy, and entropy) based on T2-weighted images were acquired by two observers. All parameters of parametrial invasion and non-invasion were analyzed by one-way analysis of variance. The diagnostic efficiency of significant variables was assessed using receiver operating characteristic analysis.Results: The invasion group of cervical cancer demonstrated significantly higher Ktrans (0.335 ± 0.050 vs. 0.269 ± 0.079; p < 0.001), lower energy values (0.503 ± 0.093 vs. 0.602 ± 0.087; p < 0.001), and higher entropy values (1.391 ± 0.193 vs. 1.24 ± 0.129; p < 0.001) than those in the non-invasion group. Optimal diagnostic performance [area under curve [AUC], 0.925; sensitivity, 0.935; specificity, 0.829] could be obtained by the combination of Ktrans, energy, and entropy values. The AUC values of Ktrans (0.788), energy (0.761), entropy (0.749), the combination of Ktrans and energy (0.814), the combination of Ktrans and entropy (0.727), and the combination of energy and entropy (0.619) were lower than those of the combination of Ktrans, energy, and entropy values.Conclusion: The combination of DCE-MRI and texture analysis is a promising method for diagnosis cervical cancer with parametrial infiltration. Moreover, the combination of Ktrans, energy, and entropy is more valuable than any one alone, especially in improving diagnostic sensitivity.

Highlights

Cervical cancer is one of the most common malignant diseases of the female reproductive system, and it seriously threatens women’s health and life
Excellent intra- and interobserver agreements were found in the measurements of DCE-MRI and texture features metrics (Table 1)
Metrics derived from DCE-MRI and texture features were compared between the invasion group and the non-invasion group and are summarized in Table 1 and Figures 1, 2

Summary

Introduction

Cervical cancer is one of the most common malignant diseases of the female reproductive system, and it seriously threatens women’s health and life. Accurate preoperative staging of cervical cancer plays an important role in clinical treatment decisions and prognosis. As a matter of principle, surgery is performed for cervical cancer without parametrial involvement, while tumors with parametrial invasion are treated with radio-chemotherapy. To the best of our knowledge, cervical cancer with parametrial invasion is closely related to recurrence and survival after treatment (Chung et al, 2010; Munagala et al, 2010; Noh et al, 2014; Kong et al, 2016; Xia et al, 2016; Dai et al, 2018). Accurate diagnosis of cervical cancer with parametrial invasion is of great clinical significance. Parametrial invasion is usually evaluated by conventional magnetic resonance (MR) imaging and gynecological examination. An objective and quantitative method for evaluating parametrial infiltration in clinical practice is needed

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