Synthetic high b-value FOCUS-MUSE diffusion-weighted imaging in identifying early-stage cervical cancer

Abstract Background Early diagnosis of cervical cancer based on FIGO stage is essential for treatment strategies, we aimed to explore the classifying ability of synthetic high-b-value FOCUS-MUSE DWI in cervical cancer FIGO stage including image quality and diagnostic efficiency. Methods 55 patients with cervical cancer and 33 volunteers were prospectively recruited. All patients and volunteers underwent three DWI sequences (FOCUS-MUSE DWI with a 13b protocol: b = 0, 25, 50, 75, 100, 150, 200, 400, 600, 800, 1000, 1200, 1500s/mm2 and 5b protocol: b = 0, 100, 400, 800, 1500s/mm2, the FOCUS DWI with the same 5b protocol. Two experienced radiologists conducted subjective and objective evaluation on 5 sets of images (sFOCUS-MUSE DWIb=800, sFOCUS-MUSE DWIb=1500, syFOCUS-MUSE DWI13b,1500, syFOCUS-MUSE DWI5b,1500, syFOCUS DWI5b,1500) and also measured ADC values. Paired T-test or Wilcoxon signed rank test were used to compare image quality and ADC values, and ROC curve was used to analyze diagnostic efficiency. Results The high-b-value syFOCUS-MUSE DWI5b/13b,1500 had higher subjective and objective image quality than sFOCUS-MUSE DWIb=1500 (P < 0.05). Compared with syFOCUS DWI5b,1500 and sFOCUS-MUSE DWIb=800, syFOCUS-MUSE DWI5b,1500 had better overall image quality and lesion conspicuity (P < 0.05). syFOCUS-MUSE DWI5b,1500 derived syADCmean, syADCmaximum and syADCminimum had equivalent AUCs to those using sFOCUS-MUSEb=800 and sFOCUS-MUSEb=1500, but superior to those using syFOCUS5b,1500. Conclusions On 3.0T MR scanner, syFOCUS-MUSE DWI provided higher overall image quality and lesion clarity than sFOCUS-MUSE DWI and syFOCUS DWI. 5b-protocol synthetic high-b-value FOCUS–MUSE DWI greatly shortened the scan time and histogram-derived syADC values (syADCmean, syADCmaximum, syADCminimum) offered more reliable diagnostic performance on cervical cancer with different FIGO stage than those of sFOCUS-MUSE and syFOCUS.