Non-invasive Differentiation of Endometrial Adenocarcinoma from Benign Lesions in the Uterus by Utilization of Amide Proton Transfer-Weighted MRI

Purpose To evaluate the utility of three-dimensional (3D) amide proton transfer-weighted (APTw) imaging for differentiation of endometrial adenocarcinoma and uterine benign lesions. Procedures This prospective study enrolled 22 normal volunteers and 113 patients with suspicious uterine lesions, including endometrial adenocarcinoma, leiomyoma, and adenomyosis. Pelvic APTw MRI was performed on a 3-T MRI scanner with default APTw parameters. Two radiologists blindly evaluated uterine lesion APTw image quality by a 3-point Likert scale and independently measured APTw values on images with excellent to good image quality. Inter-reader agreement was evaluated. The Mann-Whitney U test with Bonferroni correction was used to compare the differences among different types of uterine lesions. A receiver operating characteristic analysis was performed.

A total of 111 lesions (33 endometrial adenocarcinoma, 26 leiomyoma, and 52 adenomyosis lesions) from 99 patients revealing a majority of good quality with excellent inter-reader agreement were included for the image quality evaluation. APTw values of endometrial adenocarcinoma were 2.9 ± 0.1 %, significantly higher than those of leiomyoma (1.9 ± 0.1 %), adenomyosis (2.2 ± 0.1 %), and normal uterine myometrium (1.9 ± 0.1 %) (all p < 0.0001). The area under the receiver operating characteristic curve for differentiating endometrial adenocarcinoma from leiomyoma, adenomyosis, and myometrium was 0.87, 0.85, and 0.91, respectively. Feasible threshold APTw values of each group were determined as 2.4 %, 2.7 %, and 2.4 % with a sensitivity of 83.3 %, 76.7 %, and 83.3 % and a specificity of 83.3 %, 81.6 %, and 86.4 %, respectively.

Malignant endometrial adenocarcinoma had significantly higher APTw values than leiomyoma, adenomyosis, and normal uterine myometrium. Our study adds to the growing body of validation on 3D APTw imaging and uterine lesions. Similar content being viewed by others Abbreviations - MRI: - Magnetic resonance imaging - APTw: - Amide proton transfer-weighted - CEST: - Chemical exchange saturation transfer - 2D: - Two-dimensional - 3D: - Three-dimensional - TSE: - Turbo spin-echo - MTR: - Magnetization transfer ratio - RF: - Radiofrequency - SAR: - Specific absorption rate - DWI: - Diffusion-weighted imaging - DCE: - Dynamic contrast material-enhanced - ROI: - Region of interest - ICC: - Inter-class correlation coefficient - ROC: - Receiver operating characteristic - AUC: - Area under the curve

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Nat Med 9:1085–1090 Acknowledgments This work was supported by grants from the Natural Science Foundation of China (grant no. 81901829) and the Fundamental Research Funds for the Central Universities (grant no. 3332019032). Author information Authors and Affiliations Contributions 1. Guarantor of the integrity of the entire study: Yuan Li, Cheng-Yu Lin, Yong-Lan He, Hua-Dan Xue, and Zheng-Yu Jin 2. Study concepts and design: Yong-Lan He, Hua-Dan Xue, Zheng-Yu Jin, and Yang Xiang 3. Literature research: Yuan Li, Yong-Lan He, and Cheng-Yu Lin 4. Clinical studies: Yuan Li, Jun-Jun Yang, Chen Bo, Cheng-Yu Lin, and Ya-Fei Qi 5. Experimental studies/data analysis: Yuan Li, Yong-Lan He, Cheng-Yu Lin, Ya-Fei Qi, Xiao-Qi Wang, and Hai-Long Zhou 6. Statistical analysis: Yong-Lan He, Cheng-Yu Lin, and Yuan Li 7. Manuscript preparation: Yuan Li, Yong-Lan He, and Xiao-Qi Wang 8. Manuscript editing: Yong-Lan He, Yuan Li, Xiao-Qi Wang, Jing Ren, Yang Xiang, Cheng-Yu Lin, and Hua-Dan Xue Corresponding authors Ethics declarations Conflict of Interest Author Xiao-Qi Wang is an employee of Philips Healthcare China. The other authors have no conflicts of interest to disclose. The authors not employed by Philips were in control of this study. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Keypoints • Uterine three-dimensional turbo spin-echo APTw MR images revealed good quality in most cases. • Endometrial adenocarcinoma showed significantly higher APT-weighted values than leiomyoma, adenomyosis, and normal myometrium. • No significant differences were found among APT-weighted values of uterine benign lesions and normal myometrium. Supplementary Information ESM 1 (download DOCX ) (DOCX 15 kb) Rights and permissions About this article Cite this article Li, Y., Lin, CY., Qi, YF. et al. Non-invasive Differentiation of Endometrial Adenocarcinoma from Benign Lesions in the Uterus by Utilization of Amide Proton Transfer-Weighted MRI. Mol Imaging Biol 23, 446–455 (2021). https://doi.org/10.1007/s11307-020-01565-x Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11307-020-01565-x