Abstract

Introduction: Perineural invasion (PNI) is a crucial factor that impacts the prognosis of cervical carcinoma. The utilization of Incoherent Motion Imaging (IVIM) and mDixon-Quant MRI quantitative parameters provides a new approach for evaluating PNI in cervical carcinoma. This study aims to explore the application value of IVIM combined with mDixon-Quant multiparameter imaging in the quantitative assessment of PNI in cervical carcinoma.
Methods: Retrospective analysis was conducted on imaging data from 36 cervical carcinoma patients who were pathologically confirmed at our hospital from July 2019 to May 2023, including 12 patients with PNI(PNI(+)) and 24 patients without PNI(PNI(-)). All patients underwent magnetic resonance imaging (MRI) examination before surgery, which included scanning sequences such as T1WI, T2WI, IVIM, mDixon-Quant, etc. Two independent and blind observers measured the apparent diffusion coefficient (ADC), pure apparent diffusion coefficient (D), pseudo-apparent diffusion coefficient (D*), and perfusion fraction (f) from the IVIM sequence, as well as the fat fraction (FF), R2* value, and T2* value from the mDixon-Quant sequence. The intra-class correlation coefficient (ICC) was used to evaluate interobserver consistency, and the independent samples t-test or Mann-Whitney U test was used to compare parameter differences. The efficacy of parameters to predict PNI status in cervical carcinoma was assessed using receiver operating characteristic (ROC) curves. The Delong test was employed to compare differences among the area under the curves (AUCs).
Results: There was good agreement between the measurements of the two observers (ICC > 0.75). The PNI-positive group exhibited lower values of ADC (0.73±0.13 (×10-³mm²/s)), D (0.57±0.10 (×10-³mm²/s)), f (0.21±0.05), and T2* (48.62±8.95 ms) compared to the PNI-negative group (ADC: 0.93±0.19 (×10-³mm²/s), D: 0.68±0.11 (×10-³mm²/s), f: 0.29±0.10, T2*: 58.88±8.90 ms). The R2* value (23.13±4.10 /s) in the PNI-positive group was higher than in the PNI-negative group (18.84±3.05 /s). These differences were statistically significant (P < 0.05). There were no statistically significant differences in D2* value and FF value between the two groups (P > 0.05).The AUCs of ADC value, D value, f value, T2*value, R2*value and the combined parameters for evaluating the PNI status of cervical carcinoma were 0.800,0.736,0.743,0.809,0.795and0.882,respectively.All differences among the AUCs were statistically significant.
Conclusions: Both IVIM and mDixon-Quant multiparameter imaging can quantitatively evaluate PNI in cervical carcinoma. The combination of the two significantly improves prediction performance and holds strong clinical application prospects.

Acknowledgements

We thank all the healthcare workers who fight against cervical carcinoma. We would like to thank my teacher and my team.