INTRODUCTION

Cervical cancer is the fourth most common malignant tumor among women in the world, and one of the important factors affecting the prognosis of patients with cervical cancer is lymph node metastasis (LNM). According to the literature, the 5-year survival rate of early cervical cancer patients with LNM positive is only about 65%, which is significantly lower than that of patients with LNM negative. Therefore, it is of great significance to accurately evaluate the lymph node status before operation. Amide proton transfer-weighted imaging (APTw), as a quantitative imaging technique, can detect the contents of protein and polypeptide in diseased tissues, which has certain value for differential diagnosis of diseases. Magic mirror imaging (mDixon-Quant) sequence is a quantitative technique for separating water and fat, which has been applied to the related research of quantitative evaluation of fat content, such as the quantitative study of liver fat content and the study of lumbar vertebral body fat content. As far as we know, there is no previous report on the use of quantitative parameters of mDixon-Quant and APT to evaluate the lymph node metastasis status of cervical cancer. Based on APT and mDixon-Quant multi-parameter imaging, this study aims to evaluate the lymph node metastasis status of cervical cancer.

Materials and methods

75 cases of cervical cancer confirmed by surgery and pathology from July 2019 to May 2023 were retrospectively analyzed, including 17 cases with lymph node metastasis(LM) and 58 cases with non-lymph node metastasis(NLM). MDIXON-Quant examination was performed before operation; The APT , R2* and T2* values were measured by doctors with two years experience in imaging diagnosis. Kolmogorov-Smirnov test was used to test the normality of the data, and independent sample T test or Mann-Whitney U test was used to compare the differences between the two groups. Logistic regression was used to calculate the predicted values of APTw and mDixon-Quant series joint parameter models. The diagnostic efficacy of different parameters alone or in combination was evaluated by receiver's operating characteristic (ROC) curve.

Result

The APT value and T2* value in lymph node metastasis group (3.64% ±0.41%, 52.13(42.38,63.05)ms) were higher than those in non-lymph node metastasis group (2.57%±0.54%, 40.94(33.16,52.35)ms), and the difference was statistically significant (t=7.495, -3.05,P <0.001,P=0.002)The R2* value of lymph node metastasis group (20.74HZ±4.70HZ) was lower than that of non-lymph node metastasis group (26.91HZ±7.63HZ), and the difference was statistically significant (t/z=-4.068, P <0.001). There was no statistical difference in FF between lymph node metastasis group and non-lymph node metastasis group (z=-0.886, P=0.376). The AUC values of APT, R2* and T2* were 0.938, 0.258 and 0.744 respectively.

APT is based on the existence of saturated transfer effect of chemical exchange between free water and protein and peptides, which can detect rich amide proton components in tumors, and the results are influenced by protein concentration and pH value. APT has shown strong performance in the evaluation of cerebral ischemia, brain tumor, breast cancer and cervical cancer, and neurodegenerative diseases. At present, APT has not been used to evaluate lymph node metastasis of cervical cancer. The results show that the APT value of lymph node metastasis group is higher than that of non-bone metastasis group, which may be due to the increase of tumor malignancy and tumor proliferation rate in lymph node metastasis group, which leads to the increase of protein and polypeptide content in tumor cells and the enhancement of chemical exchange saturation transfer effect, thus making the APT value of lymph node metastasis group higher than that of non-lymph node metastasis group.

Acknowledgements

No acknowledgement found.