Parameters of simultaneous 18F-FDG-PET/MRI predict tumor stage and several histopathological features in uterine cervical cancer

Abstract

The purpose of this study was to analyze associations between apparent diffusion coefficient (ADC) and standardized uptake values (SUV) values and different histopathological parameters in uterine cervical cancer. 21 patients with primary uterine cervical cancer were involved into the study. All patients underwent a whole body simultaneous18F-FDG PET/MRI. Mean and maximum SUV were noted (SUVmean and SUVmax). In all tumors minimal, mean, and maximal ADC values (ADCmin, ADCmean, and ADCmax) were estimated. Combined parameters were calculated: SUVmax/SUVmean, ADCmin/ ADCmean, SUVmax/ADCmin and SUVmax/ADCmean. In all cases the diagnosis was confirmed histopathologically by tumor biopsy. Histological slices were stained by hematoxilin and eosin, MIB 1 monoclonal antibody, and p16. All histopathological images were digitalized and analyzed by using a ImageJ software 1.48v. The following parameters were estimated: cell count, proliferation index KI 67, total and average nucleic areas, epithelial and stromal areas. Spearman's correlation coefficient was used to analyze associations between ADC and SUV values and histological parameters. P values ≤ 0.05 were considered as statistically significant. ADCmin and ADCmin/ ADCmean were statistically significant lower in N positive tumors. KI 67 correlated statistically significant with SUVmax (r = 0.59, p = 0.005), SUVmean (0.45, p = 0.04), ADCmin (r = −0.48, p = 0.03), SUVmax/ADCmin (r = 0.71, p = 0.001), SUVmax/ADCmean (0.75, p = 0.001). SUVmax correlated well with epithelial area (r = 0.71, p = 0.001) and stromal areas (r = −0.71, p = 0.001). SUV values, ADCmin, SUVmax/ADCmin and SUVmax/ADCmean correlated statistically significant with KI 67 and can be used to estimate the proliferation potential of tumors. SUV values correlated strong with epithelial area of tumor reflected metabolic active areas.

Diagnostic Value of FDG PET/MRI in Females With Pelvic Malignancy—A Systematic Review of the Literature

“…Currently, most functional MRI clinical applications as part of hybrid PET/MRI apply DWI, which informs about the water diffusivity in tissues and providing valuable information on tissue cellularity and membrane integrity. Most reports correlating SUV with apparent diffusion coefficient (ADC) are based on fused or hybrid PET/MRI data, focusing on cervical cancer ( 13 , 14 , 16 , 18 , 20 , 21 , 29 , 36 ), and only one study each is about endometrial cancer and uterine cancer each ( 15 , 17 ).…”

“…In a study focusing on uterine cancer, Surov et al found that the combination of SUV and ADC provided the greatest correlation with the proliferation biomarker Ki-67 ( 15 ). Ki-67 correlated significantly with SUVmax ( r = 0.59, p = 0.005) and ADCmin (0.48, p = 0.03).…”

Associations between apparent diffusion coefficient (ADC) and KI 67 in different tumors: a meta-analysis. Part 2: ADCmin

“…There were studies, which showed that ADC min had stronger correlations with KI 67, and can better reflect proliferation potential of malignant lesions [ 7 , 8 ]. However, the reported data were based on small number of investigated tumors/patients.…”

Proving of a Mathematical Model of Cell Calculation Based on Apparent Diffusion Coefficient

“…For this study, we re-analyzed our previous data regarding associations between ADC parameters and histopathological findings [9] , [10] , [11] , [12] , [13] , [14] . Overall, 134 patients with different tumors were acquired for the analysis ( Table 1 ).…”