Using amide proton transfer-weighted MRI to non-invasively differentiate mismatch repair deficient and proficient tumors in endometrioid endometrial adenocarcinoma

Abstract

Objectives To investigate the utility of three-dimensional (3D) amide proton transfer-weighted (APTw) imaging to differentiate mismatch repair deficient (dMMR) and mismatch repair proficient (pMMR) tumors in endometrioid endometrial adenocarcinoma (EEA). Methods Forty-nine patients with EEA underwent T1-weighted imaging, T2-weighted imaging, 3D APTw imaging, and diffusion-weighted imaging at 3 T MRI. Image quality and measurement confidence of APTw images were evaluated on a 5-point Likert scale. APTw and apparent diffusion coefficient (ADC) values were calculated and compared between the dMMR and pMMR groups and among the three EEA histologic grades based on the Federation of Gynecology and Obstetrics (FIGO) grading system criteria. Student’s t-test, analysis of variance with Scheffe post hoc test, and receiver operating characteristic analysis were performed. Statistical significance was set at p < 0.05. Results Thirty-five EEA patients (9 with dMMR tumors and 26 with pMMR tumors) with good image quality were enrolled in quantitative analysis. APTw values were significantly higher in the dMMR group than in the pMMR group (3.2 ± 0.3% and 2.8 ± 0.5%, respectively; p = 0.019). ADC values of the dMMR and pMMR groups were 0.874 ± 0.104 × 10−3 mm2/s and 0.903 ± 0.100 × 10−3 mm2/s, respectively. No significant between-group difference was noted (p = 0.476). No statistically significant differences were observed in APTw values or ADC values among the three histologic grades (p = 0.766 and p = 0.295, respectively). Conclusions APTw values may be used as potential imaging markers to differentiate dMMR from pMMR tumors in EEA.

Multimodal MRI for Estimating Her-2 Gene Expression in Endometrial Cancer

“…In previous studies, Tian et al [7] have demonstrated the value of APTw in differentiating stage IA endometrial cancer from endometrial polyps with a diagnostic efficacy of 0.850. In addition, several studies have shown [27][28][29][30] that APTw is valuable for differentiating benign and malignant endometrial disease, assessing Ki-67 expression, preoperative risk assessment, and evaluating microsatellite instability status.…”

Effects of Breathing Patterns on Amide Proton Transfer MRI in the Kidney: A Preliminary Comparative Study in Healthy Volunteers and Patients With Tumors

“…Respiratory motion artifact is one of the crucial factors affecting the quality of abdominal MRIs. [10][11][12] In the current exploration stage of the abdominal application of APTw imaging, a few studies promoted the development of technology. Seo et al 10 demonstrated a success rate of 66% for the 3D-APTw imaging of the liver with an ICC of 0.76 (95% CI, 0.63-0.85).…”

“…Respiratory motion artifact is one of the crucial factors affecting the quality of abdominal MRIs 10–12 . In the current exploration stage of the abdominal application of APTw imaging, a few studies promoted the development of technology.…”

“…[3][4][5][6][7][8] APTw imaging is still exploratory and challenging for the abdominal organs for various reasons, such as respiratory motion and magnetic field inhomogeneity. 2,[9][10][11] Although APTw imaging exhibits high reproducibility in pelvic structures such as the uterus and prostate tumors, [12][13][14] which is likely due to their limited movement, its application to upper and middle abdominal organs remains challenging. 10,15 Animal and human studies have demonstrated that the diagnostic efficacy of APTw imaging for kidney injuries and tumors is superior to that of conventional quantitative MR techniques 9,16,17 and has clinical potential.…”

“…Given that the renal movement during free breathing (FB) can range from 2.5 to 20.5 mm, 18 employing respiratory compensation techniques becomes crucial to reduce motion artifacts and improve image quality and accuracy. 2,[10][11][12] Breath-hold, respiratory triggering, and diaphragmatic navigation are effective methods used to control the breathing motion effect. [19][20][21] However, APTw imaging can still be difficult when combined with these breathing methods; therefore, the technologies using these methods are being explored.…”