Dynamic contrast-enhanced and diffusion-weighted MRI of cervical carcinoma: Correlations with Ki-67 proliferation status

Abstract

Objectives

To investigate the association of quantitative parameter (apparent diffusion coefficient [ADC]) from diffusion-weighted imaging (DWI) and various quantitative and semiquantitative parameters from dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) with Ki-67 proliferation index (PI) in cervical carcinoma (CC).

Methods

A total of 102 individuals with CC who received 3.0 T MRI examination (DWI and DCE MRI) between October 2016 and December 2022 were enrolled in our investigation. Two radiologists separately assessed the ADC parameter and various quantitative and semiquantitative parameters including (volume transfer constant [K^trans], rate constant [k_ep], extravascular extracellular space volume fraction [v_e], volume fraction of plasma [v_p], time to peak [TTP], maximum concentration [MaxCon], maximal slope [MaxSlope] and area under curve [AUC]) for each tumor. Their association with Ki-67 PI was analyzed by Spearman association analysis. The discrepancy between low-proliferation and high-proliferation groups was subsequently analyzed. The receiver operating characteristic (ROC) curve analysis utilized to identify optimal cut-off points for significant parameters.

Results

Both ADC (ρ = − 0.457, p < 0.001) and K^trans (ρ = − 0.467, p < 0.001) indicated a strong negative association with Ki-67 PI. Ki-67 PI showed positive correlations with TTP, MaxCon, MaxSlope and AUC (ρ = 0.202, 0.231, 0.309, 0.235, respectively; all p values<0.05). Compared with the low-proliferation group, high-Ki-67 group presented a significantly lower ADC (0.869 ± 0.125 × 10⁻³ mm²/s vs. 1.149 ± 0.318 × 10⁻³ mm²/s; p < 0.001) and K^trans (1.314 ± 1.162 min⁻¹vs. 0.391 ± 0.390 min⁻¹; p < 0.001), also significantly higher MaxCon values (0.756 ± 0.959 vs. 0.422 ± 0.341; p < 0.05) and AUC values (2.373 ± 3.012 vs. 1.273 ± 1.000; p < 0.05). The cut-offs of ADC, K^trans, MaxCon and AUC for discrimating low- and high-Ki-67 groups were 0.920 × 10⁻³ mm²/s, 0.304 min⁻¹, 0.209 and 1.918, respectively.

Conclusions

ADC, K^trans, TTP, MaxCon, MaxSlope and AUC are associated with Ki-67 PI. ADC and K^trans exhibited high performance to discriminate low and high Ki-67 status of CC.