Wang Fang, Wang Yafei, Ran Chenjiao, Liang Jing, Qi Lisha, Zhang Chen, Ye Zhaoxiang
Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Xuzhou Maternity and Child Health Care Hospital, Xvzhou, China.
Abdom Radiol (NY). 2025 Jun;50(6):2720-2731. doi: 10.1007/s00261-024-04720-y. Epub 2024 Dec 6.
Detecting microsatellite instability (MSI) plays a key role in the management of endometrial cancer (EC), as it is a critical predictive biomarker for Lynch syndrome or immunotherapy response. A pressing need exists for cost-efficient, broadly accessible tools to aid patient for universal testing. Herein, we investigate the value of ZOOMit diffusion kurtosis imaging (DKI) and diffusion weighted imaging (DWI) based on preoperative pelvic magnetic resonance imaging (MRI) images in assessing MSI in EC.
Preoperative MRI examination including ZOOMit DKI and DWI of 81 EC patients were retrospectively analyzed. The apparent diffusion coefficient (ADC), mean kurtosis (MK), mean diffusivity (MD) and the largest tumor size based on MRI images, as well as patients' clinicopathological features were compared and analyzed according to different microsatellite statuses.
Of the 81 patients, 59 (72.8%) who were microsatellite stability (MSS) and 22 (27.2%) who were MSI. Interobserver agreement for the quantitative parameter measurements was excellent (ICC 0.78-0.98). The ADC and MD values were significantly lower, while Ki-67 proliferation level and MK values were significantly higher in the MSI group compared to those of the MSS group. The parameters of MD and MK were independent predictors for determining MSI, and their combination showed better diagnostic efficacy with an area under the receiver operating characteristic curve (AUROC) of 0.860 (95% confidence interval, 0.765, 0.927), although there was no significant difference compared to each individual parameter.
The microstructural heterogeneity assessment of ZOOMit DKI allowed for characterizing MSI status in EC. Within the current universal MSI testing paradigm, DKI may provide added value as a potential noninvasive imaging biomarker for preoperative assessment of MSI tumors, thereby facilitating clinical decision-making.
检测微卫星不稳定性（MSI）在子宫内膜癌（EC）的管理中起着关键作用，因为它是林奇综合征或免疫治疗反应的关键预测生物标志物。迫切需要经济高效、广泛可用的工具来帮助患者进行普遍检测。在此，我们基于术前盆腔磁共振成像（MRI）图像研究ZOOMit扩散峰度成像（DKI）和扩散加权成像（DWI）在评估EC中MSI的价值。
回顾性分析81例EC患者的术前MRI检查，包括ZOOMit DKI和DWI。根据不同的微卫星状态，比较并分析基于MRI图像的表观扩散系数（ADC）、平均峰度（MK）、平均扩散率（MD）和最大肿瘤大小，以及患者的临床病理特征。
81例患者中，59例（72.8%）为微卫星稳定（MSS），22例（27.2%）为MSI。观察者间对定量参数测量的一致性良好（ICC 0.78 - 0.98）。与MSS组相比，MSI组的ADC和MD值显著更低，而Ki-67增殖水平和MK值显著更高。MD和MK参数是确定MSI的独立预测因子，尽管与每个单独参数相比无显著差异，但它们的组合显示出更好的诊断效能，受试者操作特征曲线下面积（AUROC）为0.860（95%置信区间，0.765，0.927）。
ZOOMit DKI的微观结构异质性评估能够表征EC中的MSI状态。在当前的普遍MSI检测模式下，DKI作为一种潜在的无创成像生物标志物，可为MSI肿瘤的术前评估提供附加价值，从而促进临床决策。
