Multimodal magnetic resonance imaging in the diagnosis of cervical cancer and its correlation with the differentiation process of cervical cancer
Authors: Meng Heng , Guo Xin , Zhang Duo 
Published: September 2023

Abstract
Purpose
This study seeks to evaluate the value of MRI (Magnetic resonance imaging) diffusion weighted images (DWI), diffusion kurtosis imaging (DKI) and intravoxel incoherent motion (IVIM) in the diagnosis of cervical carcinoma.

Methods
Seventy-nine cases of cervical cancer (CC group) (39 cases of squamous carcinoma (SCC group) and 40 cases of adenocarcinoma (ACC group)) and 30 cases of healthy controls (HC group) were included in this study. All the subjects were informed of the purpose of this study. The study was approved by the Ethics Committee of Beihua University Hospital, Jinlin, China. In this study, images were acquired based on a 3T MR scanner (Ingenia; Philips, Best, the Netherlands) and measured the imaging parameters by DWI, IVIM and DKI techniques. The parameters were obtained by Philips post-processing workstation, DKE and IVIM. These ROIs (region of interest) were manually drawn on each parameter mapping image by MRI physicians. Finally, SPSS 23.0 statistical software was used for data analysis.

Results
The ADC (apparent diffusion coefficient) value of M group was lower than that of N group, and the difference was statistically significant (P < 0.05). The D (true diffusion coefficient) value, D*(pseudo diffusion coefficient) value, f (perfusion fraction) value, MD (mean diffusivity) value, and ADC value in the SCC group were lower than those in the ACC group with statistically significant differences (P < 0.05). The MK (mean kurtosis) value was higher than that of the ACC group, and the difference was statistically significant (P < 0.05). Compared with the HC group, the ADC values, D values, MD values of group CC group were lower, and the D* values, f values, MK values were higher; all the parameters were statistically significant (P < 0.05). The higher the differentiation degree of cervical cancer, the higher ADC values, D values, MD values, and the smaller D* values, f values, MK values. The difference of ADC values, D values and MK values was statistically significant (P < 0.05). MK value had the best diagnostic efficiency in the differential diagnosis of cervical cancer with low and medium differentiation, high and low differentiation (P < 0.05). There was no significant difference in the f value between high and low differentiation cervical cancer (P > 0.05). There was no significant difference in the MD value between low and high differentiation cervical cancer (P > 0.05). The strongest correlation between MK values (r = 0.796) and the degree of pathological differentiation of cervical cancer is positively correlated. The D values, MD values, and ADC values are negatively correlated with the degree of pathological differentiation of cervical cancer.

Conclusion
The ADC value of DWI parameters has important diagnostic value for different menstrual states of cervical cancer. The parameter values of DWI, IVIM, and DKI can be used to differentiate cervical cancer from normal cervical tissue, and thus have important diagnostic value for differentiating pathological types of cervical cancer. This means that these parameter values may have great significance in the differential diagnosis of cervical cancer with different degrees of pathological differentiation. The pathological differentiation degree of cervical cancer is significantly positively correlated with the MK value in the parameter values of DWI, IVIM, and DKI, while negatively correlated with the D value, MD value, and ADC value.