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Automated intertumoral susceptibility signal extraction combined with quantitative enhanced T2*-weighted angiography
Changjun Ma1,2,3, Hanyue Zhang1,2, Qi An1,2
1Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
Background:
Endometrial cancer (EC) incidence is increasing, with prognosis influenced by the tumor microenvironment. Hypoxia-inducible factor-1α (HIF-1α) promotes radioresistance, but traditional detection methods are often limited. Susceptibility-weighted imaging enables non-invasive quantitative assessment of tumor hypoxia. This study aims to investigate the efficacy of utilizing automated intertumoral susceptibility signal (ITSS) intensities extraction combined with multiple quantitative parameters derived from enhanced T2*-weighted angiography (ESWAN) for assessing HIF-1α expression in EC.
Methods:
A cohort of 219 patients diagnosed with EC through pathological examination were stratified into high and low expression groups based on their levels of HIF-1α expression and underwent preoperative pelvic 1.5-T magnetic resonance imaging (MRI) scans. Disparities in ITSS ratio, magnitude value, phase value, and R2* value between groups were evaluated through independent samples t-tests or Mann-Whitney U tests. The study utilized binary logistic regression to identify independent predictors of elevated HIF-1α expression in EC. followed by the construction of a combined model. The value of HIF-1α expression was assessed through receiver operating characteristic (ROC) curve analysis to determine statistically significant parameters.
Results:
The high HIF-1α expression group exhibited significantly higher values for the ITSS ratio (0.145±0.148 vs. 0.071±0.075, P<0.001), phase value (0.040±0.027 vs. 0.024±0.023, P<0.001), and R2* value (18.517±4.691 vs. 14.493±6.235, P<0.001) compared to the low expression group. The area under the curve (AUC) values for the ITSS ratio, phase value, R2* value, phase value + R2* value, and the combined model in evaluating HIF-1α expression in EC were 0.705, 0.672, 0.745, 0.765, and 0.828, respectively. The results of the DeLong test indicated that the combined model exhibited superior diagnostic efficacy compared to single-parameter assessments (ITSS ratio: P=0.001, phase value: P<0.001, and R2* value: P=0.006).
Conclusions:
The automatic extraction of ITSS based on ESWAN sequence enables the quantitative evaluation of HIF-1α expression in EC.
