Continuous-time random walk diffusion MRI facilitates assessment of Ki-67 expression in endometrial cancer: a...

This study aimed to evaluate the performance of continuous-time random walk (CTRW), diffusion kurtosis imaging (DKI), and diffusion-weighted imaging (DWI) in predicting the proliferative state of endometrial cancer (EC).

A cohort of 81 EC patients was recruited. The parameters obtained from CTRW (α, β, and D_m), DKI (D_app, K_app), and DWI (ADC) were computed and compared between the high- and low-proliferation groups. Logistic regression analysis was used to identify independent predictors and perform a combined diagnosis. The area under the receiver operating characteristic curve (AUC), DeLong analysis, and calibration curves were used to assess the diagnostic performance.

K_app was higher and α, β, D_m, D_app, and ADC were lower in the high-proliferation group than in the low-proliferation group (P < 0.05 for all). α, K_app, and D_app were identified as independent predictors of Ki-67 status in EC. The combined use of these predictors achieved optimal diagnostic efficacy (AUC = 0.949). The diagnostic performance of this combined approach was significantly superior to that of individual modalities such as DKI (D_app + K_app) and DWI (ADC) and individual parameters such as α, β, D_m, D_app, and K_app. However, no significant difference was observed between the results of the combined approach and those obtained from CTRW (α + β + D_m, AUC = 0.908, P = 0.165). The calibration curve showed that the combined approach offered good stability.

The combination of CTRW-derived parameter α, DKI-derived parameter K_app, and parameter D_app may be a promising set of biomarkers for assessing Ki-67 status in EC patients, providing a new reference for related clinical diagnosis and treatment.