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Comparing multi-b-value diffusion models and ROI delineation strategies for prediction of p53 abnormality and
Yi Li1, Xuemei Wang2, Kaiming Xue1
1Department of Radiology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin Province, 130033, China.
Background:
Multi-b-value diffusion-weighted MRI holds potential for noninvasively predicting p53 abnormality and microsatellite instability (MSI) in endometrial cancer (EC), but the optimal diffusion model and region of interest (ROI) strategy remain undetermined. This study aims to identify the optimal diffusion model-ROI strategy combination for predicting p53 abnormality and MSI status by comparing diffusion MRI-derived parameters from three ROI approaches.
Methods:
This retrospective study included patients with EC who underwent preoperative multi-b-value diffusion MRI between December 2020 and June 2025. Two radiologists independently quantified apparent diffusion coefficient (ADC), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) parameters using three ROI strategies (single-slice ROI [ssROI], three-slice ROI [tsROI], and whole-tumor volume ROI [wtROI]. Multivariable logistic regression identified parameters associated with p53 abnormality and MSI. Diagnostic performance was assessed using the receiver operating characteristic curve and compared with the DeLong test. Additionally, the reproducibility of the parameters was evaluated.
Results:
Among 143 enrolled patients (mean age, 57.73years ± 10.01[SD]), 136 were assessed for p53 status (37 abnormal) and 109 for mismatch repair status (17 MSI). All parameters showed good-to-excellent reproducibility. Elevated D* and lower MD in ssROI, lower D in tsROI, and decreased MD in wtROI were associated with p53 abnormality. Lower ADC across all ROIs was associated with MSI. For predicting p53 abnormality, ssROI-MD yielded the highest AUC of 0.711 (95% CI: 0.627, 0.785), which showed similar performance to other parameter-ROI combinations. For predicting MSI, tsROI-ADC (AUC,0.755 [95%CI:0.646, 0.844]) and wtROI-ADC (AUC,0.758 [95%CI:0.649, 0.846]) significantly outperformed ssROI-ADC (AUC,0.700 [95%CI:0.587, 0.797]; p = 0.006 and 0.025, respectively), with wtROI-ADC showing higher sensitivity (90.9%).
Conclusions:
MD from a single-slice ROI is optimal for the identification of p53 abnormality, combining diagnostic performance with operational simplicity and high reproducibility. For MSI prediction, ADC from a whole-tumor ROI is preferred due to its superior sensitivity and excellent reproducibility.
Insights
This study found that mean diffusivity (MD) from a single-slice region of interest (ROI) best predicts p53 abnormality in endometrial cancer, while apparent diffusion coefficient (ADC) from a whole-tumor ROI is optimal for predicting microsatellite instability (MSI). These diffusion MRI parameters offer non-invasive prediction of key biomarkers.
Area of Science:
- Radiology
- Oncology
- Biomarker Discovery
Background:
- Multi-b-value diffusion-weighted MRI (dw-MRI) shows promise for predicting p53 abnormality and microsatellite instability (MSI) in endometrial cancer (EC).
- Optimal diffusion models and region of interest (ROI) strategies for these predictions are not yet established.
Purpose of the Study:
- To identify the optimal combination of diffusion MRI models and ROI strategies for predicting p53 abnormality and MSI status in EC.
- To compare diffusion MRI-derived parameters using single-slice ROI (ssROI), three-slice ROI (tsROI), and whole-tumor volume ROI (wtROI) approaches.
Main Methods:
- Retrospective analysis of 143 EC patients who underwent preoperative multi-b-value dw-MRI.
- Independent quantification of apparent diffusion coefficient (ADC), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) parameters by two radiologists using ssROI, tsROI, and wtROI.
- Multivariable logistic regression and ROC curve analysis to assess diagnostic performance and reproducibility.
Main Results:
- Elevated D* and lower MD in ssROI, lower D in tsROI, and decreased MD in wtROI were associated with p53 abnormality.
- Lower ADC across all ROIs correlated with MSI.
- For p53 abnormality, ssROI-MD showed the highest AUC (0.711).
- For MSI prediction, wtROI-ADC (AUC, 0.758) and tsROI-ADC (AUC, 0.755) significantly outperformed ssROI-ADC (AUC, 0.700), with wtROI-ADC demonstrating higher sensitivity (90.9%).
Conclusions:
- Mean diffusivity (MD) from a single-slice ROI is optimal for predicting p53 abnormality due to its diagnostic performance, simplicity, and reproducibility.
- Apparent diffusion coefficient (ADC) from a whole-tumor ROI is preferred for MSI prediction, offering superior sensitivity and excellent reproducibility.
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