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Published on: April 22, 2019
Blood Oxygenation Level-Dependent MRI for Predicting Lymphovascular Space Invasion in Cervical Squamous Cell
Liang Yin1, Jing Zhang2, Yaxuan Pang2
1Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, PR China (L.Y, S.G.); The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, PR China (J.Z., Y.P., Y.M.L.Y, S.G.); Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou, Gansu, PR China (L.Y., S.G.); Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, PR China (L.Y, S.G.); Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, PR China (L.Y, S.G.); Reproductive Medicine Center, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, PR China (L.Y, S.G.).
Rationale And Objectives:
To assess the value of blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) in predicting lymphovascular space invasion (LVSI) after neoadjuvant chemotherapy (NACT) in patients with cervical squamous cell carcinoma (CSCC).
Materials And Methods:
This prospective study included 73 patients with CSCC who underwent BOLD-MRI before and after NACT, prior to radical surgery. R2* values were quantified from the primary tumor. Clinical, pathological, and imaging parameters were compared between patients with and without LVSI. Logistic regression analysis was used to identify independent predictors of LVSI. Receiver operating characteristic (ROC) curve analysis, bootstrap internal validation, 10-fold cross-validation, and decision curve analysis were performed to evaluate diagnostic performance and clinical utility.
Results:
The R2* values after NACT (R2*post) were significantly higher in tumors without LVSI than in those with LVSI (P < 0.001). The R2*post was a significant independent predictor of LVSI [odds ratio (OR) = 0.539, 95% confidence interval (CI): 0.321-0.903, P = 0.019], yielding an area under the curve (AUC) of 0.876 (95%CI: 0.793-0.945). At an optimal cut-off value of 21.84 Hz, R2*post demonstrated a sensitivity of 71.9%, specificity of 90.2%, and accuracy of 82.2% for predicting LVSI. The positive and negative predictive values were 85.2% and 80.4%, respectively. Bootstrap internal validation confirmed a stable AUC of 0.877 (95% CI: 0.812-0.951), while 10-fold cross-validation produced a mean AUC of 0.861 (95% CI: 0.766-0.956). Decision curve analysis indicated a net clinical benefit across a wide range of threshold probabilities. Additionally, Ki-67 index, lymph node metastasis, and depth of stromal invasion were independently associated with LVSI.
Conclusion:
The R2* values derived from BOLD-MRI were significantly higher 3-4 weeks after NACT than at baseline. The post-NACT R2* value shows promise as a non-invasive biomarker for predicting the absence of LVSI in CSCC patients treated with NACT and may aid in risk stratification to inform clinical decision-making regarding adjuvant therapy.
