Quantitative dynamic contrast-enhanced MRI and intravoxel incoherent motion facilitate the prediction of p53 status and risk stratification of early-stage endometrial carcinoma

Abstract

Objectives: To investigate the value of dynamic contrast-enhanced MRI (DCE-MRI) and intravoxel incoherent motion (IVIM) in differentiating p53-positive from negative, low-risk from non-low-risk early-stage endometrial carcinoma (EC).

Methods: A total of 74 EC patients underwent pelvic MRI. Parameters K^trans, K_ep, V_e, D, D*, and f were compared. The combination of parameters was investigated by logistic regression and evaluated by bootstrap (1000 samples), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Results: In the p53-positive group, K^trans and K_ep were higher and D was lower than in the p53-negative group; K^trans, V_e, f, and D were lower in the non-low-risk group than in the low-risk group (all P < 0.05). In the identification of p53-positive and p53-negative early-stage EC, K^trans and D were independent predictors, and the combination of them had an optimal diagnostic efficacy (AUC, 0.867; sensitivity, 92.00 %; specificity, 80.95 %), which was significantly better than D (Z = 2.169, P = 0.030) and K^trans (Z = 2.572, P = 0.010). In the identification of low-risk and non-low-risk early-stage EC, K^trans, V_e, and f were independent predictors, and the combination of them had an optimal diagnostic efficacy (AUC, 0.947; sensitivity, 83.33 %; specificity, 93.18 %), which was significantly better than D (Z = 3.113, P = 0.002), f (Z = 4.317, P < 0.001), K^trans (Z = 2.713, P = 0.007), and V_e (Z = 3.175, P = 0.002). The calibration curves showed that the above two combinations of independent predictors both have good consistency, and DCA showed that these combinations were reliable clinical treatment tools.

Conclusions: Both DCE-MRI and IVIM facilitate the prediction of p53 status and risk stratification in early-stage EC. Compare with each single parameter, the combination of independent predictors provided better predictive power and may serve as a superior imaging marker.