Diffusion-weighted MRI of advanced gastric cancer: correlations of the apparent diffusion coefficient with Borrmann classification, proliferation and aggressiveness.

Objectives: This study aimed to compare apparent diffusion coefficient (ADC) values derived from diffusion-weighted imaging (DWI) of different Borrmann types of advanced gastric cancer (AGC) and correlate these ADC values with Ki-67 expression and serum CEA levels in AGC.

Methods: A total of 84 patients with AGC who underwent DWI of the upper abdomen before tumor resection in our hospital between June 2014 and July 2018 were included in the present study. DWI was obtained with a single-shot echo planar imaging sequence in the axial plane (b values: 0, 100, 700 and 1000 s/mm²). Mean ADC values were calculated from tumor regions. Postoperatively, specimens were used to determine Borrmann type (1-4). Then, ADC values for AGCs categorized by Borrmann type were compared by one-way analysis of variance with Bonferroni correction for multiple comparisons. Subsequently, associations between ADC values and Ki-67 expression and serum CEA levels were evaluated by Spearman's correlation analysis.

Results: The mean ADC value for Borrmann type 3 AGC was significantly lower compared to the mean ADC value for Borrmann type 2 AGC (p < 0.01). There were significant negative correlations between ADC values and Ki-67 scores (r = -0.639, p < 0.001), and between ADC values and serum CEA levels (r = -0.575, p < 0.001).

Conclusions: DWI can help characterize Borrmann types of AGC. ADC values may reflect Ki-67 expression and serum CEA levels in patients with AGC, and have utility as a non-invasive indicator for evaluating the aggressiveness and prognosis of AGC.