Enhancing Parametrial Invasion Assessment in Cervical Squamous Cell Carcinoma: The Collaborative Impact of Diffusion Kurtosis Imaging & T2-Weighted Imaging, Exploring Tumor Core & 5-mm Peritumoral Tissue.

Objective: To evaluate the efficacy of magnetic resonance diffusion kurtosis imaging (DKI) combined with MRI T2-weighted imaging (T2WI) in assessing parametrial invasion in cervical squamous cell carcinoma.

Methods: 30 patients with cervical cancer underwent routine MRI and DKI scans. DKI parameters (Mean Diffusivity [MD], Mean Kurtosis [MK], Fractional Anisotropy [FA] and Kurtosis Anisotropy [KA]) were measured in the tumor parenchyma and surrounding 5 mm tissue. The integrity of the low-signal ring around the cervix on T2WI was recorded. LASSO regression identified optimal DKI parameters and ROC curves compared the diagnostic performance of each parameter and T2WI.

Results: Compared to the non-parametrial infiltration group (NPI), the parametrial infiltration group (PI) had higher values of MKT, KAT and KAP (P = 0.018, 0.008, 0.042), while MDT was higher in NPI (P = 0.038). LASSO regression showed strong correlations between MKT, KAT and KAP with PI. ROC analysis revealed the AUC, sensitivity, and specificity for MKT, KAT, and KAP were 0.765, 0.706, 0.846; 0.778, 0.882, 0.615; and 0.719, 0.529, 0.923, respectively. Combining T2WI with DKI (MKT+T2WI, KAT+T2WI, KAP+T2WI) improved AUCs to 0.846, 0.828, and 0.774. MKT+KAP and KAT+KAP yielded AUCs of 0.792 and 0.787, with sensitivity of 0.706 and specificity of 0.846.

Conclusion: DKI parameters (tumor MK, KA, and peritumoral KA) are valuable for assessing parametrial invasion. Combining tumor and peritumoral parameters, along with T2WI, enhances diagnostic accuracy.

Advances in knowledge: This study presented an approach that combined DKI parameters with T2WI, integrating tumor and peritumoral parameter analysis to enhance the accuracy of assessing parametrial invasion.