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Jiacheng Song¹, Aining Zhang¹, Xiance Zhao², Yishi Wang³, Zhiwei Shen³, and Ting Chen^1
1the first affiliated hospital of Nanjing Medical University, Nanjing, China, ²Philips Healthcare, Shanghai, China, ³Philips Healthcare, Beijing, China

Keywords: Urogenital, CEST & MT

The precise assessment of ovarian tumor, which is complex in presentation and classification, is important for clinical decision making. The value of amide proton transfer weighted (APTw) imaging in the assessment of ovarian lesion has not been comprehensively researched. In this study, we investigated the value of APTw imaging in differentiating ovarian high-grade serous carcinomas from borderline serous tumors. It was found that APT value of high-grade tumor was significantly lower than that of borderline tumor. Our finding indicates the potential of using APTw imaging as a novel method for the differentiation diagnosis of ovarian cancers.

Ma Changjun¹, Song Qingling¹, Tia Shifeng¹, Chen Lihua², Wang Nan², Lin Liangjie³, Wang Jiazheng³, and Liu Ailian^2
1Department of Radiology,, The First Affiliated Hospital of Dalian Medical University, Dalian, China, China, ²Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China, China, ³Clinical & Technical Support, Philips Healthcare, Beijing, China, China

Keywords: Pelvis, Uterus

Different biological characteristics of endometrial cancer (EC) may lead to different treatment efficacies and prognoses, so stratification of biological characteristics in EC is important for treatment planning. 

Hongxia Wang¹, Ruifang Yan¹, Beiran Wang¹, Zhong Li¹, Xingxing Jin¹, Zhenfang Guo², Wangyi Liu¹, Kaiyu Wang³, Jinxia Guo³, and Dongming Han^1
1Department of MR, the First Affiliated Hospital, Xinxiang Medical University, Weihui, China, ²Department of Neurology, the First Affiliated Hospital, Xinxiang Medical University, Weihui, China, ³MR Research China, GE Healthcare, Beijing, China

Keywords: Pelvis, Cancer

Finding a noninvasive and effective means for the risk stratification of early-stage EC is of great benefit to patients. This study aim to investigate the value of dynamic contrast-enhanced MRI (DCE-MRI) and intravoxel incoherent motion (IVIM) in differentiating low-risk from non-low-risk early-stage endometrial carcinoma (EC). Results showed that both DCE-MRI and IVIM facilitate the preoperative identification of low-risk and non-low-risk early-stage EC. Compared with each single parameter, the combination of Ktrans, Ve, and f provided better predictive power and may serve as a superior imaging marker.

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Xie Zongyuan¹, Tian Shifeng¹, and Liu Ailian^1
1Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China

Keywords: Uterus, Cancer

Lymphovascular space invasion(LVSI）is one of the important factors for poor prognosis of endometrial carcinoma（EC）.Quantitative parameters of amide proton transfer weighted（APTw）and diffusion kurtosis imaging（DKI）  is a novel MRI tool to  evaluating LVSI in EC. The APT and MK values of EC with LVSI were higher than those without LVSI.The AUC after combination was higher than that of MK alone.Both APTw and DKI can effectively evaluate EC LVSI.APTw combined DKI application can improve the evaluation efficiency . 

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Xie Zongyuan¹, Tian Shifeng¹, and Liu Ailian^1
1Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China

Keywords: Uterus, Cancer

Hypoxia -inducible factor  (HIF-1α)  is a major transcriptional factor regulating gene expression under hypoxic conditions. High expression of HIF-1α contributes to high aggressiveness or poor prognosis of cervical carcinoma. Multimodal MRI techniques DCE-MRI and ESWAN are new tools to determine the expression of HIF-1α.Its quantitative parameters Ktrans , Kep  R2 * and T2* values were correlated with HIF-1a expression . Therefore,both DCE-MRI and ESWAN techniques can effectively evaluate  HIF-1a expression in endometrial cance.

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Xie Zongyuan¹, Tian Shifeng¹, and Liu Ailian^1
1Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China

Keywords: Uterus, Cancer

Lymphovascular space invasion(LVSI）is one of the important factors for poor prognosis of endometrial carcinoma（EC）.Quantitative parameters of amide proton transfer weighted（APTw）and Modified Dixon quantification of fat（mDIXON-Quant）  is a novel MRI tool to  evaluating LVSI in EC. The APT and R2* values of LVSI(+)EC were higher than those of LVSI(-)EC.APT value was moderately positively correlated with R2* value, and APT value was weakly positively correlated with FF value . Both APTw and Mdixon-Quant techniques can effectively evaluate EC LVSI, and their combined application can improve the evaluation efficiency.

Qian Tang¹, Weiyin Vivian Liu², Qiqi Zhou³, Wen Chen³, Ling Sang³, and Lin Xu^3
1Department of Biomedical Engineering, Hubei University of Medicine, Hubei, China, ²GE Healthcare, Beijing, China, ³Department of Radiology,Taihe Hospital, Hubei University of Medicine, Hubei, China

Keywords: Pelvis, Cancer

High-b-value DWI has been widely applied in clinical practices, but it is challenging to acquire several high b-value images for long acquisition time and more eddy distortion as b-value increases, leading to patient discomfort, increased motion artifacts and decreased SNR. High-b-value SyDWIs showed better SNR and less image distortion than scanned high-b-value DWIs. Our study demonstrate the feasibility of 5b-value synthetic high-b-value reduced full-of-view diffusion weighted imaging with the pros of short scan time, better lesion clarity and higher image quality in comparison of 13b-protocol rFOV-syDWIs and 5b-protocol synthetic ADC_mean and ADC_minimum offered reliably diagnostic value compared to 13b-protocol ones.

Qingling Song¹, Wan Dong², Shifeng Tian³, Lihua Chen³, and Ailian Liu^3
1Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China, ²Radiology, Wuhan children's Hospital, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China, ³Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China

Keywords: Pelvis, Cancer

Microsatellite instability (MSI), which results from the failure of mismatch repair (MMR) proteins to fix a DNA replication error, causes insertions, mismatches, or deletions during the DNA replication process, thus having an essential role in maintaining the stability of the genome and regulating gene expression

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Xuejia Wang¹, Wangyi Liu ¹, Gaiyun Zhang¹, Ruifang Yan¹, Jie Shang¹, Kaiyu Wang², Jinxia Guo², and Dongming Han^1
1Department of MR, the First Affiliated Hospital, Xinxiang Medical University, Weihui, China, ²MR Research China, GE Healthcare, Beijing, China

Keywords: Pelvis, Cancer

Intravoxel incoherent motion (IVIM) is able to reflect the true diffusion, microcirculatory perfusion, average diffusion, and structural complexity in tissues. Dynamic contrast-enhanced MRI (DCE-MRI) can be used to analyze the dynamic distribution of contrast agents through the pharmacokinetic model to quantitatively detect the blood supply of biological tissues. Our results showed that IVIM and DCE-MRI-derived parameters such as D, α, Ktrans, and Kep were associated with Ki-67 status in EC, and the combination of D and Kep may serve as a superior imaging marker for the identification of low-proliferation and high-proliferation EC.

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Xie Zongyuan¹, Tian Shifeng¹, and Liu Ailian^1
1Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China

Keywords: Cancer, Uterus

p53 genotyping is important for EC lymph node metastasis and prognosis determination.Multimodal MRI techniques APTw, T2 mapping, mDIXON-Quant and DWI are new tools to determine p53 genotyping.Results of this study indicate the APT value and R2* value in the p53abn group were higher than those in the p53wt group, while the ADC value was lower than those in the p53wt group.Therefore, APTw, mDIXON-Quant and DWI techniques can quantitatively identify p53abn and p53wt EC, it provides a new way for preoperative quantitative evaluation of EC molecular typing.

Qian Tang¹, Weiyin Vivian Liu², Qiqi Zhou³, Wen Chen³, and Lin Xu^3
1Department of Biomedical Engineering, Hubei University of Medicine, Hubei, China, ²GE Healthcare, Beijing, China, ³Department of Radiology,Taihe Hospital, Hubei University of Medicine, Hubei, China

Keywords: Uterus, Cancer

CIN III is currently reckoned as a high-risk precancerous lesion for highly-possible transformation into cervical cancers. To improve low diagnostic efficiency of traditional MRI on precancerous CIN III for its subtle changes at the cellular level, this study built a combination model with MAGiC and IVIM derived parameters. In particular, a combined model with T2 and f values showed good performance on differentiation CIN III from cervical cancer with the sensitivity, specificity and AUC of 0.0.968, 0.839, 956, and it indeed elevated diagnostic performance especially specificity. In our study, alteration of heterogeneity at the cellular level was suspected to occur as cervix gradually progresses to CIN III stage despite no obvious morphological changes on structural images.

Mengdi Zhang¹, Qinghe Han¹, Qinghai Yuan¹, Rui Ma¹, and Jianxiu Lian^2
1The Second Hospital of Jilin University, Jilin, China, ²Philips Healthcare, Beijing, China

Keywords: Uterus, Cancer, parametrial invasion、squamous cell carcinoma antigen

Cervical cancer is one of the most common gynecological malignancies. The accurate diagnosis of cervical cancer is of great significance for the selection of treatment plan. This study is to explore the diagnostic value of the new magnetic resonance technology of amide proton transfer-weighted(APTw) imaging combined with squamous cell carcinoma antigen (SCCA) for parametrial invasion(PMI).The results showed amide proton transfer-weighted(APTw) imaging could provide more valuable for diagnosis efficiency, which maybe an invasive alternative method for evaluating parametrial invasion.   

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Han Jiang¹, Nan Meng², Ziqiang Li¹, Bo Dai², Pengyang Feng³, Yu Luo², Zhiwei Shen⁴, and Meiyun Wang*^2
1Department of Medical Imaging, Xinxiang Medical University & Henan Provincial People's Hospital, Zhengzhou, China, ²Department of Medical Imaging, Zhengzhou University People's Hospital & Henan Province People's Hospital, Zhengzhou, China, ³Department of Medical Imaging, Henan University People’s Hospital & Henan Provincial People’s Hospital, Zhengzhou, China, ⁴Philips healthcare, Beijing, China

Keywords: Pelvis, CEST & MT, cervical cancer

What are the values of three-dimensional amide proton transfer (APT) imaging and glucose-chemical exchange saturation transfer (glucoCEST) in WHO grading and staging of cervical cancer? We performed 3D-APT, 3D-glucoCEST, and DWI scans in 19 cervical cancer cases. APT signal intensity（SI）, and GlucoCEST SI could distinguish high-grade from low-grade; GlucoCEST SI can differentiate early (<IIB) from advanced (≥IIB) cervical cancer. Both APT and glucoCEST can be used for the preliminary evaluation of cervical cancer, but glucose CEST has advantages in the evaluation of cervical cancer grading and staging.

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Ana E Rodríguez-Soto¹, Elin M Lundström^1,2,3, Alexandra Besser¹, Stephane Loubrie¹, Christopher C Conlin¹, Stephan Jordan¹, Summer Batasin¹, Sheida Ebrahimi¹, Alexandra Schlein¹, Michael Hahn¹, Tyler Seibert⁴, Anders M Dale^1,5, Marianne Tom-Hedla⁶, Cheryl Saenz⁶, Shira Varon⁶, Michael McHale⁶, and Rebecca Rakow-Penner^1
1Radiology, University of California San Diego, La Jolla, CA, United States, ²Surgical Sciences, Uppsala University, Uppsala, Sweden, ³Radiology, Uppsala University, Uppsala, Sweden, ⁴Radiation Medicine, University of California San Diego, La Jolla, CA, United States, ⁵Neurosciences, University of California San Diego, La Jolla, CA, United States, ⁶Ob/Gyn & Reproductive Sciences, University of California San Diego, La Jolla, CA, United States

Keywords: Pelvis, Cancer

Restriction spectrum imaging (RSI) has shown potential to become a DWI-based, contrast-free diagnostic tool for cancer as it separates the different water pools in tissues. Here, we describe the diffusion signal of cancerous and healthy cervical tissues using RSI. Multi-exponential models with fixed ADCs were determined and the signal contribution of each component estimated. Initial results indicate that the slowest diffusion compartment of a tetra-exponential RSI model has the potential to isolate cervical cancer signal from that of surrounding tissues. This model may increase the sensitivity and specificity of DWI to evaluate response to treatment of cervical cancer patients. 

Qian Tang¹, Weiyin Vivian Liu², Qiqi Zhou³, Wen Chen³, Ling Sang³, and Lin Xu^3
1Department of Biomedical Engineering, Hubei University of Medicine, Hubei, China, ²GE Healthcare, Beijing, China, ³Department of Radiology,Taihe Hospital, Hubei University of Medicine, Hubei, China

Keywords: Uterus, Cancer

Incoherent motion in voxel (IVIM) imaging is widely utilized in grading tumor, cancer, treatment efficacy and prognosis. It is believed utility of at least 8 b-values image sets brings a more stable and accurate results. However, long acquisition time hamper clinical applications. High consistent diagnostic performance of manual ROI-based IVIM-derived measurements including ADC, D, D* and f on distinguishing patients with cervical cancer from healthy controls was found between 5b-value and 13b-value IVIM imaging protocol and no significant difference of all four values was found. We proposed a IVIM diffusion weighted imaging with a 5b-value protocol in cervical cancer.

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Petra J van Houdt¹, Abel Bregman¹, Kari Tanderup², Robert Hudej³, Marko Zaletelj³, Barbara Šegedin^3,4, Eva E Schaake¹, Ellen M Kerkhof⁵, Laura A Velema⁵, Remi A Nout⁶, and Uulke A van der Heide^1
1Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands, ²Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark, ³Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia, ⁴Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia, ⁵Radiotherapy, Leiden University Medical Center, Leiden, Netherlands, ⁶Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands

Keywords: Cancer, Quantitative Imaging, cervical cancer

The reproducibility of quantitative MRI parameters in a multicenter setting is not trivial. In this study we evaluated the in-vivo multicenter consistency of quantitative MRI parameters in cervical cancer patients. DWI, T2 mapping and T1 mapping were available from 66 patients from 3 institutes. ADC values were measured consistently across institutes despite differences in acquisition protocols. For T2 and T1 values differences between institutes were observed, which need to be accounted in future evaluation of the quantitative MRI parameters in relation to treatment outcome.

Yue Wang¹, Shifeng Tian¹, and Ailian Liu^1
1the First Affiliated Hospital of Dalian Medical University, Dalian, China

Keywords: Pelvis, Cancer

Cervical cancer (CC) is one of the most common gynecological malignancies worldwide, and its incidence is gradually increasing. Acurate identification of lymph node metastases (LNM) is crucial for predicting prognosis and choosing the best available treatment. Amide proton transfer weighted (APTw) imaging can detect the chemical exchange rate of between water and endogenous mobile proteins, peptides or polypeptides[1]. Diffusion kurtosis imaging (DKI) can reflect the limited diffusion movement of water molecules in tissue and the complexity of tissue microstructure [2]. This study is aimed to investigate the quantitative prediction of LNM in CC by APTw combined with DKI. 

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Ying Meng¹, Yuting Liang¹, Xinlian Wang¹, Keyang Wang¹, and Lizhi Xie^2
1Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China, ²GE healthcare, Beijing, Beijing, China

Keywords: Pelvis, Pelvis

DWI can differentiate benign and malignant lesions by reflecting the diffusion of water molecules in lesions, which has become a routine sequence of MRI examination of gynecological tumors. Generally, DWI signal is high, which will alert to the possibility of malignancy, while benign tumors also show high DWI signal. For solid ovarian tumors with high signal intensity on DWI, the differential diagnosis of ovarian tumors is still a difficult point in routine MRI sequence diagnosis. The results of this study showed that DCE-MRI quantitative parameters of solid ovarian masses were helpful for differential diagnosis of benign and malignant.     

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Sourajit Mitra Mustafi¹, Meredith Sadinski¹, Muller Gomes¹, Alexander Nacev¹, Hugo Davila², and Srirama S Venkataram^1
1Promaxo, Oakland, CA, United States, ²Cleveland Clinic Indian River Hospital, Vero Beach, FL, United States

Keywords: Pelvis, Body, Pelvic Imaging, Low field MRI

Promaxo's single sided, low-field MRI is used for female pelvic imaging. Five healthy female subjects were scanned. The butterfly shape of vagina and normal anatomy of the puborectails regions were observed. Delineation between puborectails and pubococcygneus muscles are clearly seen. MRI’s improved soft tissue contrast provides better visualization of anatomical regions and is less invasive than transvaginal ultrasound.