Author(s)

JunQi Sun¹, FeiFei Shan^2*

Affiliation(s)

¹Radiology Department, Yuebei People's Hospital, Shaoguan 512026, Guangdong, China.

²Ultrasound Diagnosis Department,Yuebei People's Hospital, Shaoguan 512026, Guangdong, China.

Corresponding Author

FeiFei Shan

ABSTRACT

Background: Microsatellite instability (MSI) based on multimodal MRI is a critical molecular marker in endometrial cancer (EC), associated with distinct biological behaviors and therapeutic responses. Diffusion kurtosis imaging (DKI), an advanced diffusion-weighted imaging technique, offers insights into tissue microstructural complexity and has shown potential for non-invasive cancer characterization.

Objective: This study aims to evaluate the application and diagnostic performance of DKI in assessing MSI status in endometrial cancer.

Methods: A retrospective analysis was conducted on patients with confirmed endometrial cancer who underwent preoperative DKI and MSI testing. Quantitative DKI parameters, including mean kurtosis (MK), mean diffusion(MD), and ADC were extracted and compared between MSI-high (MSI-H) and microsatellite stable (MSS) groups. Statistical analyses were performed to assess the diagnostic accuracy.

Results: MSI-H tumors demonstrated significantly higher MK,MD and ADC values compared to MSS tumors (p < 0.01), reflecting increased tissue heterogeneity and microstructural disorganization. Receiver operating characteristic (ROC) analysis indicated that MK had the highest diagnostic performance, with an area under the curve (AUC) of 0.731, sensitivity of 52.2%, and specificity of 95.1%.

Conclusion: DKI provides a non-invasive, quantitative method for differentiating MSI-H from MSS endometrial cancers. Its excellent diagnostic accuracy highlight its potential as a biomarker for MSI status of endometrial cancer.

KEYWORDS

Diffusion kurtosis imaging; Microsatellite instability; Endometrial cancer

CITE THIS PAPER

JunQi Sun, FeiFei Shan. Application of diffusion kurtosis imaging in microsatellite instability of endometrial cancer. Journal of Pharmaceutical and Medical Research. 2024, 6(4): 61-66. DOI: https://doi.org/10.61784/jpmr3026.

REFERENCES

[1] Zhang T, Zhang X, Peng P, et al. Fertility-sparing treatment in MSI-H/MMRd endometrial carcinoma or atypical endometrial hyperplasia: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol, 2024, 302: 177-183.

[2] Xiao Y, Yu X, Wang Y, et al. A novel immune-related gene signature for diagnosis and potential immunotherapy of microsatellite stable endometrial carcinoma. Sci Rep, 2024, 14(1): 3738.

[3] Kertowidjojo E, Momeni-Boroujeni A, Rios-Doria E, et al. The Significance of International Federation of Gynecology and Obstetrics Grading in Microsatellite Instability-High and POLE-Mutant Endometrioid Endometrial Carcinoma. Mod Pathol, 2023, 36(9):100234.

[4] MMDia NL, Thomas M, Ring KL, et al. Somatic Sequencing and Microsatellite Instability Results From Mismatch Repair-deficient Endometrial Carcinoma Patients Without Lynch Syndrome ("Lynch-like" tumors): Implications for Heritable Cancer Screening, Molecular Prognostication, and Immunotherapeutic Vulnerability. Am J Surg Pathol, 2023, 47(8): 878-888. 

[5] Mackinnon AC Jr, Johnson CM, Robin A, et al. Pathologic, immunologic, and clinical analysis of the microsatellite instability phenotype in endometrial carcinoma. Hum Pathol, 2023, 139: 80-90. 

[6] Colomba E, Alexandre J, Le Teuff G, et al. Response to first line platinum-based chemotherapy in mismatch repair deficient (MMRd)/ microsatellite instability high (MSI-high) endometrial carcinoma. Gynecol Oncol, 2023, 169: 78-84. 

[7] Di Dio C, Bogani G, Di Donato V, et al. The role of immunotherapy in advanced and recurrent MMR deficient and proficient endometrial carcinoma. Gynecol Oncol, 2023, 169: 27-33.

[8] Turinetto M, Lombardo V, Pisano C, et al. Pembrolizumab as a single agent for patients with MSI-H advanced endometrial carcinoma. Expert Rev Anticancer Ther, 2022, 22(10): 1039-1047.

[9] Arora S, Balasubramaniam S, Zhang W, et al. FDA Approval Summary: Pembrolizumab plus Lenvatinib for Endometrial Carcinoma, a Collaborative International Review under Project Orbis. Clin Cancer Res, 2020, 26(19): 5062-5067. 

[10] Li HJ, Cao K, Li XT, et al. A comparative study of mono-exponential and advanced diffusion-weighted imaging in differentiating stage IA endometrial carcinoma from benign endometrial lesions. J Cancer Res Clin Oncol, 2024, 150(3): 141.

[11] Meng H, Ding SX, Zhang Y, et al. Value of Multimodal Diffusion-weighted Imaging in Preoperative Evaluation of Ki-67 Expression in Endometrial Carcinoma. Curr Med Imaging, 2023. DOI: 10.2174/1573405620666230811142710.

[12] Song Q, Dong W, Tian S, et al. Diffusion kurtosis imaging with multiple quantitative parameters for predicting microsatellite instability status of endometrial carcinoma. Abdom Radiol (NY), 2023, 48(12): 3746-3756.  

[13] Tian S, Chen A, Li Y, et al. The combined application of amide proton transfer imaging and diffusion kurtosis imaging for differentiating stage Ia endometrial carcinoma and endometrial polyps. Magn Reson Imaging, 2023 , 99: 67-72. 

[14] Meng N, Fang T, Feng P, et al. Amide Proton Transfer-Weighted Imaging and Multiple Models Diffusion-Weighted Imaging Facilitates Preoperative Risk Stratification of Early-Stage Endometrial Carcinoma. J Magn Reson Imaging, 2021, 54(4): 1200-1211.

[15] Meng N, Wang X, Sun J, et al. Evaluation of amide proton transfer-weighted imaging for endometrial carcinoma histological features: a comparative study with diffusion kurtosis imaging. Eur Radiol, 2021, 31(11): 8388-8398.

[16] Song JC, Lu SS, Zhang J, et al. Quantitative assessment of diffusion kurtosis imaging depicting deep myometrial invasion: a comparative analysis with diffusion-weighted imaging. Diagn Interv Radiol, 2020, 26(2): 74-81. 

[17] Yue W, Meng N, Wang J, et al. Comparative analysis of the value of diffusion kurtosis imaging and diffusion-weighted imaging in evaluating the histological features of endometrial cancer. Cancer Imaging, 2019, 19(1): 9. 

[18] Yamada I, SMDamoto J, Kobayashi D, et al. Diffusion kurtosis imaging of endometrial carcinoma: Correlation with histopathological findings. Magn Reson Imaging, 2019, 57: 337-346.

[19] Chen T, Li Y, Lu SS, et al. Quantitative evaluation of diffusion-kurtosis imaging for grading endometrial carcinoma: a comparative study with diffusion-weighted imaging. Clin Radiol, 2017, 72(11): 995.