Multiparametric MRI with amide proton transfer imaging for assessing stromal invasion depth of early- stage cervical cancer

OBJECTIVE: To explore the value of multiparametric magnetic resonance imaging (MRI) with amide proton transfer (APT) imaging in assessing the depth of stromal invasion (DSI) in early-stage cervical cancer.

METHODS: Clinical and imaging data of patients with early-stage cervical cancer who were pathologically diagnosed at our hospital between January 2020 and June 2025 were retrospectively analyzed. All patients underwent routine MRI, diffusion-weighted imaging (DWI), APT imaging, and dynamic contrast-enhanced MRI (DCE-MRI) before treatment. Apparent diffusion coefficient (ADC), APT values, and semi-quantitative DCE-MRI parameters were measured. According to pathological findings, patients were divided into two groups: DSI ≥1/2 and DSI <1/2. Normally distributed continuous variables were compared using independent-samples t-tests, whereas skewed variables were compared using non-parametric tests. Receiver operating characteristic (ROC) analysis was performed to assess the sensitivity, specificity, and area under the curve (AUC) of ADC, APT, DCE-MRI parameters, and their combination for predicting DSI. Diagnostic performance was compared using the DeLong test.

RESULTS: A total of 61 patients were included, with 33 in the DSI <1/2 group and 28 in the DSI (≥1/2) group. The ADC values were significantly lower in the DSI ≥1/2 group compared to the DSI <1/2 group (P