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Amide proton transfer weighted and diffusion-weighted imaging in evaluating rectal cancer tumor budding grade value
DU Yunxia  XU Wenxiang  HE Yuqi  SUN Yun  LI Feixiang  CAI Wei  HUANG Gang 

Cite this article as: DU Y X, XU W X, HE Y Q, et al. Amide proton transfer weighted and diffusion-weighted imaging in evaluating rectal cancer tumor budding grade value[J]. Chin J Magn Reson Imaging, 2025, 16(1): 42-47, 73. DOI:10.12015/issn.1674-8034.2025.01.007.


[Abstract] Objective To explore the value of amide proton transfer weighted (APTw) imaging with apparent diffusion coefficient (ADC) in the preoperative assessment of tumor budding (TB) grade in rectal cancer.Materials and Methods We retrospectively analyzed the clinical and imaging data of 121 patients with rectal cancer. Based on pathological tumor budding counts, the patients were categorized into intermediate-low-grade and high-grade groups. The APT and ADC values were compared between the two groups, and the correlation between APT and ADC values and TB grades was investigated. Intra-class correlation coefficients (ICC) were used to assess the consistency of data measured by the observer before and after evaluation. Binary logistic regression comprehensive input method was employed to analyze the association between variables and the grade of rectal cancer tumor budding. Receiver operating characteristic (ROC) curves were utilized to assess the statistical significance of parameters and their combined efficacy. The area under the curve (AUC) along with its 95% confidence interval, as well as corresponding thresholds, sensitivities, and specificities, were calculated. DeLong tests were conducted to compare the differences in AUC. Spearman correlation analysis was performed to investigate the relationship between each parameter and tumor budding.Results One hundred and twenty-one patients were enrolled, The distribution of TB grade was intermediate-low grade (n = 69) and high-grade (n = 52). The APT and ADC values measured by the two observers showed good consistency, with ICC values were 0.925, 0.877. The APT value for intermediate-low grade TB of rectal cancer was significantly lower (2.068% ± 0.588%) compared to high-grade TB (3.167% ± 0.592%) (P < 0.001). Additionally, the ADC value for intermediate-low grade rectal cancer TB [(1.064 ± 0.131) × 10-3 mm2/s] was higher than that of the high-grade TB group [(0.903 ± 0.138) × 10-3 mm2/s]. In multivariate analysis, APT value [OR: 15.079 (95% CI: 4.822 to 47.154)] and ADC value [OR: 0.004 (95% CI: 0.001 to 0.228)] were identified as independent risk factors for predicting TB grades. The areas under the curve (AUC) for APT, ADC, and their combined assessment of rectal cancer tumor budding grade were 0.916, 0.821, and 0.918, respectively. The DeLong test results showed statistically significant differences in AUCs between ADC and APT values, as well as their combined assessment of TB grade (P = 0.024, 0.004). The decision curve shows that the combination of the two has higher clinical value than using APT and ADC values alone. APT values exhibited a moderate positive correlation with TB grade (r = 0.713, P < 0.001), while ADC values demonstrated a moderate negative correlation with TB grade (r = -0.550, P < 0.001).Conclusions APT and ADC can effectively assess the TB grade of rectal cancer and have some clinical applications, and the combination of APT and ADC can significantly improve the diagnostic efficacy.
[Keywords] rectal cancer；tumor budding；magnetic resonance imaging；amide proton transfer imaging；apparent diffusion coefficient

DU Yunxia1   XU Wenxiang1   HE Yuqi1   SUN Yun1   LI Feixiang1   CAI Wei2   HUANG Gang3*  

1 The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou 730000, China

2 Department of Pathology, Gansu Provincial Hospital, Lanzhou 730000, China

3 Department of Radiology, Gansu Provincial Hospital, Lanzhou 730000, China

Corresponding author: HUANG G, E-mail: huang_g2024@163.com

Conflicts of interest   None.

Received  2024-10-18
Accepted  2025-01-10
DOI: 10.12015/issn.1674-8034.2025.01.007
Cite this article as: DU Y X, XU W X, HE Y Q, et al. Amide proton transfer weighted and diffusion-weighted imaging in evaluating rectal cancer tumor budding grade value[J]. Chin J Magn Reson Imaging, 2025, 16(1): 42-47, 73. DOI:10.12015/issn.1674-8034.2025.01.007.

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