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• Clinical Article •
The value of ADC histogram in preoperative prediction of lymphvascular space invasion in early cervical cancer
LI Hongxia  REN Zhen  MO Fan  LÜ Fajin 

Cite this article as: LI H X, REN Z, MO F, et al. The value of ADC histogram in preoperative prediction of lymphvascular space invasion in early cervical cancer[J]. Chin J Magn Reson Imaging, 2025, 16(9): 132-139. DOI:10.12015/issn.1674-8034.2025.09.020.


[Abstract] Objective To explore the application value of the intratumoral and peritumoral apparent diffusion coefficient (ADC) histogram of the whole tumor in preoperative prediction of lymphovascular space invasion (LVSI) in patients with early cervical cancer.Materials and Methods A retrospective analysis was conducted on 150 patients with stage ⅠB-ⅡA1 cervical cancer confirmed by postoperative pathology, and were divided into LVSI-positive (n = 45) and LVSI-negative (n = 105) groups according to postoperative pathological results. All patients underwent pelvic MRI before surgery, and the region of interest (ROI) were manually delineated layer by layer along the largest edge of the tumor on the ADC axial image, with the peritumoral region being uniformly expanded outward. Whole-volume ADC histogram analysis was performed for intratumoral region, intratumoral-2 mm peritumoral region and intratumoral-4 mm peritumoral region, respectively. Difference in clinicopathologic characteristics and ADC histogram parameters between the two groups were analyzed, and establish a joint parameter model. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of each parameter and the combined parameter model in preoperative prediction of LVSI status in patients with early cervical cancer, the area under the curve (AUC), optimum cutoff value, sensitivity and specificity were calculated, and the AUC values of each parameter and the joint model were statistically compared using the DeLong test.Results In the intratumoral ADC histogram analysis, ADCmax, ADCmean, ADC50, ADC75, ADC90, ADC95, ADCstdev, ADCvariance and ADCkurtosis in the LVSI-positive group were significantly lower than in the LVSI-negative group (P < 0.05). Intratumoral ADC histogram parameters in predicting LVSI status of early cervical cancer, ADCmax, ADC90 and ADC95 had the best diagnostic efficacy, with AUC of 0.747, 0.756 and 0.776, respectively (P < 0.05). The AUCs of the combined parameter models for intratumoral, intratumoral+2 mm peritumoral, and intratumoral+4 mm peritumoral regions were 0.830, 0.710, and 0.673, respectively. DeLong test revealed that the AUC of the intratumoral combined model was significantly higher than that of the intratumoral+2 mm peritumoral (P < 0.05) and intratumoral+4 mm peritumoral combined models (P < 0.05); no significant difference was found between the AUCs of the intratumoral+2 mm peritumoral and intratumoral+4 mm peritumoral combined models (P > 0.05).Conclusions ADC histogram based on whole tumor volume has potential value in preoperative predicting LVSI status in patients with early cervical cancer, among which ADCmax, ADC90 and ADC95 are the most promising predictive parameters, and peritumoral region cannot increase the diagnostic efficiency of ADC histogram.
[Keywords] cervical cancer；lymphatic vascular space infiltration；magnetic resonance imaging；diffusion weighted imaging；apparent diffusion coefficient；histogram analysis

LI Hongxia1   REN Zhen1   MO Fan1   LÜ Fajin1, 2*  

1 State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China

2 Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Corresponding author: LÜ F J, E-mail: fajinlv@163.com

Conflicts of interest   None.

Received  2025-04-03
Accepted  2025-08-25
DOI: 10.12015/issn.1674-8034.2025.09.020
Cite this article as: LI H X, REN Z, MO F, et al. The value of ADC histogram in preoperative prediction of lymphvascular space invasion in early cervical cancer[J]. Chin J Magn Reson Imaging, 2025, 16(9): 132-139. DOI:10.12015/issn.1674-8034.2025.09.020.

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