The utility of APT and IVIM in the diagnosis and differentiation of squamous cell carcinoma of the cervix: A pilot study

This study aimed to investigate whether amide proton transfer (APT) imaging, compared with intravoxel incoherent motion (IVIM) imaging-derived parameters, can differentiate squamous cell carcinoma of the cervix (SCCC) from the normal cervical stroma and distinguish poorly differentiated SCCC from well-moderately differentiated SCCC.This prospective study enrolled 32 patients, comprising 20 patients with well-moderately differentiated SCCC and 12 patients with poorly differentiated SCCC. 20 healthy volunteers were enrolled as a control group. A bi-exponential model (BEM) analysis was performed to derive ADC, pure molecular diffusion coefficient (D), pseudo-diffusion coefficient (D*) and perfusion fraction (f). The APT signal intensity (APT SI), ADC, D, D* and f were measured. The parameters between the groups were compared with independent t-tests. Diagnostic performance was evaluated with a ROC analysis.The APT SI of SCCC (2.92 ± 0.24%) was higher than that of normal cervical stroma (2.72 ± 0.36%) with P = 0.020. The comparison of the AUCs for the diagnosis of SCCC was ADC > f > APT SI > D* > D. A significant difference was found in the APT SI between the well-moderately differentiated SCCC group (2.82 ± 0.15%) and the poorly differentiated SCCC group (3.09 ± 0.27%) with P = 0.006. Except for D (P = 0.012), the ADC, D* and f values were not significantly different between the groups (P > 0.05). The comparison of the AUCs for distinguishing poorly differentiated SCCC was APT SI > D > ADC > D* = f.APT imaging may be a useful technique in the diagnosis and predicting the differentiation of SCCC.