Association of the Liver and Spleen Signal Intensity on MRI with Anemia in Gynecological Cancer

Objective: This study investigates the association of the liver and spleen signal intensity on MRI with anemia in patients with gynecologic cancer. Methods: 332 patients with gynecological cancer and 78 healthy women underwent MRI examination. Liver and spleen MRI parameters and laboratory tests were obtained within 1 week. The signal intensity ratios of liver and spleen to the paraspinal muscle were calculated on gradient-echo T1-weighted images (T1WI) and T2-weighted images (T2WI) in both patients and healthy women, respectively. Results: The ratios of liver and spleen to paraspinal muscle on T1WI and T2WI were lower in patients than in the healthy women, respectively (P<0.0001). The ratios of the liver and spleen to paraspinal muscle on T1WI and T2WI decreased with the increasing stage of anemia and decreasing hemoglobin levels (P<0.001). The ratios of the liver to paraspinal muscle on T1WI, spleen to paraspinal muscle on T1WI, and the liver and spleen to paraspinal muscle on T2WI could predict anemia stage≥1 (AUC=0.576, 0.643, 0.688, and 0.756, respectively), ≥2 (AUC=0.743, 0.714, 0.891, and 0.922, respectively) and 3 (AUC=0.851, 0.822, 0.854, and 0.949, respectively). Conclusion: T2WI-based spleen signal intensity ratios showed the highest potential for non-invasive evaluation of anemia in gynecological cancer.