Relationship between tumor heterogeneity and volume in cervical cancer: Evidence from integrated fluorodeoxyglucose 18 PET/MR texture analysis

Objective The aim of this study was to evaluate the effect of cervical cancer volume on PET/magnetic resonance (MR) texture heterogeneity. Materials and methods We retrospectively analyzed the PET/MR images of 138 patients with pathologically diagnosed cervical squamous cell carcinoma, including 50 patients undergoing surgery and 88 patients receiving concurrent chemoradiotherapy. Fluorodeoxyglucose 18 ((18)FDG)-PET/MR examination were performed for each patient before treatment, and the PET and MR texture analysis were undertaken. The texture features of the tumor based on gray-level co-occurrence matrices were extracted, and the correlation between tumor texture features and volume parameters was analyzed using Spearman's rank correlation coefficient. Finally, the variation trend of tumor texture heterogeneity was analyzed as tumor volumes increased. Results PET texture features were highly correlated with metabolic tumor volume (MTV), including entropy-log2, entropy-log10, energy, homogeneity, dissimilarity, contrast, correlation, and the correlation coefficients (r(s)) were 0.955, 0.955, -0.897, 0.883, -0.881, -0.876, and 0.847 (P < 0.001), respectively. In the range of smaller MTV, the texture heterogeneity of energy, entropy-log2, and entropy-log10 increases with an increase in tumor volume, whereas the texture heterogeneity of homogeneity, dissimilarity, contrast, and correlation decreases with an increase in tumor volume. Only homogeneity, contrast, correlation, and dissimilarity had high correlation with tumor volume on MRI. The correlation coefficients (r(s)) were 0.76, -0.737, 0.644, and -0.739 (P < 0.001), respectively. The texture heterogeneity of MRI features that are highly correlated with tumor volume decreases with increasing tumor volume. Conclusion In the small tumor volume range, the heterogeneity variation trend of PET texture features is inconsistent as the tumor volume increases, but the variation trend of MRI texture heterogeneity is consistent, and MRI texture heterogeneity decreases as tumor volume increases. These results suggest that MRI is a better imaging modality when compared with PET in determining tumor texture heterogeneity in the small tumor volume range.

Automated summary

The PET texture features were highly correlated with metabolic tumor volume, with inconsistent variation trends in texture heterogeneity as tumor volume increased in the smaller MTV range. In contrast, the MRI texture heterogeneity consistently decreased with increasing tumor volume. This suggests that MRI may be a better imaging modality compared to PET for determining tumor texture heterogeneity in the small tumor volume range.