Amide proton transfer imaging in differentiation of type II and type I endometrial carcinoma: a pilot study

Purpose This study aimed at evaluating the efficacy of amide proton transfer (APT) imaging in differentiation of type II and type I uterine endometrial carcinoma. Materials and methods Thirty-three patients diagnosed with uterine endometrial carcinoma, including 24 with type I and 9 with type II carcinomas, underwent APT imaging. Two readers evaluated the magnetization transfer ratio at 3.5 ppm [MTRasym (3.5 ppm)] in each type of carcinoma. The average MTRasym (APT(mean)) and the maximum MTRasym (APT(max)) were analyzed. The receiver operating characteristic (ROC) curve analysis was performed. Results The APT(max) was significantly higher in type II carcinomas than in type I carcinomas (reader1, p = 0.004; reader 2, p = 0.014; respectively). However, APT(mean) showed no significant difference between type I and II carcinomas. Based on the results reported by reader 1, the area under the curve (AUC) pertaining to the APT(max) for distinguishing type I from type II carcinomas was 0.826, with a cut-off, sensitivity, and specificity of 9.90%, 66.7%, and 91.3%, respectively. Moreover, based on the results reported by reader 2, the AUC was 0.750, with a cut-off, sensitivity, and specificity of 9.80%, 62.5%, and 87.5%, respectively. Conclusion APT imaging has the potential to determine the type of endometrial cancer.

Automated summary

APT imaging shows potential in determining the type of endometrial cancer, with a significant difference observed in the maximum magnetization transfer ratio between type II and type I carcinomas.ROC curve analysis indicates that APT imaging can be a useful tool for distinguishing different types of uterine endometrial carcinoma.