Restriction spectrum imaging and diffusion kurtosis imaging for evaluating proliferation status in cervical cancer.

Authors

Wenling Liu, Huijia Yin, Beiran Wang, Zhong Li, Wangyi Liu, Meng Zhang, Jipeng Ren, Ruifang Yan, Dongming Han

Published in

Frontiers in medicine. Volume 13. Pages 1855242. Epub Aug 06, 2026.

Abstract

To explore the diagnostic efficacy of three-compartment restriction spectrum imaging (RSI) and diffusion kurtosis imaging (DKI) in predicting proliferative status in patients with cervical cancer (CC).
A total of 100 patients diagnosed with CC were enrolled in the present study. All patients were stratified into the high- (Ki-67 > 50%, n = 58) and low-proliferation group (Ki-67 ≤ 50%, n = 42). Quantitative parameters derived from RSI (f ₁, f ₂, f ₃), DKI (MD, MK), and conventional diffusion-weighted imaging (DWI, ADC) were compared between the two groups. Logistic regression (LR) analysis was performed to screen independent predictors and construct an integrated diagnostic model. The area under the receiver operating characteristic curve (AUC) was calculated to quantify the diagnostic performance, and the DeLong test was adopted for pairwise comparisons of AUC values.
Compared with patients in the low-proliferation group, those in the high- proliferation group presented significantly lower f ₁, MD, and ADC values, along with markedly elevated MK, f ₂, and f ₃ values (all P < 0.05). The corresponding AUC values were 0.84, 0.76, 0.76, 0.87, 0.79, and 0.80, respectively. LR analysis identified f ₂, MD, MK, and ADC as independent predictors. The integrated diagnostic model based on these four independent predictors yielded optimal diagnostic performance, with an AUC of 0.94 (95% CI: 0.87-0.98). DeLong analysis revealed that this integrated model significantly outperformed all single imaging parameters (f ₁, f ₂, f ₃, MD, MK, ADC), with Z values of 1.99, 3.11, 2.58, 4.09, 2.46, and 4.05 (all P < 0.05). Internal bootstrap validation confirmed the excellent stability of the combined model, with a corrected AUC of 0.92 (95% CI: 0.90-0.93).
RSI, DKI and conventional DWI are all reliable imaging techniques for evaluating proliferative status in CC. The combined application of f ₂, MD, MK, and ADC parameters serves as a promising non-invasive biomarker strategy for guiding individualized treatment decision-making and prognostic stratification in patients with CC.

PMID:
42625610
Bibliographic data and abstract were imported from PubMed on 21 Aug 2026.

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