Amide proton transfer-weighted imaging combined with multiple models diffusion-weighted imaging of endometrial cancer: correlations between multi-modal MRI parameters and HIF-1α expression.

Background: Hypoxia inducible factor (HIF-1α) is a major transcriptional factor regulating gene expression under hypoxic conditions. HIF-1α expression was closely correlated with the oxygenation status of tumor and could serve as an important biomarker for tumor hypoxia, aggressiveness, or radiation resistance. High expression of HIF-1α contributes to high aggressiveness or poor prognosis of endometrial cancer. Purpose: This study aimed to investigate correlations between multimodal MRI parameters (derived from amide proton transfer weighted imaging [APTw], conventional diffusion weighted imaging [DWI], intravoxel incoherent motion [IVIM] imaging and diffusion kurtosis imaging [DKI]) and HIF-1α expression, and to determine whether multimodal MRI can be used for quantitative evaluation of HIF-1α expression. Study type: Retrospective. Population: A total of 94 patients with EC were examined with 32 cases finally included in the high HIF-1α expression group and 40 cases included in the low expression group according to the exclusion and inclusion criteria. Field Strength/Sequence: 3.0T/APTw, DWI, IVIM, and DKI. Assessment: The asymmetry of magnetization transfer rate (MTR Statistical Test: Mann-Whitney U-test; Chi-square test or Fisher exact test; logistic regression analysis; Area under the receiver operating characteristic (ROC) curve (AUC); The Delong test; Pearson or Spearman correlation coefficients. The significance threshold was set at Result: MTR Conclusion: APTw combined with multi-model diffusion imaging can quantitatively evaluate the expression of HIF-1α in EC, and the combination of multiple quantitative parameters can improve the evaluation efficiency.