Value of Non-Gaussian Diffusion Imaging with a Fractional Order Calculus Model Combined with Conventional MRI for Differentiating Histological Types of Cervical Cancer

Objective: This study aimed to evaluate the value of a fractional order calculus (FROC) model combined with conventional magnetic resonance imaging (MRI) for differentiating cervical adenocarcinoma (CAC) from squamous cell carcinoma (SCC).

Methods: Diffusion-weighted imaging (DWI) with 9 b values (0-2000s/mm) was carried out in 57 cervical cancer patients. Diffusion coefficient (D), fractional order parameter (β), and microstructural quantity (μ) together with apparent diffusion coefficient (ADC) were calculated and compared between the CAC and SCC groups. Conventional MRI features included TWI signal intensity (SI), unenhanced-TWI SI, enhanced-TWI SI, and ∆TWI SI, which were also compared between the two groups. Receiver operating characteristic (ROC) analysis was employed to assess the performance of FROC parameters, ADC, and conventional MRI features in differentiating CAC from SCC.

Results: β was significantly lower in the CAC group than in the SCC group (0.682 ± 0.054 vs. 0.723 ± 0.084, P = 0.035), while D and μ were not significantly different between the two groups (D, P = 0.171; μ, P = 0.127). There was no significant difference in the ADC value between the two groups (P = 0.053). In conventional MRI features, enhanced-TWI SI was significantly higher in the SCC group than in the CAC group (985.78 ± 130.83 vs. 853.92 ± 149.65, P = 0.002). The area under the curve (AUC) of β, ADC, and enhanced-TWI SI was 0.700, 0.683, and 0.799, respectively. The combination of β, ADC, and enhanced-TWI SI revealed optimal diagnostic performance in differentiating CAC from SCC (AUC = 0.930), followed by β + enhanced-TWI SI (AUC = 0.869), ADC+ enhanced-TWI SI (AUC = 0.817), and β + ADC (AUC = 0.761).

Conclusion: The FROC model can serve as a noninvasive and quantitative imaging technique for differentiating CAC from SCC. β combined with ADC and enhanced-TWI SI had the highest diagnostic efficiency.