Assessment of the utility of intravoxel incoherent motion and diffusion kurtosis imaging for determining eligibility for fertility preservation

Abstract

Background

Accurate preoperative assessment of endometrial cancer (EC) is crucial in young women who may be eligible for fertility-preserving therapy, which is generally limited to patients with grade 1, endometrioid-type tumors without myometrial invasion (MI).

Purpose

To evaluate the utility of quantitative parameters derived from intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) for improving the diagnostic performance of magnetic resonance imaging (MRI).

Material and Methods

This retrospective study included 107 patients diagnosed with EC (mean age = 59 years; age range = 25–89 years) who underwent preoperative MRI, including multiple b-value (0–2000 s/mm²) diffusion-weighted imaging, between January 2022 and March 2024. Quantitative parameters were extracted from the mono-exponential (ADC), IVIM (Di, D*, f), and DKI (Dk, K) models and compared across clinical and pathological features.

Results

ADC, Di, and Dk values were significantly higher in patients without MI (P = 0.015, 0.035, and 0.005, respectively). Di and Dk were significantly higher (P = 0.003 and 0.016), and K was significantly lower (P = 0.013) in the G1 group. Patients eligible for fertility preservation had significantly higher ADC, Di, and Dk values (P = 0.002, 0.002, and 0.001) and significantly lower K values (P = 0.044). The overall diagnostic performance of these parameters was moderate (area under the curve < 0.70).

Conclusion

IVIM and DKI-derived metrics may enhance preoperative assessment of tumor grade and MI, supporting decisions regarding fertility-preserving treatment.