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Title: Repeatability of MR fingerprinting in normal cervix and utility in cervical carcinoma
Authors: Wang, M
Perucho, JAU
Cao, P
Vardhanabhuti, V
Cui, D
Wang, Y
Khong, PL
Hui, ES 
Lee, EYP
Issue Date: Sep-2021
Source: Quantitative imaging in medicine and surgery, Sept. 2021, v. 11, no. 9, p. 3990-4003
Abstract: Background: Magnetic resonance fingerprinting (MRF) is a fast-imaging acquisition technique that generates quantitative and co-registered parametric maps. The aim of this feasibility study was to evaluate the agreement between MRF and phantom reference values, scan-rescan repeatability of MRF in normal cervix, and its ability to distinguish cervical carcinoma (CC) from normal cervical tissues.
Methods: An International Society of Magnetic Resonance in Medicine/National Institute of Standards and Technology (ISMRM/NIST) phantom was scanned using MRF 15 times over 65 days. Agreement between MRF and phantom reference T1 and T2 values was assessed by linear regression. Healthy volunteers and patients with suspected CC were prospectively recruited. MRF was repeated twice for healthy volunteers (MRF1 and MRF2). Volumes of interest of normal cervical tissues and CC were delineated on T1 and T2 maps. MRF scan-rescan repeatability was evaluated by Bland-Altman plots, within-subject coefficients of variation (wCV), and intraclass correlation coefficients (ICC). T1 and T2 values were compared between CC and normal cervical tissues using Mann-Whitney U test. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic efficiency.
Results: Strong correlations were observed between MRF and phantom (R2≥0.999 for T1, 0.981 for T2). Twelve healthy volunteers (28.7±5.1 years) and 28 patients with CC (54.6±15.2 years) were recruited for the in-vivo experiments. Repeatability of MRF parameters were wCV <3% for T1, <5% for T2 and ICC ≥0.92 for T1, ≥0.94 for T2. T1 value of CC (1,529±112 ms) was higher than normal mucosa [MRF1: 1,430± 129 ms, MRF2: 1,440±130 ms; P≥0.031, area under the curve (AUC) ≥0.717] and normal stroma (MRF1: 1,258±101 ms, MRF2: 1,276±105 ms; P<0.001, AUC ≥0.946). T2 value of CC (69±9 ms) was lower than normal mucosa (MRF1: 88±16 ms, MRF2: 87±13 ms; P<0.001, AUC ≥0.854), but was not different from normal stroma (P≥0.919).
Conclusions: Excellent agreement was observed between MRF and phantom reference values. MRF exhibited excellent scan-rescan repeatability in normal cervix with potential value in differentiating CC from normal cervical tissues.
Keywords: Cervical carcinoma (CC)
Magnetic resonance fingerprinting (MRF)
Quantitative magnetic resonance imaging (quantitative MRI)
Repeatability
Publisher: AME Publishing Company
Journal: Quantitative imaging in medicine and surgery 
ISSN: 2223-4292
EISSN: 2223-4306
DOI: 10.21037/qims-20-1382
Rights: © Quantitative Imaging in Medicine and Surgery. All rights reserved.
This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
The following publication Wang M, Perucho JAU, Cao P, Vardhanabhuti V, Cui D, Wang Y, Khong PL, Hui ES, Lee EYP. Repeatability of MR fingerprinting in normal cervix and utility in cervical carcinoma. Quant Imaging Med Surg 2021;11(9):3990-4003 is available at https://doi.org/10.21037/qims-20-1382
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