{
  "abstract": "Objective: This study aimed to evaluate whether voxel-level IVIM-based habitat analysis supports exploratory pretreatment stratification of Ki-67 proliferation status in cervical cancer.\n\nMaterials and methods: Between January 2019 and June 2025, medical records of 149 patients with histopathologically confirmed cervical cancer were initially screened. Before image-quality assessment, 49 were excluded because IVIM MRI had been performed after chemoradiotherapy (n = 5), cervical biopsy sampling (n = 21), or lesion excision (n = 10), or because no pathological Ki-67 immunohistochemistry result was available (n = 13). Of the remaining 100 patients, 17 were excluded because of severe image artefacts (n = 11) or lesions too small for reliable ROI delineation (n = 6), leaving 83 patients for analysis. Patients were stratified into high Ki-67 (Ki-67 >70%, n = 38) and low/equal Ki-67 (Ki-67 ≤70%, n = 45) groups. Solid-tumour regions were analysed with patient-level K-means clustering using normalised D, f, and ADC features; D* was excluded from clustering because of voxel-level fitting instability. Habitat labels were harmonised according to quantitative parameter profiles and treated as image-defined phenotypes. Habitat-derived features, conventional ROI parameters, and logistic models were evaluated for Ki-67 stratification.\n\nResults: Hab1 ADC was lower in the high- than in the low/equal-Ki-67 group (median [Q1–Q3], 0.947 [0.862–1.161] vs. 1.257 [1.113–1.455] × 10 ⁻³ mm ² /s; P < 0.001; BH q = 2.04×10 ⁻⁶ ), whereas Hab3 volume proportion was higher (0.396 [0.341–0.488] vs. 0.279 [0.190–0.390]; P = 0.002; BH q = 0.006). Hab1 ADC outperformed conventional ROI ADC for identifying high Ki-67 status [AUC, 0.826 (95% CI, 0.726–0.909) vs. 0.563 (95% CI, 0.429–0.695); paired DeLong P < 0.001]. The combined Hab1 ADC and Hab3 volume proportion model showed the numerically highest discrimination (apparent AUC, 0.877; 95% CI, 0.794–0.938), but this numerical improvement over Hab1 ADC alone was not statistically significant (paired DeLong P = 0.056). Fixed-feature leave-one-out validation of the combined model yielded an AUC of 0.855 (95% CI, 0.771–0.923) and a Brier score of 0.157 (95% CI, 0.112–0.204).\n\nConclusion: IVIM-based habitat analysis showed exploratory potential for non-invasive Ki-67 stratification by isolating a low-diffusivity imaging compartment otherwise obscured by conventional whole-tumour averaging. The combined habitat model should be interpreted as a research-stage imaging biomarker, not a clinical decision tool, and requires prospective external validation before clinical translation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Radiology, The Fifth Affiliated Hospital of Xinjiang Medical University",
    "Department of Cardiovascular Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
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        0
      ],
      "name": "Wenjing Yue"
    },
    {
      "affs": [
        0
      ],
      "name": "Hui Tian"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaofei Cai"
    },
    {
      "affs": [
        1
      ],
      "name": "Bofeng Yu"
    },
    {
      "affs": [
        0
      ],
      "name": "Yunqing Ban"
    },
    {
      "affs": [
        0
      ],
      "name": "Qiqi Kong"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/e82h07sp0m1fq.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1885498",
  "fulltext_url": "https://europepmc.org/articles/PMC13713370",
  "id": "e82h07sp0m1fq",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1885498/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
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      "openalex",
      "2741|MRI in cancer diagnosis"
    ]
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  "openalex": "W7221768235",
  "pdf_url": "https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1885498/pdf",
  "pmcid": "PMC13713370",
  "pmid": "42952534",
  "published": "2026-10-14",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/e82h07sp0m1fq.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:13Z",
      "native_id": "10.3389/fonc.2026.1885498",
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      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1885498/full"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2741|MRI in cancer diagnosis",
      "subfield": "imaging"
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  "title": "IVIM-based habitat imaging for non-invasive assessment of Ki-67 proliferation status in cervical cancer",
  "title_text": "IVIM-based habitat imaging for non-invasive assessment of Ki-67 proliferation status in cervical cancer",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:21:03Z",
  "url": "https://research.draconitic.com/paper/e82h07sp0m1fq",
  "venue": "Frontiers in Oncology",
  "versions": []
}