Time-dependent diffusion MRI in determining mismatch repair status of endometrial cancer

@article{zhang2026timedependent,
  title = {{Time-dependent diffusion MRI in determining mismatch repair status of endometrial cancer}},
  author = {Jiarui Zhang and Diwei Shi and Jing Xi Joshua Li and Cheuk Nam Hwang and Fan Liu and Zongshu Wang and Grace Ho and Thorsten Feiweier and Juan Wei and Hua Guo and Elaine YP Lee},
  journal = {European Radiology Experimental},
  year = {2026},
  month = nov,
  doi = {10.1186/s41747-026-00830-y},
  url = {https://doi.org/10.1186/s41747-026-00830-y},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Time-dependent diffusion MRI in determining mismatch repair status of endometrial cancer
AU  - Jiarui Zhang
AU  - Diwei Shi
AU  - Jing Xi Joshua Li
AU  - Cheuk Nam Hwang
AU  - Fan Liu
AU  - Zongshu Wang
AU  - Grace Ho
AU  - Thorsten Feiweier
AU  - Juan Wei
AU  - Hua Guo
AU  - Elaine YP Lee
PY  - 2026
DA  - 2026/11/03
JO  - European Radiology Experimental
DO  - 10.1186/s41747-026-00830-y
UR  - https://doi.org/10.1186/s41747-026-00830-y
AB  - Objectives: Mismatch repair (MMR) proteins are important in determining therapeutic strategy in endometrial cancer (EC). We investigated the role of microstructural parameters derived from time-dependent diffusion magnetic resonance imaging (td-dMRI) in differentiating MMR status of EC.  Materials and methods: This prospective single-center study enrolled patients with suspected EC who underwent preoperative td-dMRI. Tumors were classified as MMR-deficient (dMMR) and MMR-proficient (pMMR) by immunohistochemistry. The microstructural parameters, including intracellular volume fraction (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}v_in\end{document}vin), cell diameter (dd), cellularity (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}ρ\end{document}ρ), extracellular diffusivity (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}D_ex\end{document}Dex), and water exchange rate constant (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}k_in\end{document}kin), were derived by fitting td-dMRI data with three methods (IMPULSED, JOINT, and EXCHANGE), together with the apparent diffusion coefficient (ADC). Differences in these microstructural parameters between dMMR and pMMR EC were compared. The diagnostic performances were evaluated by the areas under the receiver operating characteristic curve (AUC).  Results: Eighty-two patients (17 dMMR, 61.8 ± 10.1 years and 65 pMMR, 58.6 ± 11.8 years) were recruited. dMMR EC exhibited higher \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}v_in\end{document}vin, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}ρ\end{document}ρ and lower \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}D_ex\end{document}Dex, ADC values than pMMR EC (p ≤ 0.003). IMPULSED and JOINT demonstrated higher AUCs than conventional ADC (p = 0.025 and 0.046, respectively). The combined selected microstructural parameters (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}v_in\end{document}vin and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}D_ex\end{document}Dex) derived from JOINT achieved an AUC of 0.903; JOINT demonstrated superior parametric stability and marginally better calibration than IMPULSED.  Conclusion: In this exploratory study, td-dMRI discriminated between dMMR and pMMR ECs, providing information on the intricate microscopic organizational structures in tumors. The microstructural parameters may serve as a promising method to improve the diagnostic efficacy of diffusion-weighted MRI in differentiating MMR status of EC.  Key Points: Question There remains an unmet need for noninvasive, preoperative tools to assess DNA MMR status in EC.  Findings td-dMRI showed significant differences in microstructural parameters between dMMR and pMMR tumors.  Relevance statement td-dMRI shows potential as a noninvasive imaging approach for preoperative assessment of MMR status in EC and may support individualized treatment planning.  Graphical Abstract:
SN  - 2509-9280
ER  -