Amide Proton Transfer‐Weighted Imaging and Multiple Models Diffusion‐Weighted Imaging Facilitates Preoperative Risk Stratification of Early‐Stage Endometrial Carcinoma

Background Endometrial carcinoma (EC) risk stratification is generally based on histological assessment. It would be beneficial to perform risk stratification noninvasively by MRI. Purpose To investigate the application of amide proton transfer‐weighted imaging (APTWI), monoexponential, biexponential, and stretched exponential intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) for the evaluation of risk stratification in early‐stage EC. Study Type Prospective. Population Eighty patients with early‐stage EC (47 classified as low risk, 20 as medium risk, and 13 as high risk by histological grade and International Federation of Gynecology and Obstetrics stage). Field Strength/Sequence T1‐weighted imaging, T2‐weighted imaging, IVIM, APTWI, and DKI MRI at 3 T. Assessment The magnetization transfer ratio asymmetry (MTRasym [3.5 ppm]), apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), distributed diffusion coefficient (DDC), water molecular diffusion heterogeneity index (α), mean kurtosis (MK), and mean diffusivity (MD) were calculated and compared between low‐risk and non‐low‐risk groups. Statistical Tests Individual sample t test, analysis of variance, and logistic regression. A P‐value