Blood Oxygenation Level-Dependent MRI for Predicting Lymphovascular Space Invasion in Cervical Squamous Cell Carcinoma Treated with Neoadjuvant Chemotherapy: A Prospective Study.

RATIONALE AND OBJECTIVES: To assess the value of blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) in predicting lymphovascular space invasion (LVSI) after neoadjuvant chemotherapy (NACT) in patients with cervical squamous cell carcinoma (CSCC). MATERIALS AND METHODS: This prospective study included 73 patients with CSCC who underwent BOLD-MRI before and after NACT, prior to radical surgery. R2* values were quantified from the primary tumor. Clinical, pathological, and imaging parameters were compared between patients with and without LVSI. Logistic regression analysis was used to identify independent predictors of LVSI. Receiver operating characteristic (ROC) curve analysis, bootstrap internal validation, 10-fold cross-validation, and decision curve analysis were performed to evaluate diagnostic performance and clinical utility. RESULTS: demonstrated a sensitivity of 71.9%, specificity of 90.2%, and accuracy of 82.2% for predicting LVSI. The positive and negative predictive values were 85.2% and 80.4%, respectively. Bootstrap internal validation confirmed a stable AUC of 0.877 (95% CI: 0.812-0.951), while 10-fold cross-validation produced a mean AUC of 0.861 (95% CI: 0.766-0.956). Decision curve analysis indicated a net clinical benefit across a wide range of threshold probabilities. Additionally, Ki-67 index, lymph node metastasis, and depth of stromal invasion were independently associated with LVSI. CONCLUSION: The R2* values derived from BOLD-MRI were significantly higher 3-4 weeks after NACT than at baseline. The post-NACT R2* value shows promise as a non-invasive biomarker for predicting the absence of LVSI in CSCC patients treated with NACT and may aid in risk stratification to inform clinical decision-making regarding adjuvant therapy.