The value of dynamic contrast-enhanced MRI combined with DWI and the serum β-hCG for assessing villous apoptosis in early tubal pregnancy

<title>Abstract</title> <p> Purpose To evaluate the combined value of dynamic contrast-enhanced (DCE) MRI, diffusion-weighted imaging (DWI), and serum β-hCG level in assessing villous apoptosis in early tubal pregnancy. Methods Fifty patients with tubal pregnancy undergoing preoperative MRI (DCE and DWI) and surgical treatment were prospectively enrolled. Maximum enhancement amplitude and apparent diffusion coefficient (ADC) of villi were measured, and serum β-hCG was obtained on the day of MRI. Villous apoptosis was assessed histopathologically by TUNEL staining to determine the apoptosis index (AI). Imaging parameters and β-hCG were correlated with AI and compared between groups. Results ADC correlated negatively with enhancement amplitude ( <italic>r</italic> = -0.742, <italic>p</italic>  &lt; 0.001) and β-hCG ( <italic>r</italic> = -0.644, <italic>p</italic>  = 0.001). Enhancement amplitude correlated positively with β-hCG ( <italic>r</italic>  = 0.688, <italic>p</italic>  &lt; 0.001). Both enhancement amplitude and β-hCG correlated negatively with AI ( <italic>r</italic> = -0.804, -0.821; <italic>p</italic>  &lt; 0.001), whereas ADC correlated positively with AI ( <italic>r</italic>  = 0.842, <italic>p</italic>  &lt; 0.001). The areas under the ROC curve for enhancement amplitude, ADC, β-hCG, and their combination were 0.864, 0.905, 0.926, and 0.982, respectively; corresponding sensitivities were 82.6%, 85.0%, 78.3%, and 87.0%; specificities were 85.2%, 82.6%, 96.3%, and 99.5%. Conclusion Combined DCE-MRI, DWI, and serum β-hCG improve diagnostic performance for noninvasively assessing villous apoptosis in early tubal pregnancy. Lower ADC values accompanied by higher enhancement amplitude and higher serum β-hCG levels indicate a lower degree of trophoblast apoptosis, and vice versa, potentially guiding individualized conservative management. </p>