直肠腺癌扩散峰度成像定量参数与Ki-67表达的相关性研究  

Relationship between the quantitative parameters of diffusion kurtosis imaging and the Ki-67 expression level in rectal adenocarcinoma

作　　者：张道春[1] 黄金标[1] 刘子珊 周凯 张敏鸽[1] 潘善军[1] 喻海燕[1] 陈维翠 ZHANG Dao-chun;HUANG Jin-biao;LIU Zi-shan;ZHOU Kai;ZHANG Min-ge;PAN Shan-jun;YU Hai-yan;CHEN Wei-cui(Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University,Taizhou,Zhejiang 317000,China;不详)

机构地区：[1]台州医院放射科,浙江台州317000 [2]台州恩泽医疗中心(集团)恩泽医院检验科,浙江台州317000 [3]广东省中医院(广州中医药大学第二附属医院)放射科,广东广州510120

出　　处：《中华全科医学》2021年第1期99-102,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2019RC089)。

摘　　要：目的探讨直肠腺癌扩散峰度成像(DKI)定量参数与Ki-67表达的相关性。方法选取广东省中医院2019年1月—2020年6月收治的术前未接受新辅助化疗行高分辨率MRI、扩散加权成像(DWI,b=0、1000 s/mm^(2))及DKI(b=0、600、1000、2000 s/mm^(2))检查的43例直肠腺癌患者,测量病灶相应的平均扩散峰度(MK)、平均扩散系数(MD)及表观扩散系数(ADC),按Ki-67表达将其分为低表达组(Ki-67指数≤25%)和高表达组(Ki-67指数>25%),比较2组间MK、MD及ADC有无差异,用Spearman相关法评价各定量参数与Ki-67表达的相关性,并通过受试者工作特征曲线(ROC)来确定各参数鉴别诊断直肠腺癌Ki-67低表达与高表达的效能。结果直肠腺癌Ki-67低表达组与高表达组的MK、ADC分别为[0.88(0.81,0.94)vs.1.22(1.06,1.34);1.20(1.12,1.30)×10^(-3)mm^(2)/s vs.1.10(0.94,1.15)×10^(-3)mm^(2)/s],差异有统计学意义(均P<0.01),2组间MD[1.20(1.12,1.30)×10^(-3)mm^(2)/s vs.1.20(1.10,1.30)×10^(-3)mm^(2)/s]比较差异无统计学意义(P>0.05)。MK与Ki-67表达呈正相关(r=0.523,P<0.001),ADC与Ki-67表达呈负相关(r=-0.467,P<0.01)。MK的曲线下面积(AUC=0.906)较ADC、MD的更大,以MK=0.96为诊断阈值时,敏感性为96.77%,特异性为75.00%。结论MK、ADC与Ki-67表达相关,均可间接评估直肠腺癌肿瘤细胞的增殖情况,但MK在诊断效能方面优于ADC,能更好地反映直肠腺癌的侵袭性和分子生物学特性。Objective To explore the relationship between quantitative parameters of diffusion kurtosis imaging(DKI)and the molecular markers Ki-67 in patients with rectal adenocarcinoma.Methods A total of 43 patients with rectal adenocarcinoma who underwent surgery and did not receive chemoradiotherapy were selected in this retrospective study.The image data included high-resolution MRI,conventional diffusion-weighted imaging and DKI,Mean kurtosis(MK),mean diffusivity(MD)and apparent diffusion coefficient(ADC)were calculated.The patients were divided into the low-Ki-67 group(Ki-67≤25%)and high-Ki-67 group(Ki-67>25%)on the basis of the Ki-67 level.The difference of each parameter between the two groups was compared.Spearman correlation analysis was applied to confirm the correlation between each parameter value and Ki-67 expression level.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of each parameter.Results In the high-Ki-67 group,MK and MD were significantly different compared with those in the low-Ki-67 group[0.88(0.81,0.94)vs.1.22(1.06,1.34),P<0.01;1.20(1.12,1.30)×10^(-3)mm^(2)/s vs.1.10(0.94,1.15)×10^(-3)mm^(2)/s,P<0.01].However,MD showed no difference between the two groups[1.20(1.12,1.30)×10^(-3)mm^(2)/s vs.1.20(1.10,1.30)×10^(-3)mm^(2)/s,P>0.05].MK showed a positive association with the Ki-67 expression level(r=0.523,P<0.001),whereas ADC showed a negative association with the Ki-67 expression level(r=-0.467,P<0.01).Compared with MD and ADC,MK showed relatively higher area under the ROC curve of 0.906,sensitivity of 0.97 and specificity of 0.75.Conclusion MK and ADC are related to Ki-67 expression,which can indirectly evaluate the proliferation of rectal adenocarcinoma cells.However,MK is superior to ADC in diagnosis efficiency,and can better reflect the invasion and molecular biological characteristics of rectal adenocarcinoma.

关 键 词：直肠腺癌 磁共振成像 扩散峰度成像 扩散加权成像 KI-67表达 

分 类 号：R735.37[医药卫生—肿瘤] R445.2[医药卫生—临床医学]