表观弥散系数的直方图特征与弥漫性胶质瘤组织学分级、Ki⁃67增殖指数的对照研究  

A Comparative Study of Histogram Parameters of Apparent Diffusion Coefficient with Histological Grade of Diffuse Gliomas and Ki⁃67 Proliferation Index

作　　者：卢海涛[1] 邢伟[1] 张艳文[1] 周鹏[2] 顾正章[1] LU Haitao;XING Wei;ZHANG Yanwen;ZHOU Peng;GU Zhengzhang(Department of Radiology,The First People's Hospital of Changzhou;Department of Neurosurgery,The First People's Hospital of Changzhou Address:185 Juqian Street,Changzhou 213003,China)

机构地区：[1]常州市第一人民医院影像科 [2]常州市第一人民医院神经外科

出　　处：《中国医学计算机成像杂志》2022年第1期1-7,共7页Chinese Computed Medical Imaging

基　　金：常州市卫生计生委青年人才科技项目(QN201811);常州市卫生健康青苗人才培养工程(CZQM2020032)。

摘　　要：目的:探讨表观弥散系数(ADC)的直方图特征鉴别弥漫性胶质瘤高、低级别的价值,并评价其与Ki-67增殖指数的相关性。方法:回顾性分析67例经术后病理证实的弥漫性胶质瘤(其中高级别组48例,低级别组19例)的影像学及病理学资料。比较高、低级别组弥漫性胶质瘤ADC值的多个直方图特征差异,对满足正态分布及方差齐性的特征采用独立样本t检验进行分析,对不满足正态分布或方差不齐的特征采用Mann⁃Whitney秩和检验,然后绘制ROC曲线以评价其ADC值直方图特征鉴别高、低级别脑胶质瘤的效能。采用Pearson相关分析评价ADC值的直方图特征与Ki⁃67增殖指数的相关性。结果:高级别胶质瘤的ADC最大值、标准差及不均匀度分别为2.395(2.359,3.227)×10^(-3)mm^(2)/s、0.410(0.306,0.534)×10^(-3)mm^(2)/s、0.305±0.086,大于低级别胶质瘤相对应的直方图特征[分别为2.107(1.927,2.546)×10^(-3)mm^(2)/s、0.204(0.171,0.383)×10^(-3)mm^(2)/s、0.203±0.114],2组间差异具有统计学意义(P值分别为0.025、0.001、0.000)。高级别胶质瘤的ADC值第10百分位数、第25百分位数分别为0.825(0.749,0.991)×10^(-3)mm^(2)/s、(1.068±0.246)×10^(-3)mm^(2)/s,小于低级别胶质瘤相对应的直方图特征[分别为1.191(0.863,1.313)×10^(-3)mm^(2)/s、(1.225±0.297)×10^(-3)mm^(2)/s],2组间差异具有统计学意义(P值分别为0.002、0.029)。ROC曲线示ADC值的不均匀度鉴别高、低级别胶质瘤的ROC曲线下面积最大(0.815),同时对鉴别诊断的灵敏度最高(95.8%),最大值、第10百分位数的特异度最高(均为68.4%)。Pearson相关性分析示ADC值的第10百分位数与Ki⁃67增殖指数呈负相关(r=-0.415,P=0.002),不均匀度与Ki⁃67增殖指数呈正相关(r=0.343,P=0.008)。结论:表观弥散系数的直方图特征有助于预测弥漫性胶质瘤的组织学分级、Ki⁃67增殖指数,对胶质瘤临床治疗方案的选取具有一定的价值。Purpose To explore the clinical value of histogram parameters of apparent diffusion coefficient(ADC)in distinguishing high-and low-grade diffuse gliomas,and evaluate its correlation with Ki-67 proliferation index.Methods:A retrospective analysis of the imaging and pathological data of 67 cases of diffuse gliomas confirmed by postoperative pathology(48 cases in high-grade group and 19 cases in low-grade group)were analyzed.The independent samples t test(normal distribution and homogeneity of variance)or Mann-Whitney rank sum test(abnormal distribution or heterogeneity of variance)were used to compare the differences of histogram parameters of ADC values between high-and low-grade gliomas.Receiver operating characteristic(ROC)curve was used to evaluate the efficiency of histogram parameters of ADC value in distinguishing high-and low-grade glioma of the brain.Pearson correlation was used to assess associations between histogram parameters of ADC value and Ki-67 proliferation index.Results:The ADC maximum value,standard deviation and unevenness of high-grade glioma were 2.395(2.359,3.227)×10^(-3)mm^(2)/s,0.410(0.306,0.534)×10^(-3)mm^(2)/s,0.305±0.086,which were greater than those of low-grade gliomas[2.107(1.927,2.546)×10^(-3)mm^(2)/s,0.204(0.171,0.383)×10^(-3)mm^(2)/s,0.203±0.114],the difference between the two groups was statistically significant(P values were 0.025,0.001,0.000,respectively).The 10th percentile and 25th percentile of ADC values for high-grade gliomas were 0.825(0.749,0.991)×10^(-3)mm^(2)/s,(1.068±0.246)×10^(-3)mm^(2)/s,which were smaller than those of low-grade gliomas[1.191(0.863,1.313)×10^(-3)mm^(2)/s,(1.225±0.297)×10^(-3)mm^(2)/s],the difference between the two groups was statistically significant(P values are 0.002,0.029,respectively).In all histogram parameters of ADC value,inhomogeneity had the largest area of ROC curve(0.815),and the highest sensitivity(95.8%)in differential high-and low-grade brain gliomas.The maximum and the 10th percentile had the largest specificity(68.4%).P

关 键 词：弥漫性胶质瘤 组织学分级 Ki⁃67增殖指数 表观弥散系数 直方图分析 

分 类 号：R445.2[医药卫生—影像医学与核医学]