肺癌脑转移瘤平均表观扩散系数值预测原发病灶Ki-67水平及亚型鉴别的价值  

The value of mean apparent diffusion coefficient of brain metastatic lung cancer in predicting Ki-67 level in the primary lesion and identifying subtypes

作　　者：赵晶晶 王刚 努尔比耶姆·阿布力克木 刘珺迪 姜春晖 丁爽 王云玲 刘文亚 贾文霄 王俭 ZHAO Jingjing;WANG Gang;NUERBIYEMU·Abulikemu;LIU Jundi;JIANG Chunhui;DING Shuang;WANG Yunling;LIU Wenya;JIA Wenxiao;WANG Jian(Imaging Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China;Department of Imaging,Shenzhen Hospital of Integrated Chinese and Western Medicine,Shenzhen,Guangdong Province 518104,China;Department of Radiology,Xi’an GEM Flower Changqing Hospital,Xi’an 710201,China)

机构地区：[1]新疆医科大学第一附属医院影像中心,新疆乌鲁木齐830000 [2]深圳市中西医结合医院医学影像科,广东深圳518104 [3]西安宝石花长庆医院放射科,陕西西安710201

出　　处：《实用放射学杂志》2023年第2期210-213,共4页Journal of Practical Radiology

摘　　要：目的探讨肺癌脑转移瘤平均表观扩散系数(ADCmean)值与原发病灶Ki-67水平的相关性及在亚型鉴别中的价值。方法回顾性纳入肺癌脑转移患者51例(共63个病灶),其中腺癌29例(31个病灶),鳞癌8例(13个病灶),小细胞癌14例(19个病灶),所有患者原发病灶均经病理检查、扩散加权成像(DWI)(b=1000 s/mm^(2))扫描及Ki-67检测。通过测量获得ADCmean值,采用SPSS 25.0软件及R语言进行相关性分析,组间两两比较采用LSD检验,同时将脑转移患者分为Ki-67高表达组(>25%)、Ki-67低表达组(≤25%),应用受试者工作特征(ROC)曲线评判Ki-67表达的诊断能力。结果肺癌脑转移瘤的ADCmean值与原发病灶Ki-67呈显著负相关(r=-0.655,P<0.01),3种肺癌亚型ADCmean值与Ki-67呈负相关(r腺癌=-0.495,r磷癌=-0.395,r小细胞癌=-0.694),亚型ADCmean差异有统计学意义(P<0.05)。Ki-67低表达组的ADCmean值高于Ki-67高表达组,差异有统计学意义(P<0.05);ADCmean值判断Ki-67低表达的曲线下面积(AUC)为0.881,以0.878×10^(-3)mm^(2)/s为界值判断Ki-67低表达的敏感性、特异性、阳性预测值、阴性预测值分别为87%、81%、60%、95%。结论肺癌脑转移瘤ADCmean值与原发病灶Ki-67表达水平呈负相关性具有一定的预测价值,在肺癌亚型鉴别中提供潜在的影像学信息,为临床精准治疗提供依据。Objective To investigate the correlation between mean apparent diffusion coefficient(ADCmean)value of brain metastatic lung cancer and Ki-67 level in the primary lesion and its value in subtype differentiation.Methods A total of 51 eligible patients including 63 metastatic brain lesions of lung cancer were retrospectively enrolled,including 29 adenocarcinoma(31 lesions),8 squamous carcinoma(13 lesions),and 14 small cell carcinoma(19 lesions).The primary lesions of all patients were examined by pathological examination,diffusion weighted imaging(DWI)(b=1000 s/mm^(2))scan and Ki-67 detection.The ADCmean value was obtained by measurement,and correlation analysis was performed by SPSS 25.0 software and R language.LSD test was used for pair comparison between groups.Meanwhile,patients were divided into high(>25%)and low(≤25%)expression groups of Ki-67.The diagnostic ability of ADCmean value to evaluate Ki-67 expression by receiver operating characteristic(ROC)curve was performed.Results There was a significant negative correlation between the ADCmean value of brain metastatic lung cancer and Ki-67 in the primary lesion(r=-0.655,P<0.01),and there was a negative correlation between the ADCmean value of three lung cancer subtypes and Ki-67(r value of adenocarcinoma=-0.495,r value of squamous carcinoma=-0.395 and r value of small cell carcinoma=-0.694).There were significant differences in ADCmean values among three subtype(P<0.05).The ADCmean value of Ki-67 low expression group was higher than that of Ki-67 high expression group,and the difference was statistically significant(P<0.05).The ADCmean value judged the area under the curve(AUC)of Ki-67 low expression was 0.881,with 0.878×10-3 mm2/s as the cutoff value,the sensitivity,specificity,positive predictive value and negative predictive value of Ki-67 low expression were 87%,81%,60%and 95%,respectively.Conclusion The negative correlation is found between ADCmean of brain metastatic lung cancer and Ki-67 expression level of primary lesion,which has certain predictive

关 键 词：表观扩散系数 肿瘤转移 KI-67 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R734.2[医药卫生—诊断学] R739.41[医药卫生—临床医学]