表观弥散系数预测脑膜瘤病理学分级及其与Ki-67增殖指数的相关性  

Apparent diffusion coefficient predicts the pathological grade of meningioma and its correlation with the Ki-67 proliferation index

作　　者：方磊 方慧 耿源源 殷润 刘新疆 FANG Lei;FANG Hui;GENG Yuanyuan;YIN Run;LIU Xinjiang(Department of Medical Imaging College,Binzhou Medical University,Yantai 264003,Shandong Province,China;Department of Radiology,Pudong Hospital,Fudan University,Shanghai 201399,China;Department of Pathology,Pudong Hospital,Fudan University,Shanghai 201399,China)

机构地区：[1]滨州医学院医学影像学院,山东烟台264003 [2]复旦大学附属浦东医院放射科,上海201399 [3]复旦大学附属浦东医院病理科,上海201399

出　　处：《肿瘤影像学》2024年第2期136-142,共7页Oncoradiology

基　　金：上海市卫生健康委员会面上项目(202140266);复旦大学附属浦东医院特色专病(Tszb2023-08)。

摘　　要：目的:探讨表观弥散系数(apparent diffusion coefficient,ADC)鉴别诊断脑膜瘤组织病理学分级的价值及其与Ki-67增殖指数的关系。方法:回顾并分析经术后病理学检查证实为脑膜瘤的51例患者资料,根据世界卫生组织(World Health Organization,WHO)病理学分级分为低级别脑膜瘤(low-grade meningioma,LGM)组45例和高级别脑膜瘤(high-grade meningioma,HGM)组6例,计算平均ADC(ADC_(mean))、最小ADC(ADC_(min)),以及两者相对值(rADC_(mean)、rADC_(min))。比较两组ADC_(mean)、ADC_(min)、rADC_(mean)、rADC_(min)的差异。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估ADC各参数的鉴别诊断效能,并采用DeLong检验比较ROC曲线的曲线下面积(area under the curve,AUC)的差异。采用Spearman相关分析评估ADC各参数与Ki-67增殖指数之间的相关性。结果:LGM组的ADC_(mean)、ADC_(min)、rADC_(mean)及rADC_(min)均高于HGM组,组间差异有统计学意义(P<0.05)。4种ADC参数均有较好的诊断效能,DeLong检验显示AUC两两比较差异均无统计学意义(P>0.05),其中ADC_(min)的鉴别诊断效能最高,其最佳截断值为0.657×10^(-3)mm^(2)/s,灵敏度为66.67%,特异度为95.56%。ADC_(mean)、ADC_(min)、rADC_(mean)及rADC_(min)均与Ki-67增殖指数呈负相关(P<0.05)。结论:ADC有助于术前预测脑膜瘤的病理学分级及Ki-67增殖指数,可为临床诊疗提供支持。Objective:To investigate the value of apparent diffusion coefficient(ADC)for differential diagnosis of histopathologic grade of meningiomas and its relationship with Ki-67 proliferation index.Methods:The data of 51 patients with meningioma confirmed by surgery and pathology were reviewed and analyzed.According to the World Health Organization(WHO)pathological grade,patients were divided into low-grade meningioma(LGM)group(45 cases)and high-grade meningioma(HGM)group(6 cases).The average ADC(ADC_(mean)),minimum ADC(ADC_(min)),and their relative values(rADC_(mean)and rADC_(min))were calculated.The differences of ADC_(mean),ADC_(min),rADC_(mean)and rADC_(min)between the two groups were compared.The receiver operating characteristic(ROC)curve was used to assess the diagnostic efficacy of each ADC parameter’s diagnostic efficacy,and DeLong’s test was used to compare the difference in area under curve(AUC)of the ROC curve.Spearman correlation analysis was performed to assess the correlation between each of the ADC parameters and Ki-67 proliferation index.Results:The ADC_(mean),ADC_(min),rADC_(mean)and rADC_(min)values of the LGM group were higher than those of the HGM group,and the differences between the groups were all statistically significant(P<0.05).The four ADC parameters all had good diagnostic efficacy,DeLong test showed that there was no significant difference in AUC between any two groups(P>0.05).And ADC_(min)had the best differential diagnostic efficacy.The optimal cut-off value of ADC_(min)was 0.657×10^(-3)mm^(2)/s,and the sensitivity was 66.67%,and the specificity was 95.56%.ADC_(mean),ADC_(min),rADC_(mean)and rADC_(min)values were all negatively correlated with Ki-67 proliferation index(P<0.05).Conclusion:ADC values were helpful to predict the pathological grade of meningiomas and Ki-67 proliferation index before operation,and it can provide support for clinical diagnosis and treatment.

关 键 词：脑膜瘤 磁共振成像 表观弥散系数 Ki-67增殖指数 

分 类 号：R739.45[医药卫生—肿瘤] R445.2[医药卫生—临床医学]