Relationship between the quantitative parameters of diffusion kurtosis imaging and the Ki-67 expression level in rectal adenocarcinoma
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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、1 000 s/mm2)及DKI(b=0、600、1 000、2 000 s/mm2)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 mm2/s vs. 1.10(0.94, 1.15)×10-3 mm2/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 mm2/s vs.1.20(1.10, 1.30)×10-3 mm2/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。 Abstract: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 mm2/s vs. 1.10(0.94, 1.15)×10-3 mm2/s, P < 0.01]. However, MD showed no difference between the two groups [1.20(1.12, 1.30)×10-3 mm2/s vs. 1.20(1.10, 1.30)×10-3 mm2/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. -
图 1 直肠中下段高-中分化腺癌DWI及DKI图像结果
A为T2WI; B为MK图; C为MD图; D为ADC图; E为免疫组化图。同一患者，男性，55岁，直肠中下段高-中分化腺癌。肿瘤在T2WI序列呈稍高信号，在MK图呈稍高信号，MK=0.87，在MD图呈低信号，MD=1.12×10-3mm2/s，在ADC图呈低信号，ADC=1.17×10-3mm2/s，Ki-67染色在高倍镜下(×100)呈均一棕黄色颗粒(Ki-67指数为25%)。
图 2 直肠中段中分化腺癌DWI及DKI图像结果
A为T2WI; B为MK图; C为MD图; D为ADC图; E为免疫组化图。同一患者，男性，62岁，直肠中段中分化腺癌。肿瘤在T2WI序列呈稍高信号，在MK图呈高信号，MK=1.26，在MD图呈低信号，MD=0.96×10-3mm2/s，在ADC图呈低信号，ADC=0.98×10-3mm2/s，Ki-67染色在高倍镜下(×100)呈均一棕黄色颗粒(Ki-67指数为80%)。
表 1 2组直肠癌患者MK、MD及ADC比较(x ±s)
组别 例数 MK MD (×10-3 mm2/s) ADC (×10-3 mm2/s) 低表达组 12 0.88(0.81, 0.94) 1.20(1.12, 1.30) 1.20(1.12, 1.30) 高表达组 31 1.22(1.06, 1.34) 1.20(1.10, 1.30) 1.10(0.94, 1.15) Z值 -4.090 -0.109 -3.035 P值 < 0.001 0.083 0.004 
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表 3 MK、MD及ADC的受试者工作曲线
参数 曲线下面积 阈值 敏感性(%) 特异性(%) P值 MK 0.906 0.96 96.77 75.00 0.012 MD(×10-3 mm2/s) 0.511 1.11 83.87 33.33 0.924 ADC(×10-3 mm2/s) 0.800 1.04 61.29 91.67 0.010
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