The value of multiple quantitative parameters of diffusion kurtosis imaging sequence to
evaluate the expression of Ki-67 in endometrial carcinoma: a preliminary study
TIAN Shi-feng, LIU Ai-lian, ZHU Wen, WANG Xue-dong, SONG Qing-wei, GUAN Hong-wei, LI Ye, LIU Jing-hong
The First Affiliated Hospital of Dalian Medical University, Dalian Liaoning 116011, China
Abstract：Objective: To investigate the correlation between multiple quantitative parameters of diffusion kurtosis imaging sequence and the expression of proliferating antigen Ki-67 in endometrial carcinoma(EC). Methods: We retrospectively analyzed 21 cases of imaging data with 1.5T MRI examination(including DKI sequence) diagnosed as EC. The index of immunohistochemical analysis included Ki-67. According to the Ki-67 expression index(<50% was low expression, ≥50% was high expression), 21 cases were divided into Ki-67 high expression group(11 cases) and Ki-67 low expression group(10 cases). The DKI parameters of two groups were measured by two observers, included mean kurtosis(MK), axial kurtosis(Ka), radial kurtosis(Kr), fractional anisotropy of kurtosis(FAk), mean diffusivity(MD), axial diffusivity(Da), radial diffusivity(Dr) and fractional anisotropy(FA). The intra-class correlation coefficients(ICC) was used to test the consistency of the parameters measured results with the two observers. The two independent samples t test was used to compare the parameters of two groups. For the parameters that had the differential value, the ROC curve was used to evaluate their efficacy in the differential diagnosis of Ki-67 high and low expression groups. The Pearson correlation analysis was used to assess the correlation between the values of each parameter and Ki-67 expression index. Results: The data consistency of two observers was good(ICC>0.75). The MK, Ka, Kr, FAk, MD, Da, Dr and FA values of Ki-67 high expression group were 1.05±0.13, 1.17±0.21, 0.95±0.14, 0.41±0.14, (0.93±0.18) μm2/ms, (1.19±0.17) μm2/ms, (0.80±0.21) μm2/ms, 0.27±0.11, respectively. The parameters of Ki-67 low expression group were 0.79±0.10, 0.86±0.12, 0.72±0.14, 0.35±0.11, (1.33±0.28) μm2/ms, (1.64±0.37) μm2/ms, (1.17±0.25) μm2/ms, 0.23±0.08, respectively. The difference of MK, Ka, Kr, MD, Da and Dr values was statistically significant(P<0.05). The FAk, FA values of two groups were not statistically significant(P>0.05). The area under curve(AUC) of MK, Ka, Kr, MD, Da, Dr values to diagnose Ki-67 high expression were 0.982, 0.900, 0.900, 0.900, 0.973, 0.882, respectively. The boundary values were 0.92, 1.09, 0.85, 1.08 μm2/ms, 1.41 μm2/ms, 0.96 μm2/ms, respectively. The sensitivity was 90.9%, 72.7%, 81.8%, 81.8%, 100%, 81.8%, the specificity was 100%, 100%, 90%, 90%, 90%, 90%, respectively. The MK, Ka, Kr values were positively correlated with the Ki-67 expression index, the MD, Da, Dr values were negatively correlated with the Ki-67 expression index(P<0.05), and there were no correlation between the FAk and FA valueswith the Ki-67 expression index(P>0.05). Conclusion: The MK, Ka, Kr, MD, Da, Dr values of DKI sequence are related to the expression of Ki-67, and have the potential to reflect the proliferation of EC cells. MK value is the best parameter.
田士峰，刘爱连，朱 雯，王学东，宋清伟，关宏伟，李 烨，刘静红. 初探扩散峰度成像多定量参数评估子宫内膜癌Ki-67表达的价值[J]. 中国临床医学影像杂志, 2018, 29(11): 808-813.
TIAN Shi-feng, LIU Ai-lian, ZHU Wen, WANG Xue-dong, SONG Qing-wei, GUAN Hong-wei, LI Ye, LIU Jing-hong. The value of multiple quantitative parameters of diffusion kurtosis imaging sequence to
evaluate the expression of Ki-67 in endometrial carcinoma: a preliminary study. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(11): 808-813.
[1]Di Donato V, Iacobelli V, Schiavi MC, et al. Impact of hormone receptor status and Ki-67 expression on disease-free survival in patients affected by high-risk endometrial cancer[J]. Int J Gynecol Cancer, 2018, 28(3): 505-513.
[2]Stoenescu VE, Niculescu M, Novac L, et al. Immunohistochemical reaction of the glandular epithelium in endometrial hyperplasia compared to endometrial carcinoma[J]. Rom J Morphol Embryol, 2017, 58(3): 791-800.
[3]Niikura N, Masuda S, Kumaki N, et al. Prognostic significance of the Ki67 scoring categories in breast cancer subgroups[J]. Clin Breast Cancer, 2014, 14(5): 323-329.
[4]Yin J, Sun H, Wang Z, et al. Diffusion kurtosis imaging of acute infarction: comparison with routine diffusion and follow-up MR imaging[J]. Radiology, 2018, 287(2): 651-657.
[5]Peiró G, Mayr D, Hillemanns P, et al. Analysis of HER-2/neu amplification in endometrial carcinoma by chromogenic in situ hybridization. Correlation with fluorescence in situ hybridization, HER-2/neu, p53 and Ki-67 protein expression, and outcome[J]. Mod Pathol, 2004, 17(3): 277-287.
[6]Yoshikawa K, Shimada M, Higashijima J, et al. Ki-67 and survivin as predictive factors for rectal cancer treated with preoperative chemoradiotherapy[J]. Anticancer Res, 2018, 38(3): 1735-1739.
[7]Kushitani K, Amatya VJ, Mawas AS, et al. Utility of survivin, BAP1, and Ki-67 immunohistochemistry in distinguishing epithelioid mesothelioma from reactive mesothelial hyperplasia[J]. Oncol Lett, 2018, 15(3): 3540-3547.
[8]Jiang JX, Zhao JL, Zhang Q, et al. Endometrial carcinoma: diffusion-weighted imaging diagnostic accuracy and correlation with Ki-67 expression[J]. Clin Radiol, 2018, 73(4): 413.
[9]王琨华, 郭启勇. 子宫内膜癌的DWI成像特征及其与PCNA、Ki-67表达相关性研究[J]. 医学影像学杂志，2011，21（11）：1718-1723.
[10]Shen L, Zhou G, Tang F, et al. MR diffusion kurtosis imaging for cancer diagnosis: A meta-analysis of the diagnostic accuracy of quantitative kurtosis value and diffusion coefficient[J]. Clin Imaging, 2018, 52(1): 44-56.
[11]Chen T, Li Y, Lu SS, et al. Quantitative evaluation of diffusion-kurtosis imaging for grading endometrial carcinoma: a comparative study with diffusion-weighted imaging[J]. Clin Radiol, 2017, 72(11): 995e11-e20.
[12]Zhao L, Wang Y, Jia Y, et al. Microstructural abnormalities of basal ganglia and thalamus in bipolar and unipolar disorders: a diffusion kurtosis and perfusion imaging study[J]. Psychiatry Investig, 2017, 14(4): 471-482.
[13]徐红霞，黄小华，刘梦苓，等. 扩散峰度成像在腹部疾病中的研究进展[J]. 国际医学放射学杂志，2018，41（2）：190-193.
[14]McKenna BS, Brown GG, Archibald S, et al. Microstructural changes to the brain of mice after methamphetamine exposure as identified with diffusion tensor imaging[J]. Psychiatry Res, 2016, 249(1): 27-37.
[15]Raab P, Hattingen E, Franz K, et al. Cerebral gliomas: diffusional kurtosis imaging analysis of microstructural differences[J]. Radiology, 2010, 254(3): 876-881.
[16]朱庆强，朱文荣，叶靖，等. 扩散峰度成像评价肾透明细胞癌恶性程度的价值[J]. 中华放射学杂志，2017，51（3）：188-191.
[17]田士峰，刘爱连，陈丽华，等. 扩散峰度成像预估宫颈鳞癌病理分级的价值[J]. 实用放射学杂志，2017，33（1）：111-114.
