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

doi:10.12117/jccmi.2018.11.010

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摘要目的：初探MR扩散峰度成像（DKI）多定量参数与子宫内膜癌（EC）增殖抗原Ki-67表达的相关性。方法：回顾性分析21例行1.5T MRI检查（含DKI序列），经手术病理（免疫组化分析指标含Ki-67）诊断为EC的影像资料，按照Ki-67表达指数（<50%为低表达，≥50%为高表达），分为Ki-67高表达组11例，Ki-67低表达组10例。由两位观察者分别测量两组病灶实质区DKI各参数值，包括平均弥散峰度值（MK）、平行弥散峰度值（Ka）、垂直弥散峰度值（Kr）、峰度各向异性分数（FAk）、平均弥散系数值（MD）、平行弥散系数值（Da）、垂直弥散系数值（Dr）及各向异性分数（FA）。采用组内相关系数（ICC）检验两位观察者各参数测量结果一致性；采用两独立样本t检验比较两组各参数值差异；采用ROC曲线评估有鉴别价值的参数对Ki-67高、低表达组鉴别诊断的效能；采用Pearson相关分析评价各参数值与Ki-67表达指数的相关性。结果：两位观察者测得两组病灶各参数值的一致性均良好（ICC>0.75）。Ki-67高表达组的MK、Ka、Kr、FAk、MD、Da、Dr、FA值分别为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，Ki-67低表达组的各参数值分别为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，Ki-67高表达组的MK、Ka、Kr值大于低表达组，MD、Da、Dr值小于低表达组（P均<0.05），两组间FAk、FA值差异无统计学意义（P>0.05）。MK、Ka、Kr、MD、Da、Dr值预估Ki-67高表达的曲线下面积（AUC）分别为0.982、0.900、0.900、0.900、0.973、0.882，截断值分别为0.92、1.09、0.85、1.08 μm2/ms、1.41 μm2/ms、0.96 μm2/ms，敏感度分别为90.9%、72.7%、81.8%、81.8%、100%、81.8%，特异度分别为100%、100%、90%、90%、90%、90%。MK、Ka、Kr与Ki-67表达指数正相关（P均<0.05），MD、Da、Dr与Ki-67表达指数负相关（P均<0.05），FAk、FA值与Ki-67表达指数无相关性（P>0.05）。结论：DKI序列的MK、Ka、Kr、MD、Da、Dr值与EC Ki-67表达具有相关性，有反映EC肿瘤细胞增殖程度的潜力，MK值为最佳参数。

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	田士峰
	刘爱连
	朱雯
	王学东
	宋清伟
	关宏伟
	李烨
	刘静红

关键词 ：子宫内膜肿瘤, Ki-67抗原, 磁共振成像

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.

Key words： Endometrial neoplasms Ki-67 antigen Magnetic resonance imaging

收稿日期: 2018-08-10

PACS:	Ｒ737.33
	Ｒ445.2

基金资助:辽宁省教育科学“十三五”规划课题基金资助项目（JG17DB112）。

通讯作者: 刘爱连，大连医科大学附属第一医院放射科，116011。E-mail：cjr.liuailian@vip.163.com

作者简介: 田士峰（1987-），男，辽宁大连人，主治医师。E-mail：TSF253356@163.com

引用本文:

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.

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http://www.jccmi.com.cn/CN/10.12117/jccmi.2018.11.010 或 http://www.jccmi.com.cn/CN/Y2018/V29/I11/808

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