增强T<sub>1</sub> mapping和ZOOMit IVIM成像的定量参数与肺癌Ki67表达的相关性及预测价值

doi:10.3760/cma.j.cn101202-20221010-00304

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摘要目的探讨增强T₁ mapping和缩放成像技术的体素内不相干运动（ZOOMit IVIM）成像的定量参数与肺癌Ki67表达的相关性,以及对肺癌Ki67表达预测价值的比较。方法回顾性纳入2020年9月—2022年4月山东第一医科大学附属省立医院52例经病理证实的肺癌患者的临床和MRI资料。患者男37例、女15例,年龄50~79岁（中位年龄63岁）,术前均行增强T₁ mapping和ZOOMit IVIM成像。测量病变的定量参数：ZOOMit IVIM定量参数包括表观弥散系数（ADC）、真弥散系数（D）、灌注分数（f）、伪弥散系数（D^*）;增强T₁ mapping定量参数包括增强前、后T₁值（T₁pre、T₁post）,T₁增强前后的变化值（∆T₁）及T₁值的变化百分比（∆T₁%）。根据患者病理检查细胞染色结果计算阳性细胞所占细胞总数的百分比（Ki67表达指数）,以25％为界将患者分为低表达组（Ki67表达指数≤25％）和高表达组（Ki67表达指数>25%）。观察指标：（1）比较2组患者的性别、年龄、病灶大小等基线资料。（2）分析各定量参数与肺癌Ki67表达指数间的相关性。（3）比较各定量参数在2组不同肺癌Ki67表达状态时的差异。（4）评价和比较差异有统计学意义的定量参数对Ki67高表达组的鉴别诊断效能。（5）分析2种成像中与灌注相关的参数之间的相关性。结果 52例患者中,Ki67低表达组19例,Ki67高表达组33例。（1）2组患者的性别、年龄、病灶大小差异均无统计学意义（P值均>0.05）。（2）ADC、D、∆T₁、∆T₁%与肺癌Ki67表达指数呈负相关,T₁post与Ki67表达指数呈正相关,其中以∆T₁%相关性最强（r=-0.659,P<0.001）;D^*、f、T₁pre与Ki67表达指数无明显相关。（3）肺癌Ki67高表达组的ADC、D、∆T₁、∆T₁%均低于低表达组,T₁post高于低表达组,差异均有统计学意义（P值均<0.01）;D^*、f、T₁pre在2组之间的差异均无统计学意义（P值均>0.05）。（4）2种成像中诊断效能最高的定量参数分别为ADC与∆T₁%（AUC=0.799、0.941）,二者诊断效能间的差异有统计学意义（Z=2.14,P=0.032）,其中∆T₁%的诊断效能更高,敏感度（78.79%）、特异度（94.74%）更高。（5）ZOOMit IVIM的定量参数D*、f与增强T₁ mapping定量参数间均无相关性（P值均>0.05）。结论增强T₁ mapping及ZOOMit IVIM成像均可预测肺癌Ki67的表达,其定量参数（ADC、D、T₁post、∆T₁、∆T₁%）与肺癌Ki67表达指数均具有相关性。其中以T₁mapping中的∆T₁%与Ki67表达指数相关性最强,且预测Ki67表达的效能最高,可为术前早期预测肺癌Ki67表达提供新视角。

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关键词 ：肺肿瘤, 功能磁共振成像, Ki67抗原, T₁ mapping技术, 体素内不相干运动

Abstract：Objective This study aims to investigate the correlation between the quantitative parameters of intravoxel incoherent motion imaging based on ZOOM imaging technology (ZOOMit IVIM) and enhanced T₁ mapping and the expression index of Ki67 in lung cancer and to compare the predictive value of these parameters for Ki67 expression in lung cancer. Methods In this retrospective study, the clinical and MRI data of 52 patients with pathologically confirmed lung cancer in Shandong Provincial Hospital Affiliated with Shandong First Medical University from September 2020 to April 2022 were included. The participants included 37 males and 15 females, aged 50-79 years (median age 63 years), and all of them underwent enhanced T₁ mapping and ZOOMit IVIM imaging before surgery. The following quantitative parameters were measured for lesions based on ZOOMit IVIM imaging: apparent diffusion coefficient (ADC) value, true diffusion coefficient (D) value, pseudo-diffusion coefficient (D*)value, and perfusion fraction (f) value. The quantitative parameters of the enhanced T₁ mapping included T₁ value before and after injection of the contrast medium (T₁pre, T₁post) and the change value of T₁ (∆T₁) as well as the percentage of change (∆T₁%). According to the results of pathological examination and cell staining, the percentage of positive cells in the total number of cells (Ki67 index) was calculated. The patients were divided into 19 cases in the low expression group (Ki67 index ≤25%) and 33 cases in the high expression group (Ki67 index >25%) with a cut-off of 25%. Observation index was used:(1) compare the baseline data of gender, age,and lesion size of two groups; (2) to analyze the correlation between each parameter and the expression index of Ki67 in lung cancer; (3) to explore the difference between the quantitative parameters in the different expression groups of Ki67; (4) to evaluate and compare the differential diagnostic efficacy of quantitive parameters with statical significance significance on Ki67 expression; (5) to investigate the correlation between perfusion-related parameters in the two imaging modalities. Results Among the 52 patients, 19 were in the low expression group and 33 were in the high expression group. (1) No significant differences were found in gender, age, and lesion size between the two groups (all P values >0.05). (2) ADC values, D values, ∆T₁, and ∆T₁% were negatively correlated with the expression index of Ki67 in lung cancer, and T₁post was positively correlated with the expression index. ∆T₁% had the strongest correlation (r=-0.659, P<0.001). No obvious correlation was found between D* value, f-value, T₁pre, and Ki67 expression. (3) ADC values, D values, ∆T₁ values, and ∆T₁% in the Ki67 high expression group were lower than those in the low expression group, and T₁post was higher than that in the low expression group, and the differences were statistically significant (all P values <0.01). D* value, f-value, and T₁pre were not significant different between the two groups (all P values >0.05). (4) The quantitative parameters with the highest diagnostic efficiency in the two imaging were ADC value and ∆T₁% (AUC=0.799, 0.941), and the difference between the diagnostic performance of the two quantitative parameters was statistically significant (Z=2.14, P=0.032), among which ∆T₁% had higher diagnostic performance and higher sensitivity (78.79%) and specificity (94.74%). (5) There was no correlation between the quantitative parameters D* and f of ZOOMit IVIM and the quantitative parameters of enhanced T₁ mapping (all P values >0.05). Conclusion The quantitative parameters (ADC value, D value, T₁post, ∆T₁, ∆T₁%) of ZOOMit IVIM and enhanced T₁ mapping were correlated with the expression of Ki67 in lung cancer. The enhanced T₁ mapping and ZOOMit IVIM sequences can predict the expression of Ki67 in lung cancer. ∆T₁% of the T₁ mapping has the strongest correlation with Ki67 expression index, and the highest efficiency in predicting Ki67 high and low expression, which can provide a new perspective for predicting Ki67 expression in lung cancer at an early stage of surgery.

Key words： Lung neoplasms Functional magnetic resonance imaging Ki67 antigen T₁ mapping technology Intravoxel incoherent motion

收稿日期: 2022-10-10

通讯作者: 赵鹏,Email：Gavinsdu@126.com

引用本文:

郭文秀, 赵鹏, 林祥涛, 苑乐添, 杨涛, 田迷迷. 增强T₁ mapping和ZOOMit IVIM成像的定量参数与肺癌Ki67表达的相关性及预测价值[J]. 中华解剖与临床杂志, 2023, 28(6): 357-364.
Guo Wenxiu, Zhao Peng, Lin Xiangtao, Yuan Letian, Yang Tao, Tian Mimi. Correlation and predictive value of quantitative parameters of enhanced T₁ mapping and ZOOMit intravoxel incoherent motion imaging with Ki67 expression in lung cancer. Chinese Journal of Anatomy and Clinics, 2023, 28(6): 357-364.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20221010-00304 或 http://www.cjac.com.cn/CN/Y2023/V28/I6/357

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