Role of quantitative dynamic contrast-enhanced MRI parameters and extracellular volume fraction in differentiating non-small cell lung cancer subtypes and predicting lymph node metastasis
Guo Wenxiu1, Zhao Peng1,2, Lin Xiangtao1,2, Lyv Binglin3, Yang Tao2, Tian Mimi2
1Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China; 2Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan 250021, China; 3Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China
Abstract:Objective This study aimed to investigate the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters and extracellular volume (ECV) fraction in the diagnosis of non-small cell lung cancer (NSCLC) subtypes and prediction of lymph node metastasis. Methods A retrospective cohort study was performed, and the clinical and MRI data of 70 patients diagnosed with NSCLC by pathological examination from September 2020 to December 2022 in the Provincial Hospital of Shandong First Medical University were included. The patients aged 45-74 (60.7±6.9) and were composed of 55 males and 15 females. The patients underwent DCE-MRI and enhanced T1 mapping within 1 week prior to treatment. The quantitative parameters, namely, volume transfer constant (Ktrans), flux rate constant (Kep), extracellular extravascular volume fraction (Ve) were measured. Venous blood was collected from the patient within 3 days of the MRI scan, and the patient's hematocrit was then measured. The detection of T1 values based on T1 mapping was used to calculate ECV fraction. The patients were divided into adenocarcinoma group (41 cases) and squamous carcinoma group (29 cases) according to NSCLC pathological typing. The patients were divided into groups with metastasis (28 cases) and without metastasis (42 cases) according to the presence or absence of lymph node metastasis. The observation indexes were obtained as follows: (1) Clinical baseline data, such as gender, age, degree of tumor differentiation, and maximum diameter of lesions in different groups of patients were compared; (2) The consistency between observers in detecting quantitative DCE-MRI parameters and ECV fraction results was evaluated; (3) the quantitative DCE-MRI parameters and ECV fraction of different groups were compared; (4) the diagnostic efficacy of parameters that differed among subgroups was analyzed for the typing of NSCLC, and the predictive efficacy for the metastatic status of NSCLC lymph nodes was evaluated; (5) the correlation between the quantitative parameter Ve of DCE-MRI and ECV fraction was analyzed. Results (1) No statistically significant differences in age, degree of tumor differentiation, and maximum tumor diameter were found between the adenocarcinoma and squamous carcinoma groups (all P values>0.05), whereas the difference in gender between the groups was statistically significant (χ2=13.50, P<0.001). Differences in gender, age, degree of tumor differentiation, and maximum tumor diameter between patients with lymph node metastasis and patients without metastasis were not statistically significant (all P values>0.05). (2) The levels of inter-observer agreement in detecting quantitative DCE-MRI parameters and ECV fraction were defined as follows: ICCKtrans=0.815, ICCKep=0.835, ICCVe=0.871, and ICCECV fraction=0.853. Good agreement was identified between the observers. (3) The quantitative DCE-MRI parameters Ktrans, Kep, and Ve in the adenocarcinoma group were 0.23 (0.19,0.29), 0.79 (0.60,0.90), and 0.32 (0.24,0.45), respectively, which were higher than those in the squamous carcinoma group (0.14 [0.12,0.20], 0.61 [0.52,0.78], and 0.25 [0.20 ,0.38]). The differences between the groups were statistically significant (Z=4.763, 2.212, 2.438; all P values <0.05). No statistically significant difference in ECV fraction was found between the groups (P>0.05). The ECV fraction of the group with metastasis was 0.33±0.07, which was higher than that of the group without metastasis (0.26±0.06), and the difference was statistically significant (t=4.436, P<0.001). Differences in the quantitative parameters Ktrans, Kep, and Ve of DCE-MRI between the groups were not statistically significant (all P values>0.05). (4) In the adenocarcinoma and squamous carcinoma groups, Ktrans, Kep, and Ve with statistically significant differences were used in analyzing the diagnostic efficacy of NSCLC subtypes, and Ktrans had the best diagnostic efficacy, which had an area under the curve (AUC) of 0.836 (95% confidence interval [CI] 0.743-0.929), sensitivity of 68.3%, and specificity of 86.2% for the diagnosis of adenocarcinoma and squamous carcinoma when the cutoff value was 0.208. Difference in ECV fraction between the groups with and without lymph node metastasis was statistically significant, and thus the predictive performance of Ktrans for the lymph node metastasis status of NSCLC was analyzed. The AUC of ECV fraction was 0.764 (95% CI 0.652-0.877). When the cutoff value was 0.293, the sensitivity of ECV fraction in predicting lymph node metastasis was 64.3%, and the specificity was 81.0%. (5) No correlation was found between ECV fraction and Ve in NSCLC (rs=0.071, P=0.558). Conclusion Among the DCE-MRI parameters, Ktrans had the best diagnostic efficacy in the diagnosis of NSCLC subtypes, and ECV fraction had a good predictive value in predicting NSCLC lymph node metastasis.
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Guo Wenxiu, Zhao Peng, Lin Xiangtao, Lyv Binglin, Yang Tao, Tian Mimi. Role of quantitative dynamic contrast-enhanced MRI parameters and extracellular volume fraction in differentiating non-small cell lung cancer subtypes and predicting lymph node metastasis. Chinese Journal of Anatomy and Clinics, 2023, 28(9): 567-573.
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