Applicable value of diffusion kurtosis imaging in assessing the status of KRAS mutation in rectal cancer
Li Dandan1, Cui Yanfen2, Yang Xiaotang2
1Department of Medical Imaging, Shanxi Medical University, Taiyuan 030000, China; 2Department of Radiology, Shanxi Province Tumor Hospital, Taiyuan 030000, China
Abstract：Objective To investigate the applicable value of diffusion kurtosis imaging (DKI) in assessing the status of KRAS mutation in patients with rectal cancer.Methods The data of 152 patients with rectal cancer confirmed by pathology, in the Shanxi Province Tumor Hospital from November 2016 to June 2018, were retrospectively analyzed, including 92 males and 60 females, average age was 61 years (33-86 years). Patients underwent morphologic MRI and functional DKI imaging sequences before operation. The tumor region of interest (ROI) was delineated by two radiologist, and they were blind to KRAS mutational analysis . MatLab software was applied to calculated the quantitative parameters of DKI, including mean diffusivity (MD) and mean kurtosis (MK) , as well as apparent diffusion coefficient (ADC) in two groups, respectively, and the consistency analyses were performed according to intraclass correlation coefficients(ICC). The patients were divided into KRAS wild type and mutant groups, according to the results of KRAS mutational analysis on surgical specimens. Student's t-test was used to compare the quantitative parameters of DKI between two groups. Receiver-operating characteristic curve (ROC) was generated to evaluate the diagnostic value of each parameter in predicting the mutation status of KRAS in rectal cancer. The optimal cut-off values of each quantitative parameter was chosen according to Youden's index. The corresponding sensitivity and specificity were also calculated. Differences in performance of them were analyzed by comparing the areas under the ROC curves (AUC) of the quantitative each parameters using the method developed by DeLong et al.Results For a total of 152 rectal lesions, the KRAS mutation rate was 48.6%, divide into mutant group(n=74), and wildtype group(n=78). The ADC and MD values as well as MK value were (1.18±0.18) ×10-3 mm2/s, (1.28±0.18) ×10-3 mm2/s, and 0.97±0.11 in the mutated group, respectively; while they were (1.33±0.18)×10-3 mm2/s, (1.42±0.17)×10-3 mm2/s, and 0.82±0.09 in the wildtype group, respectively. The ADC and MD values were significantly lower in the mutated group than those in the wildtype group, while MK value was higher in the mutated group compared with those in the wildtype group (t=5.424, 4.882, -8.809, all P values＜0.01). The AUC, sensitivity and specificity of ADC, MK and MD values for predicting KRAS mutations were 0.758, 75.7%, 68.0%, and 0.740, 82.4%, 57.8%, and 0.84, 77.0%, 84.6%, respectively, which indicated the MK value have higher specificity in predicting KRAS mutation status in rectal cancer compared to MD and ADC values, while MD showed the highest sensitivity. In addition, the AUC of MK value was higher than with the MD and ADC values (all P values＜0.01). However, there was no significant difference between ADC value and MD value in terms of DeLong et al(P＞0.05).Conclusions Both ADC and MD as well as MK metrics exhibit potential for predicting KRAS mutation status in rectal cancer. However, the MK value has higher AUC and specificity, which shows it has higher diagnostic value for analysis of KRAS mutation status in rectal cancer.
李丹丹, 崔艳芬, 杨晓棠. 扩散峰度成像在预测直肠癌KRAS基因突变中的应用价值[J]. 中华解剖与临床杂志, 2020, 25(2): 102-108.
Li Dandan, Cui Yanfen, Yang Xiaotang. Applicable value of diffusion kurtosis imaging in assessing the status of KRAS mutation in rectal cancer. Chinese Journal of Anatomy and Clinics, 2020, 25(2): 102-108.
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2020, Vol. 25 
