动态增强MRI与DWI联合应用在肝细胞癌Ki-67表达水平的价值研究OA
Combined prediction of DCE-MRI and DWI for Ki-67 expression level in HCC
目的:探讨动态增强磁共振成像(DCE-MRI)与弥散加权成像(DWI)联合应用在肝细胞癌Ki-67表达水平中的价值,以期为临床无创评估肿瘤增殖活性提供依据.方法:前瞻性选取2020年1月至2025年1月安徽医科大学第二附属医院收治的150例肝细胞癌患者,根据术后病理细胞增殖核抗原(Ki-67)表达水平将其分为高表达组(90例,Ki-67指数≥20%)和低表达组(60例,Ki-67指数＜20%).所有患者术前均接受DCE-MRI和DWI检查,测量容积转移常数(Ktrans)、速率常数(Kep)、血管外细胞外容积分数(Ve)和表观弥散系数(ADC)等影像学参数,同时检测血清甲胎蛋白(AFP)水平及肿瘤最大径等临床指标,并观察比较两组术前各指标差异.结果:影像学参数比较中,Ve参数高表达组与低表达组比较差异无统计学意义(P＞0.05).高表达组Ktrans、Kep分别为(0.35±0.12)min-1和(1.23±0.45)min-1,高于低表达组的(0.28±0.09)min-1和(0.98±0.38)min-1,差异有统计学意义(t=3.456、2.987,P＜0.05);高表达组ADC为(950.45±120.67)×10-6 mm2/s,低于低表达组的(1 050.78±135.89)×10-6 mm2/s,差异有统计学意义(t=-3.210,P＜0.05).高表达组肿瘤最大径和血清AFP水平均高于低表达组,差异有统计学意义(t=4.567、7.890,P＜0.05);肝功能分级组间比较差异有统计学意义(x2=5.432,P＜0.05).多因素logistic回归分析显示,Ktrans、ADC和AFP是Ki-67高表达的独立预测因素(OR=1.412、0.996、1.002,P＜0.05).受试者工作特征(ROC)曲线分析表明,DCE-MRI与DWI联合应用在区分Ki-67表达状态中诊断效能较高.结论:DCE-MRI与DWI联合应用能有效预测肝细胞癌Ki-67表达水平,影像学参数与临床指标结合可显著提高预测准确性,具有较高的临床应用潜力.
Objective:To investigate value of combined prediction of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and diffusion-weighted imaging(DWI)for Ki-67 expression level in hepatocellular carcinoma(HCC),so as to provide basis for noninvasive assessing proliferative activity of tumor in clinical practice.Methods:A total of 150 HCC patients admitted to the Second Affiliated Hospital of Anhui Medical University between January 2020 and January 2025 were enrolled in this study.Based on Ki-67 expression level of postoperative pathological cell proliferation marker,the patients were divided into a high-expression group(n=90)and a low-expression group(n=60).All participants underwent preoperative DCE-MRI and DWI examinations.Imaging parameters,including the volume transfer constant(Ktrans),rate constant(Kep),extravascular extracellular volume fraction(Ve),and apparent diffusion coefficient(ADC),were measured.Results:In the comparison of imaging parameters,the difference of Ve was not significant between high-expression group and low-expression group(P>0.05),and the Ktrans and Kep of high-expression group were respectively(0.35±0.12)min-1 and(1.23±0.45)min-1,all of which were higher than(0.28±0.09)min-1 and(0.98±0.38)min-1 of low-expression group,and the differences were significant(t=3.456,2.987,P<0.05).The ADC value of high-expression group was(950.45±120.67)×10-6 mm2/s,which was lower than(1 050.78±135.89)×10-6 mm2/s of low-expression group,and the difference was significant(t=-3.210,P<0.05).The maximum diameter of tumor,and serum AFP level of high-expression group were all higher than those of low-expression group,and the differences of them were significant(t=4.567,7.890,P<0.05).The difference of the grading of hepatic function between two groups was significant(x2=5.432,P<0.05).The results of multivariate logistic regression analysis indicated that Ktrans,ADC and AFP were independent predictors for Ki-67 high expression(OR=1.412,0.996,1.002,P<0.05).Receiver operating characteristic(ROC)curve analysis indicated that the diagnostic performance of combined prediction model was highest in distinguishing expression statuses of Ki-67.Conclusion:The combined application of DCE-MRI and DWI can effectively predict expression level of Ki-67 in HCC.The combination of imaging parameters and clinical indicators can significantly improve predictive accuracy,which has higher potential in clinical application.
濮毅峰;谢伟选;许怀生;张彬
安徽医科大学第二附属医院肝胆胰外科 合肥 232601||中国人民解放军联勤保障部队第904医院(无锡市太湖医院)肝胆胰外科 无锡 214000中国人民解放军联勤保障部队第904医院(无锡市太湖医院)肝胆胰外科 无锡 214000中国人民解放军联勤保障部队第904医院(无锡市太湖医院)肝胆胰外科 无锡 214000安徽医科大学第二附属医院肝胆胰外科 合肥 232601
医药卫生
动态增强磁共振成像(DCE-MRI)弥散加权成像(DWI)肝细胞癌细胞增殖核抗原(Ki-67)
Dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)Diffusion-weighted imaging(DWI)Hepatocellular carcinoma(HCC)Proliferation marker Ki-67(Ki-67)
《中国医学装备》 2026 (8)
40-45,6
国家自然科学基金(82370591)National Natural Science Foundation of China(82370591)
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