扩散峰度成像诊断子宫内膜癌的价值及其与Ki-67的相关性

Diffusion Kurtosis Imaging in Diagnosis of Endometrial Carcinoma and Its Correlation with Ki-67

目的探讨MR扩散峰度成像(DKI)在子宫内膜癌中的诊断价值,并分析其参数与Ki-67表达水平的相关性。资料与方法回顾性分析33例子宫内膜癌患者和20例子宫内膜正常者的DKI资料,测量子宫内膜癌组织和正常子宫内膜组织的平均扩散峰度(MK)值、各向异性分数(FA)值和平均扩散系数(MD)值。比较子宫内膜正常组与子宫内膜癌组、Ki-67高表达组(Ki-67≥50%)和低表达组(Ki-67<50%)间各参数值的差异,评价各参数诊断阈值及效能,并分析各参数值与Ki-67表达水平的相关性。结果子宫内膜癌组、Ki-67高表达组的MD值分别低于子宫内膜正常组、低表达组(P<0.05),但MK值分别高于子宫内膜正常组、低表达组(P<0.05);子宫内膜癌组FA值高于子宫内膜正常组(P<0.05),但Ki-67高表达组、低表达组FA值差异无统计学意义(P>0.05);FA、MK及MD值对子宫内膜癌的诊断阈值分别为0.13、0.73和1.26,ROC曲线下面积分别为0.674、0.817和0.781;Ki-67高表达组、低表达组MD值与Ki-67呈负相关(r=-0.699、-0.884,P<0.05);Ki-67高表达组、低表达组MK值与Ki-67呈正相关(r=0.563、0.813,P<0.05);Ki-67高表达组、低表达组FA值与Ki-67表达水平无显著相关性(r=0.155、0.378,P>0.05)。结论 DKI有助于诊断子宫内膜癌,其MK、MD参数与Ki-67表达水平具有相关性,为无创评估肿瘤细胞增殖活性提供了新思路。

Purpose To explore the value of MR diffusion kurtosis imaging(DKI)in diagnosing endometrial carcinoma,and to analyze the correlation between its parameters and Ki-67 expression level.Materials and Methods DKI data of 33 patients with endometrial cancer and 20 patients with normal endometrium were retrospectively analyzed.The mean kurtosis(MK)value,fractional anisotropy(FA)value and mean diffusion(MD)value of endometrial cancer tissues and normal endometrial tissues were measured.The differences concerning parameter values between the normal endometrium group and the endometrial cancer group,the Ki-67 high expression group(Ki-67≥50%)and the low expression group(Ki-67<50%)were compared.Diagnostic thresholds and efficacy of each parameter were evaluated,and the correlation between each parameter value and Ki-67 expression level was analyzed.Results The MD in endometrial cancer group and Ki-67 high expression group were respectively lower than those of normal endometrium group and low expression group(P<0.05),but there showed higher MK in the former two groups(P<0.05);FA in endometrial cancer group was higher than that in normal endometrium group(P<0.05),but the difference concerning FA between the Ki-67 high expression group and low expression group was not statistically significant(P>0.05).The diagnostic thresholds of FA,MK and MD for endometrial cancer were 0.13,0.73 and 1.26,respectively;and the areas under ROC curve were 0.674,0.817 and 0.781,respectively.The MD in Ki-67 high expression group and low expression group were negatively correlated with Ki-67(r=-0.699,-0.884,P<0.05);MK values in Ki-67 high expression group and low expression group were positively correlated with Ki-67(r=0.563,0.813,P<0.05);FA values in Ki-67 high expression group and low expression group were not significantly correlated with Ki-67 expression level(r=0.155,0.378,P>0.05).Conclusion DKI is helpful in diagnosing endometrial cancer whose MK and MD parameters are correlated with Ki-67 expression level,providing a new idea for noninvasive evaluation of tumor cell proliferation activity.