不同病理类型肺癌磁共振定量灌注直方图参数、表观扩散系数与Ki-67相关性分析

Correlation between DCE-MRI quantitative perfusion histogram parameters,apparent diffusion coefficient and Ki-67 in different pathological types of lung cancer

目的探讨动态对比增强磁共振成像(DCE-MRI)功能成像定量直方图参数、表观扩散系数(ADC)在不同病理类型肺癌中的差异以及其与Ki-67相关性。方法收集2017年3月至2018年3月在绍兴市人民医院经病理证实的肺癌患者33例,男28例、女5例,年龄50~85岁,其中鳞癌15例,腺癌12例,小细胞肺癌6例,手术或穿刺前一周内行DCE-MRI检查及DWI成像,计算灌注参数容量转运常数(Ktrans)、返流速率常数(Kep)、血管外细胞外间隙容积分数(Ve)及血浆容积分数(Vp)的直方图参数(平均值、能量、熵值、均质性、偏度、峰度、百分位数),病灶ADC值,免疫组化方法测定肺癌组织Ki-67表达;比较分析不同病理亚型肺癌定量灌注直方图参数、ADC值、Ki-67免疫组化分数的组间差异,符合正态分布且方差齐的参数采用单因素方差分析、LSD法分别比较组间、组内差异;否则采用Kruskal-Walls检验、Mann-Whitney U检验分别比较组间、组内差异。Pearson相关分析分别比较定量灌注直方图参数、ADC值与免疫组化分数三者之间的相关性。结果小细胞肺癌Ki-67指数(458±82,P=0.011)、鳞癌组Ki-67指数(355±277,P=0.034)显著大于腺癌组(168±164),相关性分析结果显示,肺癌ADC值与Ki-67的表达呈现显著的负相关关系(P=0.018,r=-0.416),Ve(Q5、Q10)与Ki-67呈负相关(P=0.017,r=-0.420;P=0.040,r=-0.366);在鳞癌患者中,Ve(均质性)与Ki-67的表达呈显著负相关(P=0.033,r=-0.570),Ktrans(均质性),Ve(均质性、Q5、Q10、Q25)与ADC值呈显著正相关(P值范围0.001~0.035,r值范围0.545~0.765)。结论DCE-MRI定量灌注直方图参数、ADC值具有相关性,可以评价肺癌细胞增殖活性。

Objective To explore the efficacy of dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)histogram molecular imaging index,apparent diffusion coefficient(ADC)in different types of lung cancer and explore their correlation with Ki-67.Methods A total of 33 cases of lung cancer patients confirmed by pathology in Shaoxing People′s Hospital from March 2017 to March 2018 were collected,28 males and 5 females aged 50-85 years old,including 15 cases of squamous cell carcinoma,12 cases of adenocarcinoma,and 6 cases of small cell carcinoma.All patients performed DCE-MRI and DWI imaging within one week before surgery or puncture.ADC values,DCE-MRI quantitative perfusion parameters by histogram metrics analysis(mean value,skewness,kurtosis,uniformity,entropy,energy,quantile)of Ktrans,Kep,Ve,and Vp were then collected.Ki-67 expression in lung cancer tissue was detected by immunohistochemical method.One-way analysis of variance and least significant difference were used to compare the differences among the parameters of the three groups which were normal distribution and equal variances,while Kruskal-Walls test and Mann-Whitney U test were used to compare the parameters that did not conform to normal distribution or variance.Pearson correlation analysis was used to compare the correlations between quantitative perfusion histogram parameters,ADC values and immunohistochemical scores of Ki-67.Results The Ki-67 count in small cell lung cancer(458±82,P=0.011)and squamous cell carcinoma(355±277,P=0.034)were significantly higher than that in adenocarcinoma(168±164).The correlation analysis showed that there was a significant negative correlation between ADC values and Ki-67(P=0.018,r=-0.416).And Ve(Q5,Q10)was negatively related to Ki-67(P=0.017,r=-0.420;P=0.040,r=-0.366).In squamous cell carcinoma patients,Ve(homogeneity)was significantly negatively correlated with the expression of Ki-67(P=0.033,r=-0.570).Ktrans(homogeneity)and Ve(homogeneity,Q5,Q10,Q25)were significantly positively correlated with ADC values(P value from 0.001 to 0.035,r value from 0.545 to 0.765).Conclusion DCE-MRI quantitative perfusion histogram parameters,ADC value can evaluate the lung cancer cell proliferation activity in different pathological types.