体素内不相干运动成像鉴别肺部鳞、腺癌并评估Ki-67表达

Intravoxel Incoherent Motion Imaging for Identification of Lung Squamous Cell Carcinoma and Adenocarcinoma and Assessment of Ki-67 Expression

目的对比体素内不相干运动成像(IVIM)和^(18)F-FDG PET鉴别肺部鳞、腺癌的价值,评估各参数与Ki-67表达水平的相关性。资料与方法前瞻性分析河南省人民医院2020年7月—2021年2月经术后病理证实的41例肺鳞癌及肺腺癌患者,分析IVIM和^(18)F-FDG PET图像,分别测量最大标准化摄取值(SUVmax)、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)、扩散系数(D)、假扩散系数(D^(*))及灌注分数(f)值。对比分析鳞、腺癌组间各参数的差异及诊断效能,并评估^(18)F-FDG PET与IVIM参数的相关性及其各参数与Ki-67表达水平的相关性。结果鳞癌组的SUVmax(14.63±7.85比7.10±4.30,t=3.995)和TLG值[49.56(25.37,202.29)比15.27(4.63,60.91),Z=−2.007]高于腺癌组(P均<0.05),D、D^(*)和f值显著低于腺癌组[D:(0.97±0.15)×10^(−3)mm^(2)/s比(1.24±0.97)×10^(−3)mm^(2)/s,t=−3.135;D^(*):20.99(9.35,51.72)×10^(−3)mm^(2)/s比40.03(17.44,138.55)×10^(−3)mm^(2)/s,Z=−2.034;f:(21.73±12.16)%比(32.70±11.68)%,t=−2.803;P均<0.05],两组MTV差异无统计学意义(Z=−1.320,P>0.05)。D、SUVmax、f、D^(*)和TLG值诊断鳞、腺癌的曲线下面积分别为0.817、0.796、0.749、0.696、0.693,差异无统计学意义(P>0.05)。SUVmax与Ki-67呈正相关(r=0.354,P<0.05),D值与Ki-67呈负相关(r=−0.371,P<0.05),f值分别与SUVmax、MTV、TLG呈负相关(r=−0.359、−0.315、−0.331,P均<0.05)。结论^(18)F-FDG PET和IVIM均可用于鉴别诊断肺部鳞、腺癌,两者诊断效能相似,部分参数与非小细胞肺癌的Ki-67存在相关性。

Purpose To compare the value of intravoxel incoherent motion(IVIM)imaging and ^(18)F-FDG PET in differentiating squamous cell carcinoma and adenocarcinoma of the lung and to assess the correlation of each parameter with Ki-67 expression levels.Materials and Methods Forty-one cases of lung squamous cell carcinoma and adenocarcinoma confirmed by postoperative pathology in Henan Provincial People's Hospital from July 2020 to February 2021 were prospectively analyzed.IVIM and ^(18)F-FDG PET images were analyzed to measure the maximum standard uptake value(SUVmax),metabolic tumor volume(MTV),total lesion glycolysis(TLG),diffusion coefficient(D),false diffusion coefficient(D^(*))and perfusion fraction(f)values.The differences and diagnostic efficacy of various parameters between squamous cell carcinoma and adenocarcinoma groups were compared.The correlation between ^(18)F-FDG PET and IVIM parameters was evaluated,as well as the correlation between each parameter and Ki-67 expression level.Results SUVmax and TLG values of the squamous cell carcinoma group were significantly higher than those of the adenocarcinoma group[SUVmax:14.63±7.85 vs.7.10±4.30,t=3.995;TLG:49.56(25.37,202.29)vs.15.27(4.63,60.91),Z=−2.007;all P<0.05],while the D,D^(*)and f values were significantly lower than those of the adenocarcinoma group[D:(0.97±0.15)×10^(−3)mm^(2)/s vs.(1.24±0.97)×10^(−3)mm^(2)/s,t=−3.135;D^(*):20.99(9.35,51.72)×10^(−3)mm^(2)/s vs.40.03(17.44,138.55)×10^(−3)mm^(2)/s,Z=−2.034;f:(21.73±12.16)%vs.(32.70±11.68)%,t=−2.803,all P<0.05].There was no significant difference in MTV between the two groups(Z=−1.320,P>0.05).The AUC of D,SUVmax,f,D^(*)and TLG for differential diagnosis of squamous cell carcinoma and adenocarcinoma were 0.817,0.796,0.749,0.696 and 0.693,respectively;with no statistically significant difference between them(P>0.05).SUVmax was positively correlated with Ki-67(r=0.354,P<0.05),D value was negatively correlated with Ki-67(r=−0.371,P<0.05),f value was negatively correlated with SUVmax,MTV and TLG(r=−0.359,−0.315,−0.331;all P<0.05),and there was no significant correlation among the other parameters.Conclusion Both ^(18)F-FDG PET and IVIM can be used for the differential diagnosis of lung squamous cell carcinoma and adenocarcinoma and have similar diagnostic performance,with some parameters correlating with Ki-67 in non-small cell lung cancer.