定量CT联合MRI扩散加权成像在预测肺癌表皮生长因子受体突变中的应用价值

Application value of quantitative CT combined with MR diffusion weighted imaging in predicting epidermal growth factor receptor mutations in lung cancer

目的探讨采用定量CT联合MRI扩散加权成像(MR-DWI)预测肺癌表皮生长因子受体(EGFR)基因突变状态,并评估二者的诊断效能。方法选取47例经EGFR基因检测的肺腺癌患者,其中EGFR突变19例,未突变28例。全部患者治疗前均接受CT、MRI扫描,并取病理活检。将CAD定量分析结果及ADC值进行分析,并将有统计学意义的参数使用二元Logistic回归分析,用于筛选预测EGFR突变的影响因子。绘制ROC曲线,评估预测效能。结果两组间性别、年龄差异无统计学意义(P>0.05),病灶体积差异有统计学意义(P=0.020)。由2位放射科医师对ADC值测量的一致性较好(ICC=0.978)。EGFR突变型组与野生型组两组间ADC值差异有统计学意义(P=0.045)。肿瘤体积、ADC值均是预测肺腺癌EGFR基因突变状态的独立危险因素。联合ADC值与体积二者较单独ADC值、体积可提高预测EGFR突变状态的敏感度(84.2%vs 50.0%vs 64.3%)及AUC(0.805 vs 0.674 vs 0.701)。结论肿瘤体积、MR-DWI ADC值可用来无创的预测肺癌EGFR基因突变状态,联合二者可提高预测能力,为临床制定治疗策略提供影像学依据。

Objective Quantitative CT and DWI were used to predict EGFR gene mutation status in lung adenocarcinoma,and to evaluate the diagnostic efficacy of the two methods.Methods Forty-seven patients with lung adenocarcinoma tested by EGFR gene were retrospectively collected,including 19 cases with EGFR mutation and 28 cases without mutation.All patients received CT and MR scans and biopsies before treatment.The quantitative analysis results of CT and ADC value were analyzed,and the parameters with statistical significance were analyzed by binary Logistic regression to screen the influencing factors for predicting EGFR mutation.ROC curve was drawn to evaluate the predictive performance.Results There was no significant difference in gender and age between the two groups(P>0.05),but there was significant difference in tumor volume(P=0.020).There was good agreement between the two radiologists on ADC measurements(ICC=0.978).There was statistical difference in ADC values between EGFR mutation and wild group(P=0.045).Tumor volume and ADC value were independent risk factors for predicting EGFR gene mutation status in lung cancer.Tumor volume,ADC value and the combination of them had well sensitivity and specificity in predicting EGFR mutation status,with AUC of 0.701,0.674 and 0.805,respectively.Conclusions Tumor volume and ADC value can be used to noninvasively predict EGFR gene mutation status in lung cancer,and the combination of the two can improve the predictive ability and provide imaging basis for clinical treatment strategy.