DCE-MRI结合DWI对前列腺癌Ki-67表达和Gleason评分的预测价值

The predictive value of DCE-MRI and DWI for Ki-67 expression and Gleason score in prostate cancer

目的旨在评估动态对比增强磁共振成像(dynamic contrast-enhancement magnetic resonance imaging,DCE-MRI)结合扩散加权成像(diffusion weighted imaging,DWI)在预测前列腺癌(prostate cancer,PCa)Ki-67表达和Gleason评分中的诊断效能。材料与方法回顾性分析了2019年1月至2023年10月自贡市第四人民医院收治的66例PCa患者的临床及影像资料。结合T2WI、DWI序列和由DWI自动计算出的表观扩散系数(apparent diffusion coeffieient,ADC),在DCE-MRI图像上手动勾画肿瘤感兴趣区(region of interest,ROI),计算ROI药代动力学参数,包括容积转运常数(volume transfer contrast,K^(trans))、速率常数(rate contrast,K_(ep))、血管外细胞外容积分数(extravascular extracellular volume fraction,Ve),并测量ADC值。根据靶向穿刺病理诊断Gleason评分和Ki-67表达水平,分为Ki-67高表达组(Ki-67>10%)和低表达组(Ki-67≤10%),Gleason评分低级别(GG 1~2)和高级别(GG 3~5)组。组间差异比较使用两独立样本t检验或非参数检验,采用Spearman相关分析评价DCE-MRI参数和ADC值与Ki-67、Gleason评分的相关性,并建立logistic回归模型,通过受试者工作特征(receiver operating characteristic,ROC)曲线评估诊断效能。结果ADC值与Ki-67表达、Gleason评分均呈负相关(P<0.001),K^(trans)、K_(ep)、Ve与Ki-67表达均呈正相关(P<0.001),K^(trans)、K_(ep)与Gleason评分均呈正相关(P<0.001)。Ki-67高、低表达组K^(trans)、K_(ep)、Ve、ADC值比较差异均具有统计学意义(P<0.01),Gleason评分高、低级别组K^(trans)、K_(ep)、ADC值比较差异均具有统计学意义(P<0.01);Ki-67表达的ROC曲线分析显示,联合模型K^(trans)+K_(ep)+Ve+ADC诊断效能最好,曲线下面积(area under the curve,AUC)为0.940;Gleason评分分级的ROC曲线分析显示,联合模型K^(trans)+K_(ep)+ADC诊断效能最好,AUC为0.861。结论DCE-MRI的药代动力学参数和ADC值相结合,在预测PCa的Ki-67表达和Gleason评分中显示出高诊断效能。联合使用DCE-MRI定量参数与ADC值可提高PCa病理分级和生物侵袭性的预测准确性。

Objective:To evaluate the diagnostic efficacy of dynamic contrast enhancement magnetic resonance imaging(DCE-MRI)combined with diffusion weighted imaging(DWI)in predicting Ki-67 expression and Gleason score in prostate cancer(PCa)Ki-67 expression and Gleason score.Materials and Methods:A retrospective analysis of MRI data from 66 PCa patients treated at the Zigong Fourth People's Hospital from January 2019 to October 2023 was conducted.Combining T2WI,DWI sequences and the apparent diffusion coefficient(ADC)automatically calculated by DWI,the regions of interest(ROI)of the tumor was manually outlined on the DCE-MRI images,calculate ROI pharmacokinetic parameters,including volumetric transport constants(K^(trans)),rate constant(K_(ep)),extravascular extracellular volume fraction(Ve),and measure apparent diffusion coefficient values(ADC).According to the targeted puncture pathology diagnosis Gleason score and Ki-67 expression level were categorized into Ki-67 high expression group(Ki-67>10%)and low expression group(Ki-67≤10%),and Gleason score low grade(GG 1-2)and high grade(GG 3-5)groups.Differences between groups were compared using two independent samples t-test or non-parametric test,Spearman correlation analysis was used to evaluate the correlation of DCE-MRI parameters and ADC values with Ki-67 and Gleason scores,and logistic regression model was established to evaluate the diagnostic efficacy by receiver operating characteristic(ROC)curve to evaluate the diagnostic efficacy.Results:ADC values in PCa were negatively correlated with Ki-67 expression and Gleason score(P<0.001),while K^(trans),K_(ep) and Vewere positively correlated with Ki-67 expression(P<0.001).K^(trans) and K_(ep) were also positively correlated with Gleason score(P<0.001).Statistically significant differences were found in K^(trans),K_(ep),Ve and ADC values between high and low Ki-67 expression groups(P<0.01),as well as between high and low Gleason score groups(P<0.01).ROC curve analysis for Ki-67 expression showed that the combined model of K^(trans)+K_(ep)+Ve+ADC had the best diagnostic performance,with an area under the curve(AUC)of 0.940.ROC curve analysis for Gleason score grading showed that the combined model of K^(trans)+K_(ep)+ADC had the best diagnostic performance,with an AUC of 0.861.Conclusions:The quantitative parameters of DCE-MRI combined with ADC values show high diagnostic efficacy in predicting Ki-67 expression and Gleason score in PCa.These findings suggest that the combined use of quantitative DCE-MRI parameters with ADC values improves the accuracy of predicting pathological grading and biological aggressiveness of PCa.