摘要
目的探讨基于动态增强能谱CT参数与肝细胞癌(HCC)中Ki-67高表达的相关性。方法横断面研究。回顾性分析2017年12月至2023年3月在厦门市中医院和厦门大学附属中山医院就诊并病理证实的101例HCC患者的临床资料,其中男84例,女17例,年龄[M(Q_(1),Q_(3))]为59.0(49.0,66.0)岁。根据患者肿瘤组织免疫组化Ki-67的表达情况将患者分为高表达组(Ki-67阳性率>20%,n=59)和低表达组(Ki-67阳性率≤20%,n=42)。分别测量两组HCC患者的动脉期及门静脉期病灶70 keV、140 keV单能量CT值(HU_(70 keV-a)、HU_(140 keV-a)、HU_(70 keV-p)、HU_(140 keV-p))和水密度值(D_(water-a)、D_(water-p)),并计算相应参数门静脉期和动脉期的差值(ΔHU_(70 keV)、ΔHU_(140 keV)、ΔD_(water))和比值(HU_(70 keV)比值、HU_(140 keV)比值、D_(water)比值)。采用Spearman相关分析评估CT能谱参数与Ki-67表达的相关性。采用多因素logistic回归模型来确定Ki-67高表达的相关因素。采用受试者工作特征(ROC)曲线下面积(AUC)表示动态增强能谱CT各参数评估HCC中Ki-67高表达的效能。结果与Ki-67低表达组比高表达组甲胎蛋白更高、肿瘤直径更大、肿瘤形态更不规则,差异均有统计学意义(均P<0.05)。Spearman相关分析显示,HU_(140 keV-p)、D_(water-p)、HU_(70 keV)比值、HU_(140 keV)比值、D_(water)比值、ΔHU_(70 keV)、ΔHU_(140 keV)、ΔD_(water)与Ki-67阳性率呈正相关(r:0.31~0.50,均P<0.05)。Ki-67高表达组的HU_(70 keV-p)、HU_(140 keV-p)、D_(water-p)及其相应的比值和差值均高于低表达组,差异均有统计学意义(均P<0.05)。多因素logistic回归模型显示,D_(water-p)(OR=1.16,95%CI:1.05~1.29,P=0.005)、ΔHU_(140 keV)(OR=1.39,95%CI:1.20~1.62,P<0.001)和肿瘤形态不规则(OR=5.25,95%CI:1.61~17.12,P=0.006)是HCC中Ki-67高表达的相关因素。HU_(140 keV)比值和ΔHU_(140 keV)单独评估HCC中Ki-67高表达的AUC最高,均为0.82(95%CI:0.74~0.90),灵敏度均为61.0%,特异度分别为88.1%和85.7%
Objective To investigate the correlation between dynamic enhanced energy spectral CT parameters and Ki-67 high expression in hepatocellular carcinoma(HCC).Methods A cross-sectional study.This retrospective case-control study analyzed the clinical data of 101 patients with pathologically confirmed HCC in Xiamen Hospital of Traditional Chinese Medicine and Zhongshan Hospital of Xiamen University from December 2017 to March 2023.These 101 patients included 84 males and 17 females,and the age[M(Q_(1),Q_(3))]was 59.0(49.0,66.0)years.These patients were divided into two groups according to the immunohistochemical Ki-67 expression levels in tumor tissues:the high expression group(Ki-67%>20%,n=59)and the low expression group(Ki-67%≤20%,n=42).CT values on 70 keV and 140 keV monochromatic energy images(HU_(70 keV-a),HU_(140 keV-a),HU_(70 keV-p),HU_(140 keV-p))and water density(D_(water-a),D_(water-p))were measured in arterial phase and portal vein phase,and the difference of HU_(70 keV),HU_(140 keV),D_(water)values between portal vein and arterial phase(ΔHU_(70 keV),ΔHU_(140 keV),ΔD_(water)),as well as ratio of HU_(70 keV),HU_(140 keV),D_(water)values between portal vein and arterial phase(HU_(70 keV)ratio,HU_(140 keV)ratio,D_(water)ratio)were calculated.Spearman correlation analysis was used to analyze the correlation between the CT spectral parameters and Ki-67%.Multivariate logistic regression model was used to determine the factors associated with high expression of Ki-67.The receiver operating characteristics(ROC)curves were used to indicate the efficacy of dynamic enhanced spectral CT in evaluating Ki-67 high expression in HCC.Results The high Ki-67 expression group revealed higher alpha fetal protein levels,larger tumor diameter and more irregular tumor shape compared with the low Ki-67 expression group,and the differences were statistically significant(all P<0.05).Spearman correlation analysis showed that the HU_(140 keV-p),D_(water-p),HU_(70 keV)ratio,HU_(140 keV)ratio,D_(water)ratio,ΔHU_(70 keV),ΔHU_(140 k
作者
李彩云
林禹
丁鑫
张鹏
廖良忠
岳鑫
Li Caiyun;Lin Yu;Ding Xin;Zhang Peng;Liao Liangzhong;Yue Xin(Department of Radiology,Xiamen Hospital of Traditional Chinese Medicine,Xiamen 361009,China;Department of Radiology,Zhongshan Hospital of Xiamen University,Xiamen 361004,China;Department of Pathology,Zhongshan Hospital of Xiamen University,Xiamen 361004,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第47期3835-3841,共7页
National Medical Journal of China
基金
2018年厦门市医疗卫生项目(指导性项目)(3502Z20189037)
关键词
癌
肝细胞
KI-67
动态增强能谱CT
单能量图像
横断面研究
Carcinoma,Hepatocellular
Ki-67
Dynamic enhanced energy spectrum CT
Monochromatic energy image
Cross-sectional study
