目的 探讨表观扩散系数(apparent diffusion coefficient,ADC)鉴别诊断肺癌脑转移瘤组织学分型的价值及其与Ki-67增殖指数之间的关系.材料与方法 回顾性分析经手术病理证实的20例小细胞肺癌脑转移瘤和41例非小细胞肺癌脑转移瘤患者的资料,并测定其Ki-67增殖指数.在ADC图上测量肿瘤实性部分的最小ADC值(the minimum ADC,ADCmin)、平均ADC值(the mean ADC,ADCmean)及对侧正常脑白质ADC值,并计算相对ADCmin(relative ADCmin,rADCmin)及相对ADCmean(relative ADCmean,rADCmean).对比分析二者ADC值的差异,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价ADC值的鉴别诊断价值,并计算ADC值与Ki-67增殖指数之间的相关性.结果 小细胞肺癌脑转移瘤组的ADCmin、ADCmean、rADCmin及rADCmean值均小于非小细胞肺癌脑转移瘤组,组间差异均具有统计学意义(P<0.05).各ADC值均能对小细胞肺癌脑转移瘤及非小细胞肺癌脑转移瘤进行有效鉴别,其中rADCmean值的鉴别诊断效能最好,曲线下面积(area under the curve,AUC)为0.950[95%置信区间(confidence interval,CI):0.907～0.994],最佳截断值为0.955,相应的敏感度和特异度分别为96.23%、83.87%,准确度为91.67%.小细胞肺癌脑转移瘤组的Ki-67增殖指数大于非小细胞肺癌脑转移瘤组,组间差异具有统计学意义(P<0.05).61例肺癌脑转移瘤患者的ADCmin、ADCmean、rADCmin及rADCmean值均与Ki-67增殖指数呈不同程度的负相关(r=-0.506、r=-0.480、r=-0.569、r=-0.541).结论 ADC值可以对肺癌脑转移瘤的组织学分型进行鉴别诊断,并可以预测Ki-67增殖指数的表达水平.
Apparent diffusion coefficient distinguishes histologic typing of lung cancer brain metastases and its correlation with the Ki-67 proliferation index
Objective:To investigate the value of apparent diffusion coefficient(ADC)for differential diagnosis of histological type of lung cancer brain metastases and its relationship with Ki-67 proliferation index.Materials and Methods:The clinical data of 20 patients with small-cell carcinoma brain metastases and 41 patients with non-small-cell lung carcinoma brain metastases confirmed by surgery were analyzed retrospectively.The minimum ADC value(ADCmin),the mean ADC value(ADCmean),and the ADC values in contralateral normal cerebral white matter were measured on the ADC map,and the relative ADCmin value(rADCmin)and relative ADCmean value(rADCmean)were calculated.The differences in ADC values were compared and analyzed,the differential diagnostic value of ADC values was evaluated by plotting receiver operating characteristic(ROC)curves,and the correlation between ADC values and Ki-67 proliferation index was calculated.Results:The ADCmin,ADCmean,rADCmin and rADCmean values of the small cell lung cancer brain metastasis tumor group were smaller than those of the non-small fine lung cancer brain metastasis tumor group,and the differences between the groups were all statistically significant(P<0.05).Each ADC value could effectively discriminate between small cell lung cancer brain metastases and non-small cell lung cancer brain metastases,among which the rADCmean value had the best differential diagnostic efficacy,with an area under the curve(AUC)of 0.950[95%confidence interval(CI):0.907-0.994].The optimal cutoff value was of 0.955,and the corresponding sensitivity and specificity were 96.23%and 83.87%,respectively,and the accuracy was 91.67%.The Ki-67 proliferation index in the small cell lung cancer brain metastasis group was greater than that in the non-small cell lung cancer brain metastasis group,and the difference between the groups was statistically significant(P<0.05).A total of 61 patients with lung cancer brain metastasis showed different degrees of negative correlation between the ADCmin,ADCmean,rADCmin and rADCmean values and the Ki-67 proliferation index(r=-0.506,r=-0.480,r=-0.569,r=-0.541).Conclusions:ADC values can provide differential diagnosis of histological type of lung cancer brain metastases and can predict the expression level of Ki-67 proliferation index.
lung neoplasmsbrain metastasesmagnetic resonance imagingapparent diffusion coefficientKi-67 proliferation index
万方数据
维普
