实性非小细胞肺癌能谱CT参数与Ki-67表达水平的相关性研究

目的:探讨实性非小细胞肺癌(NSCLC)能谱CT定量参数与Ki-67表达水平的关系。方法:回顾性分析105例实性非小细胞肺癌患者的临床资料。免疫组化检测Ki-67阳性癌细胞百分率(Ki-67值)。根据Ki-67值将患者分为3组:高水平组>30%,中水平组>10%~30%,低水平组≤10%。用能谱分析软件GSI Viewer测量静脉期CT能谱成像的定量参数,包括碘浓度(IC)、40 keV和100 keV的CT值(CT40 keV、CT100 keV),计算能谱衰减曲线斜率(K)和标准碘浓度(NIC)。3组间比较采用单因素方差分析,定量参数与Ki-67表达水平的相关性采用Spearman相关分析。绘制具有统计学差异参数的ROC曲线,并用曲线下面积(AUC)衡量各参数的鉴别诊断性能。结果:单因素方差分析显示3组间IC、NIC、CT40 keV、K有显著性差异(P<0.05)。LSD-t检验分析显示,高水平与低水平之间IC、CT40 keV、K有显著性差异(P<0.05);高水平与中水平之间IC、NIC、CT40 keV、K有显著性差异(P<0.05)。Spearman相关分析显示,IC、NIC、CT40 keV、K与Ki-67表达水平呈负相关(|r|<0.4,均P<0.05)。ROC曲线分析表明,IC和K判别高水平组和非高水平组的AUC值较大,分别为0.707和0.709。IC和K的敏感性均为68.5%,特异性均为70.6%。结论:能谱CT定量参数为评价实性NSCLC癌细胞增殖情况提供了一种新的无创性方法。

The association between quantitative parameters of energy spectrum CT and Ki-67 expression levels in solid non-small cell lung cancer

Objective:To investigate the relationship between the quantitative parameters of energy spectrum CT and the expression of Ki-67 in solid non-small cell lung cancer(NSCLC).Methods:The clinical data of 105 patients with solid NSCLC were analyzed retrospectively.The percentage of Ki-67 positive cancer cells(Ki-67 value)was detected by immunohistochemistry.According to the Ki-67 value,the patients were divided into 3 groups:high level group>30%,medium level group>10%~30%,and low level group≤10%.The quantitative parameters of energy spectrum CT imaging in venous phase were measured by energy spectrum analysis software GSI Viewer,including iodine concentration(IC),CT value at 40 keV and 100 keV(CT40 keV,CT100 keV).The slope of energy spectrum attenuation curve(K)and standardized iodine concentration(NIC)were calculated.One-way ANOVA was used to compare the 3 groups,and the correlation between quantitative parameters and Ki-67 expression level was analyzed by Spearman correlation analysis.ROC curves were drawn for these parameters with statistical difference and area under the curve(AUC)was used to measure the differential diagnostic performance of each parameter.Results:One-way ANOVA showed that there were significant differences in IC,NIC,CT40 keV,K among the 3 groups(P<0.05).LSD-t pairwise comparative analysis showed that there were significant differences in IC,CT40 keV,K between high level group and low level group(P<0.05).And between high level group and middle level group,there were significant differences in IC,NIC,CT40 keV,K(P<0.05).Spearman correlation analysis showed that the IC,NIC,CT40 keV and K were negatively correlated with the expression level of Ki-67(|r|<0.4,all P<0.05).ROC curve analysis showed that the AUC values of IC and K for distinguishing high level group and non-high level group were larger,which were 0.707 and 0.709 respectively.The sensitivity of IC and K was 68.5%,and the specificity of IC and K was 70.6%.Conclusion:It is found that the quantitative parameters of energy spectrum CT provide a new non-invasive method for evaluating the proliferation of cancer cells in NSCLC.