弥散峰度成像预测直肠腺癌UGT1A1*28基因突变的价值

目的评估弥散峰度成像(DKI)对直肠腺癌尿苷二磷酸葡萄糖醛酸基转移酶1A1(UGT1A1)*28基因突变的预测价值。方法回顾性研究。纳入山西省肿瘤医院2016年11月—2020年8月167例直肠腺癌患者的临床资料,其中男98例、女69例,年龄29~89岁、中位年龄为62岁。患者术前均行MR常规序列和DKI序列检查,将DKI图像导入Matlab软件并勾画感兴趣区,计算相应的平均弥散系数(MD)、平均峰度系数(MK)以及表观弥散系数(ADC)。依据患者UGT1A1*28基因多态性检测结果,将其分为野生型组和突变型组,采用独立样本t检验,比较2组患者MD、MK、ADC的差异。将差异有统计学意义的参数作为预测指标,采用受试者操作特征曲线(ROC曲线)以及DeLong检验分析,评价其对直肠腺癌UGT1A1*28基因突变状态的诊断效能。结果在167例直肠腺癌患者中,UGT1A1*28野生型(TA6/6)130例(77.8%)、突变型37例,后者中杂合突变型(TA6/7)34例(20.4%)、纯合突变型(TA7/7)3例(1.8%)。野生型患者的ADC与MD值均高于突变型,而MK值低于突变型患者,差异均有统计学意义(P值均<0.01)。根据ROC曲线分析,MD、MK以及ADC值预测UGT1A1*28基因突变的AUC分别为0.747、0.836、0.723,对应的灵敏度和特异度分别是83.8%和57.7%、78.4%和81.5%、75.7%和65.4%。结论DKI参数(MD、MK)以及ADC值均可用于直肠腺癌UGT1A1*28基因突变的预测。

The value of diffusion kurtosis imaging in predicting UGT1A1 * 28 gene mutation in rectal adenocarcinoma

Objective To evaluate the predictive value of diffusion kurtosis imaging (DKI) in predicting uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) *28 gene mutation in rectal adenocarcinoma. Methods The clinical data of 167 patients with rectal adenocarcinoma confirmed by pathology in Shanxi Province Tumor Hospital from November 2016 to August 2020 were retrospectively analyzed among 98 males and 69 females, with median aged of 62 (29–89) years. All patients underwent routine magnetic resonance imaging (MRI) sequence and DKI sequence examinations before operation. The DKI images were imported into Matlab software and the region of interest (ROI) of the tumor was delineated. The corresponding mean diffusivity (MD), mean kurtosis (MK), and apparent diffusion coefficient (ADC) were then generated. According to the results of UGT1A1*28 gene polymorphism, the patients were divided into wild and mutant type groups. Independent sample t-test was used to compare the differences of MD, MK, and ADC between two groups. The parameters with statistically significant differences were used as predictors, and receiver operating characteristic (ROC) curve and Delong test were used to evaluate the diagnostic efficacy of UGT1A1*28 gene mutation in rectal adenocarcinoma. Results Among the 167 patients with rectal adenocarcinoma, 130 cases (77.8%) were UGT1A1*28 wild type (TA6/6), while the other 37 cases were mutated. Of which 34 cases (20.4%) were heterozygous (TA6/7) and 3 cases (1.8%) were homozygous (TA7/7). MD and ADC values of wild-type group were significantly higher than those of mutant group, while MK value was significantly lower than that of mutant group, (all P values < 0.01). According to ROC curve analysis, the AUC of MD, MK, and ADC values for UGT1A1 * 28 gene mutation were 0.747, 0.836, 0.723, respectively. The corresponding sensitivity and specificity of them were 83.8% and 57.7%, 78.4% and 81.5%, 75.7% and 65.4%, respectively. Conclusion DKI parameters (MD and MK) and ADC values can be used to predict the mutation status of UGT1A1*28 gene in rectal adenocarcinoma.