非小细胞肺癌DLSCT双期定量参数与Ki-67表达水平的相关性研究

高楠琳; 王新文; 薛莉雅; 王杰; 丁金祥

doi:10.15953/j.ctta.2024.299

非小细胞肺癌DLSCT双期定量参数与Ki-67表达水平的相关性研究

山西医科大学医学影像学院，太原 030000

详细信息

作者简介:
高楠琳，女，山西医科大学在读硕士，主要研究方向为胸部系统疾病诊断

通讯作者:
王新文✉，男，山西医科大学第二医院放射科主任医师，主要从事胸部系统疾病影像诊断及研究，E-mail：sxeywxw@163.com。

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出版历程
- 收稿日期: 2024-12-11
- 修回日期: 2025-02-27
- 录用日期: 2025-02-27
- 网络出版日期: 2025-04-05

Correlation between Dual-Phase Quantitative Parameters from Dual-Layer Spectral Detector Computed Tomography and Ki-67 Expression in Non-Small Cell Lung Cancer

Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030000, China

摘要

摘要:
目的：研究双层探测器光谱CT（DLSCT）双期定量参数对非小细胞肺癌Ki-67表达的预测价值。方法：回顾性分析我院自2022年8月至2024年12月进行DLSCT双期增强扫描且经病理证实的非小细胞肺癌患者77例，按免疫组化结果分为低表达组(Ki-67≤30%)、高表达组(Ki-67＞30%)。使用Spectral CT viewer软件测量、计算、分析两组病例动脉期和静脉期的双层光谱CT定量参数，包括碘密度(IC)、标准化碘密度(NIC)、有效原子序数(Zeff)、能谱曲线斜率(K_{40-100 keV}，简称K)、MonoE(单能量光谱结果)间隔10 keV的CT_{40 keV}-CT_{100 keV}。统计学方法：采用独立样本t检验方法比较组间差异；用Spearman相关分析评价DLSCT双期定量参数和Ki-67表达水平间的相关性；绘制受试者工作曲线(ROC),获得曲线下面积(AUC)，约登指数、敏感度、特异度衡量DLSCT各定量参数评估Ki-67表达水平的效能。结果：静脉期低表达组IC、NIC、Zeff、K_{40-100 keV}、CT_{40 keV}-CT_{70 keV}(间隔10 keV)均高于高表达组，动脉期低表达组K_{40-100 keV}、CT_{40 keV}高于高表达组，差异均具有统计学意义。静脉期IC、NIC、Zeff、K_{40-100 keV}、CT_{40 keV}-CT_{60 keV}(间隔10 keV)、动脉期K_{40-100 keV}、CT_{40 keV}与Ki-67表达水平呈负相关。绘制ROC，静脉期K40-100 keV评估非小细胞肺癌Ki-67表达水平最佳。结论：DLSCT双期定量参数是预测非小细胞肺癌 Ki-67 表达水平的有效工具，研究证据表明静脉期能谱曲线斜率 (K) 是其中最具预测价值的指标。
- 光谱CT /
- 非小细胞肺癌 /
- Ki-67增殖抗原
Abstract:
Objective: We investigated the predictive value of dual-phase quantitative parameters of dual-layer spectral detector computed tomography (DLSCT) combined with Ki-67 expression in non-small-cell lung cancer (NSCLC). Methods: Seventy-seven patients with pathologically confirmed non-small cell lung cancer who underwent dual-phase enhanced scanning at our hospital between August 2022 and December 2024 were retrospectively analyzed. According to immunohistochemical results, they were divided into low (Ki-67≤30%) and high (Ki-67＞30%) Ki-67 expression groups. Spectral CT viewer software was used to measure, calculate, and analyze the quantitative parameters obtained with dual-layer spectral CT in the arterial and venous phases in both groups, including iodine density (IC), standardized iodine density (NIC), effective atomic number (Zeff), and energy spectrum curve slope (K, P < 0.05) (referred to as K and MonoE [monochromatic energy spectroscopy]) results, and CT40 keV-CT100 keV at 10 keV intervals. An independent samples t-test was used to compare differences between groups. Spearman’s correlation analysis was used to evaluate the correlation between the quantitative parameters of DLSCT and Ki-67 expression. A receiver-operating characteristic (ROC) curve was constructed to obtain the area under the curve (AUC). Youden index, sensitivity, and specificity were used to measure the efficacy of each quantitative parameter of DLSCT in predicting Ki-67 expression. Results: IC, NIC, Zeff, K40-100 keV, CT40 keV-CT70 keV (interval 10 keV) were higher in the low expression group than in the high expression group in venous phase, and K40-100 keV and CT40 keV were higher in the low expression group than in the high expression group in arterial phase. The differences were statistically significant (P＜0.05). IC, NIC, Zeff, K40-100 keV, CT40 keV-CT60 keV (interval 10 keV) in venous phase, and K40-100 keV, CT40 keV in arterial phase correlated negatively with Ki-67 expression level (|r| < 0.40,P < 0.05). The ROC curve showed that K40-100 keV in venous phase was the best parameter for predicting Ki-67 expression in NSCLC (AUC=0.750). Conclusion: Dual-phase quantitative parameters of DLSCT are effective tools for predicting Ki-67 expression in non-small cell lung cancer, and research evidence shows that the slope (K) of the spectral curve in the venous phase is the most valuable index.
- spectral CT /
- carcinoma non-small-celllung /
- Ki-67 proliferation.

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图 1 患者女，55岁，右肺下叶腺癌(圆圈为ROI)，Ki-67为3%

注：（a）~（d）依次为有效原子序数图(Zeff=8.13)、碘密度图(IC=1.54)、胸部40 keV单能量图(CT_{40 keV}=184.446)、能谱曲线图(K=1.94)。

Figure 1. A 55-year-old female patient with adenocarcinoma of the right lower lobe of the lung (circle is ROI), Ki-67 was 3%

下载: 全尺寸图片幻灯片

图 2 患者女，66岁，右肺上叶鳞癌(圆圈为ROI)，Ki-67为60%

注：（a）~（d）依次为有效原子序数图(Zeff=7.94)、碘密度图(IC=1.12)、胸部40 keV单能量图(CT_{40 keV}=133.940)、能谱曲线图(K=1.36)。

Figure 2. A 66-year-old female patient with squamous cell carcinoma in the right upper lobe of the lung (circle is ROI), Ki-67 was 60%

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图 3 静脉期光谱CT各参数鉴别Ki-67高表达组与非高表达组的ROC曲线

Figure 3. ROC curve of each parameter of venous phase spectral CT for identifying high and low Ki-67 expression groups

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图 4 动脉期光谱各参数鉴别Ki-67高表达组与非高表达组的ROC曲线

Figure 4. The receiver operating characteristic (ROC) curve of each parameter of arterial phase spectral CT in identifying high and low Ki-67 expression groups

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表 1 Ki-67高、低表达组静脉期光谱CT各参数比较

Table 1 Comparison of spectral CT parameters in venous phase from high and low Ki-67 expression groups

参数	组别		统计检验
参数	低表达组	高表达组	t值	P值
n	27	50
IC/（mg/mL）	1.37±0.39	1.12±0.36	2.9	0.01
NIC	0.31±0.08	0.25±0.08	3.27	＜0.01
Zeff	8.08±0.18	7.95±0.26	2.3	0.02
K_{40-100 keV}	1.87±0.44	1.43±0.48	3.93	＜0.01
CT_{40 keV}/HU	164.68±32.27	137.72±34.98	3.31	＜0.01
CT50_keV/HU	121.38±26.42	103.3±25.39	2.94	＜0.01
CT_{60 keV}/HU	93.03±17.37	81.84±17.87	2.65	0.01
CT_{70 keV}/HU	75.8±13.62	68.37±13.14	2.34	0.02
CT_{80 keV}/HU	63.86±12.76	60.71±11.53	1.1	0.28
CT_{90 keV}/HU	56.6±12.92	55.38±9.96	0.46	0.65
CT_{100 keV}/HU	52.68±11.97	51.78±9.02	0.37	0.71

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表 2 Ki-67高、低表达组动脉期光谱CT各参数比较

Table 2 Comparison of arterial phase spectral CT parameters from high and low Ki-67 expression groups

参数	组别		统计检验
参数	低表达组	高表达组	t值	P值
n	27	50
IC/（mg/mL）	1.31±0.39	1.15±0.36	1.5	0.14
NIC	0.11±0.03	0.09±0.04	1.75	0.08
Zeff	7.99±0.24	7.95±0.26	0.66	0.51
K_{40-100 keV}	1.61±0.45	1.33±0.50	2.42	0.02
CT_{40 keV}/HU	150.30±31.75	132.03±35.03	2.26	0.03
CT50_keV/HU	109.08±21.23	100.58±24.32	1.53	0.13
CT_{60 keV}/HU	86.11±15.43	80.42±16.98	1.45	0.15
CT_{70 keV}/HU	72.69±12.37	68.32±12.50	1.47	0.15
CT_{80 keV}/HU	63.54±10.60	60.60±9.96	1.21	0.23
CT_{90 keV}/HU	57.66±9.72	55.51±8.26	1.03	0.31
CT_{100 keV}/HU	53.54±9.23	52.01±7.19	0.81	0.42

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表 3 静脉期光谱CT各参数与Ki-67表达水平的相关性分析

Table 3 Correlation analysis between Ki-67 expression and parameters from venous phase spectral CT

	r值	P值
分组	1
IC(mg/ml)	−0.267	0.02
NIC	−0.297	0.01
Zeff	−0.251	0.03
K_{40-100 keV}	−0.398	＜0.01
CT_{40 keV}(HU)	−0.315	0.01
CT50_keV(HU)	−0.278	0.01
CT_{60 keV}(HU)	−0.243	0.03
CT_{70 keV}(HU)	−0.194	0.10
CT_{80 keV}(HU)	−0.062	0.60
CT_{90 keV}(HU)	−0.007	−0.95
CT_{100 keV}(HU)	−0.007	0.95

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表 4 动脉期光谱CT各参数与Ki-67表达水平的相关性分析

Table 4 Correlation analysis between Ki-67 expression and parameters from arterial phase spectral CT

	分组	K_{40-100 keV}	CT_{40 keV}(HU)
r值	1	−0.225	−0.225
P值		0.05	＜0.05

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表 5 光谱CT各参数诊断Ki-67高表达组与非高表达组肺癌病灶的效能

Table 5 Efficacy of spectral CT parameters in diagnosis of lung cancer lesions in the high Ki-67 group and the low Ki-67 group

指标	约登指数	临界值	敏感度(%)	特异度(%)	AUC	95%CI
IC (V)	0.284	1.145	70.4	58.0	0.674	0.549-0.799
NIC(V)	0.275	0.245	81.5	46.0	0.683	0.561-0.804
Zeff(V)	0.292	7.925	85.2	44.0	0.660	0.538-0.782
K_{40-100 keV}(V)	0.409	1.366	88.9	52.0	0.750	0.641-0.859
CT_{40 keV}(V)	0.347	150.772	66.7	68.0	0.698	0.575-0.820
CT_{50 keV}(V)	0.356	116.921	55.6	80.0	0.679	0.549-0.809
CT_{60 keV}(V)	0.353	89.047	59.3	76.0	0.666	0.536-0.796
CT_{70 keV}(V)	0.316	74.610	55.6	76.0	0.644	0.513-0.776
K_{40-100 keV}(A)	0.321	1.407	74.1	58.0	0.662	0.537-0.788
CT_{40 keV}(A)	0.295	130.264	81.5	48.0	0.657	0.531-0.783
注：AUC：曲线下面积；CT_{40 keV}(V)、CT_{40 keV}(A)：分别代表静脉期CT_{40 keV}、动脉期CT_{40 keV}，余数据以此类推。

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