【摘要】 目的 探讨肺癌脑转移瘤平均表观扩散系数(ADC_mean)值与原发病灶Ki-67水平的相关性及在亚型鉴别中的价值。方法回顾性纳入肺癌脑转移患者51例（共63个病灶）,其中腺癌29例（31个病灶）,鳞癌8例（13个病灶）,小细胞癌14例（19个病灶）,所有患者原发病灶均经病理检查、扩散加权成像（DWI）（b=1 000 s/mm²）扫描及Ki-67检测。通过测量获得ADC_mean值,采用SPSS 25.0软件及R语言进行相关性分析,组间两两比较采用LSD检验,同时将脑转移患者分为Ki-67高表达组（>25%）、Ki-67低表达组（≤25%）,应用受试者工作特征（ROC）曲线评判Ki-67表达的诊断能力。结果 肺癌脑转移瘤的ADC_mean值与原发病灶Ki-67呈显著负相关（r=-0.655,P<0.01）,3种肺癌亚型ADC_mean值与Ki-67呈负相关（r腺癌=-0.495,r磷癌=-0.395,r小细胞癌=-0.694）,亚型ADC_mean差异有统计学意义（P<0.05）。Ki-67低表达组的ADC_mean值高于Ki-67高表达组,差异有统计学意义（P<0.05）;ADC_mean值判断Ki-67低表达的曲线下面积（AUC）为0.881,以0.878×10^-3 mm²/s为界值判断Ki-67低表达的敏感性、特异性、阳性预测值、阴性预测值分别为87%、81%、60%、95%。结论 肺癌脑转移瘤ADC_mean值与原发病灶Ki-67表达水平呈负相关性具有一定的预测价值,在肺癌亚型鉴别中提供潜在的影像学信息,为临床精准治疗提供依据。更多还原

【Abstract】 Objective To investigate the correlation between mean apparent diffusion coefficient(ADC_mean) value of brain metastatic lung cancer and Ki-67 level in the primary lesion and its value in subtype differentiation.Methods A total of 51 eligible patients including63 metastatic brain lesions of lung cancer were retrospectively enrolled,including 29 adenocarcinoma（31 lesions）,8 squamous carcinoma（13 lesions）,and 14 small cell carcinoma（19 lesions）.The primary lesions of all patients were examined by pathological examination,diffusion weighted imaging（DWI）（b=1 000 s/mm²） scan and Ki-67 detection.The ADC_mean value was obtained by measurement,and correlation analysis was performed by SPSS 25.0 software and R language.LSD test was used for pair comparison between groups.Meanwhile,patients were divided into high（>25%） and low（≤25%） expression groups of Ki-67.The diagnostic ability of ADC_mean value to evaluate Ki-67 expression by receiver operating characteristic（ROC） curve was performed.Results There was a significant negative correlation between the ADC_mean value of brain metastatic lung cancer and Ki-67 in the primary lesion（r=-0.655,P<0.01）,and there was a negative correlation between the ADC_mean value of three lung cancer subtypes and Ki-67（r value of adenocarcinoma=-0.495,r value of squamous carcinoma=-0.395 and r value of small cell carcinoma=-0.694）.There were significant differences in ADC_mean values among thre-e subtype（P<0.05）.The ADC_mean value of Ki-67 low expression group was higher than that of Ki-67 high expression group,and the difference was statistically significant（P<0.05）.The ADC_mean value judged the area under the curve（AUC） of Ki-67 low expression was 0.881,with 0.878×10^-3 mm²/s as the cutoff value,the sensitivity,specificity,positive predictive value and negative predictive value of Ki-67low expression were 87%,81 %,60% and 95%,respectively.Conclusion The negative correlation is found between ADC_mean of brain metastatic lung cancer and Ki-67 expression level of primary lesion,which has certain predictive value,and the ADC_mean value provides potential imaging information in the differentiation of lung cancer subtypes and objective proof for clinical precision treatment.更多还原