扩散峰度成像鉴别交界性与恶性上皮性卵巢肿瘤：与 Ki-67 表达的相关性。
Diffusion kurtosis imaging for differentiating borderline from malignant epithelial ovarian tumors: A correlation with Ki-67 expression.
机构信息
Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
Department of Radiology, Nantong Cancer Hospital, Nantong University, Nantong, Jiangsu, P.R. China.
出版信息
J Magn Reson Imaging. 2017 Nov;46(5):1499-1506. doi: 10.1002/jmri.25696. Epub 2017 Mar 10.
PURPOSE
To investigate the use of diffusion kurtosis imaging (DKI) in differentiating borderline from malignant epithelial ovarian tumors (MEOTs) and to correlate DKI parameters with Ki-67 expression.
MATERIALS AND METHODS
Fifty-two consecutive patients with epithelial ovarian tumors (17 borderline epithelial ovarian tumors, BEOTs; 35 MEOTs) were prospectively evaluated using DKI with b values of 0, 500, 1000, 1500, 2000, and 2500 s/mm and standard diffusion-weighted imaging (DWI) with b values of 0 and 1000 s/mm using a 1.5T magnetic resonance imaging (MRI) unit. The kurtosis (K) and diffusion coefficient (D) from DKI and apparent diffusion coefficient (ADC) from standard DWI were measured, compared, and correlated with Ki-67 expression between the two groups. Statistical analyses were performed using the Mann-Whitney U-test, receiver operating characteristic (ROC) curves, and Spearman's correlation.
RESULTS
The K value was significantly lower in BEOTs than in MEOTs (0.55 ± 0.09 vs. 0.9 ± 0.2), while the D and ADC values were significantly higher in BEOTs than in MEOTs (2.27 ± 0.35 vs. 1.39 ± 0.37 and 1.72 ± 0.36 vs. 1.1 ± 0.25, respectively) (P < 0.001). For differentiating between BEOTs and MEOTs, the sensitivity, specificity, and accuracy were 88.2%, 94.3%, and 92.3% for K value; 88.2%, 91.4%, and 90.4% for D value; and 88.2%, 88.6%, and 88.5% for ADC value, respectively. However, there were no differences in the diagnostic performances among the three parameters above (K vs. ADC, P = 0.203; D vs. ADC, P = 0.148; K vs. D, P = 0.904). The K value was positively correlated with Ki-67 expression (r = 0.699), while the D and ADC values were negatively correlated with Ki-67 expression (r = -0.680, -0.665, respectively).
CONCLUSION
Preliminary findings demonstrate that DKI is an alternative tool for differentiating BEOTs from MEOTs, and is correlated with Ki-67 expression. However, no added value is found for DKI compared with standard DWI.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1499-1506.
目的
探讨扩散峰度成像（DKI）在鉴别交界性和恶性上皮性卵巢肿瘤（MEOT）中的作用，并将 DKI 参数与 Ki-67 表达相关联。
材料与方法
对 52 例上皮性卵巢肿瘤患者（17 例交界性上皮性卵巢肿瘤，BEOT；35 例 MEOT）进行前瞻性评估，使用 1.5T 磁共振成像（MRI）设备进行 DKI（b 值为 0、500、1000、1500、2000 和 2500 s/mm）和标准扩散加权成像（DWI）（b 值为 0 和 1000 s/mm）。测量并比较 DKI 的峰度（K）和扩散系数（D）和标准 DWI 的表观扩散系数（ADC），并在两组之间与 Ki-67 表达进行相关性分析。使用 Mann-Whitney U 检验、受试者工作特征（ROC）曲线和 Spearman 相关进行统计分析。
结果
BEOT 的 K 值明显低于 MEOT（0.55±0.09 比 0.9±0.2），而 BEOT 的 D 和 ADC 值明显高于 MEOT（2.27±0.35 比 1.39±0.37 和 1.72±0.36 比 1.1±0.25，分别）（P＜0.001）。对于鉴别 BEOT 和 MEOT，K 值的灵敏度、特异性和准确性分别为 88.2%、94.3%和 92.3%；D 值为 88.2%、91.4%和 90.4%；ADC 值为 88.2%、88.6%和 88.5%。然而，上述三个参数之间的诊断性能无差异（K 与 ADC，P=0.203；D 与 ADC，P=0.148；K 与 D，P=0.904）。K 值与 Ki-67 表达呈正相关（r=0.699），而 D 和 ADC 值与 Ki-67 表达呈负相关（r=-0.680，-0.665，分别）。
结论
初步研究结果表明，DKI 是鉴别 BEOT 和 MEOT 的一种替代工具，与 Ki-67 表达相关。但是，与标准 DWI 相比，DKI 并没有提供更多的价值。
证据水平
1 技术功效：第 2 阶段 J. Magn. Reson. Imaging 2017；46：1499-1506。
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