基于扩散峰度成像的直方图指标预测直肠腺癌 KRAS 突变：初步研究结果。
Diffusion kurtosis imaging-derived histogram metrics for prediction of KRAS mutation in rectal adenocarcinoma: Preliminary findings.
机构信息
Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan, China.
Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
J Magn Reson Imaging. 2019 Sep;50(3):930-939. doi: 10.1002/jmri.26653. Epub 2019 Jan 14.
BACKGROUND
Although histological examination is the standard method for assessing genetic status, the development of a noninvasive method, which can display the heterogeneity of the whole tumor to supplement genotype analysis, might be important for personalized treatment strategies.
PURPOSE
To evaluate the potential role of diffusion kurtosis imaging (DKI)-derived parameters using histogram analysis derived from whole-tumor volumes for prediction of the status of KRAS mutations in patients with rectal adenocarcinoma.
STUDY TYPE
Retrospective.
SUBJECTS
In all, 148 consecutive patients with histologically confirmed rectal adenocarcinoma who were treated at our institution.
SEQUENCE
DKI was performed with a 3.0 T MRI system using a single-shot echo-planar imaging sequence with b values of 0, 700, 1400, and 2100 sec/mm .
ASSESSMENT
D, K, and apparent diffusion coefficient (ADC) values were measured using whole-tumor volume histogram analysis and were compared between different KRAS mutations status.
STATISTICAL TESTS
Student's t-test or Mann-Whitney U-test, and receiver operating characteristic (ROC) curves were used for statistical analysis.
RESULTS
All the percentile metrics of ADC and D values were significantly lower in the mutated group than those in the wildtype group (all P < 0.05), except for the minimum value of ADC and D (both P > 0.05), while K-related percentile metrics were higher in the mutated group compared with those in the wildtype group (all P < 0.05). Regarding the comparison of the diagnostic performance of all the histogram metrics, K showed the highest AUC value of 0.871, and the corresponding values for sensitivity, specificity, positive predictive value, and negative predictive value were 81.43%, 78.21%, 77.03%, and 82.43%, respectively.
DATA CONCLUSION
DKI metrics with whole-tumor volume histogram analysis is associated with KRAS mutations, and thus may be useful for predicting the KRAS status of rectal cancers for guiding targeted therapy.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:930-939.
背景
尽管组织学检查是评估遗传状态的标准方法，但开发一种非侵入性方法，能够显示整个肿瘤的异质性，以补充基因型分析，可能对个性化治疗策略很重要。
目的
使用全肿瘤体积的直方图分析评估扩散峰度成像（DKI）衍生参数在预测直肠腺癌患者 KRAS 突变状态中的潜在作用。
研究类型
回顾性。
受试者
共纳入 148 例经组织学证实的直肠腺癌患者，均在我院接受治疗。
序列
使用 3.0T MRI 系统，采用单次激发回波平面成像序列，b 值为 0、700、1400 和 2100 sec/mm²。
评估
使用全肿瘤体积直方图分析测量 D、K 和表观扩散系数（ADC）值，并比较不同 KRAS 突变状态下的这些值。
统计学检验
使用 Student's t 检验或 Mann-Whitney U 检验，以及受试者工作特征（ROC）曲线进行统计学分析。
结果
突变组的 ADC 和 D 值的所有百分位度量均显著低于野生型组（均 P<0.05），除了 ADC 和 D 的最小值（均 P>0.05），而突变组的 K 相关百分位度量高于野生型组（均 P<0.05）。关于所有直方图指标的诊断性能比较，K 显示出最高的 AUC 值 0.871，其对应的灵敏度、特异性、阳性预测值和阴性预测值分别为 81.43%、78.21%、77.03%和 82.43%。
数据结论
全肿瘤体积直方图分析的 DKI 指标与 KRAS 突变相关，因此可能有助于预测直肠癌的 KRAS 状态，以指导靶向治疗。
证据水平
3 技术功效：阶段 2 J. Magn. Reson. Imaging 2019;50:930-939.
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