Deng Jinling, Tang Qin, Wei Qijun, Ruan Fengqiu, Li Xuan, Long Liling
Department of Radiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Quant Imaging Med Surg. 2025 May 1;15(5):4262-4273. doi: 10.21037/qims-24-2313. Epub 2025 Apr 27.
Ki-67 is a pivotal biomarker for evaluating the prognosis of hepatocellular carcinoma (HCC). This study aimed to investigate the utility of qualitative and quantitative parameters derived from spectral computed tomography (CT) in assessing Ki-67 expression in HCC.
This prospective, single-center study included 89 patients (94 lesions) with pathologically confirmed HCC from February 2023 to February 2024. Participants underwent enhanced abdominal spectral CT scans within one week prior to surgery. The patients were divided into the following two groups based on the positive rate of Ki-67 (Ki-67%): a high-expression group (Ki-67 >20%, n=42); and a low-expression group (Ki-67 ≤20%, n=52). The spectral parameters assessed included CT values at 40 and 70 keV, iodine concentration (IC), the slope of the spectral Hounsfield unit (HU) curve (λHU), normalized iodine concentration (NIC) during the arterial phase (AP) and portal venous phase (PVP), and extracellular volume (ECV) fraction. Statistical significance of spectral CT parameters related to Ki-67 expression status was compared across different groups, and correlations between spectral CT parameters and Ki-67 expression levels were analyzed.
Significant differences were observed between the low and high Ki-67 expression groups concerning age, alpha-fetoprotein (AFP) levels, and capsule integrity (P=0.002, P=0.013, and P=0.005, respectively). Notable differences were also found in intratumoral NIC-AP, NIC-PVP, AP slope, PVP slope, and ECV fraction (P=0.017, P=0.005, P=0.001, P<0.001, and P=0.001, respectively). Meanwhile, in the comparative analysis between the low and high expression group of Ki-67, there were no statistically significant differences in the peritumoral <1 cm NIC-AP and NIC-PVP, as well as transtumoral NIC-AP and NIC-PVP levels (P>0.05). Ki-67 expression in HCC exhibited negative correlations with intratumoral NIC-AP (r=-0.248; P=0.016), NIC-PVP (r=-0.291; P=0.004), AP slope (r=-0.330; P=0.001), PVP slope (r=-0.367; P<0.001), and ECV fraction (r=-0.339; P=0.001).
Qualitative and quantitative parameters from spectral CT provide valuable information for distinguishing between low and high Ki-67 expression in HCC.
Ki-67是评估肝细胞癌（HCC）预后的关键生物标志物。本研究旨在探讨光谱计算机断层扫描（CT）得出的定性和定量参数在评估HCC中Ki-67表达的效用。
这项前瞻性单中心研究纳入了2023年2月至2024年2月期间89例经病理证实为HCC的患者（94个病灶）。参与者在手术前一周内接受了腹部增强光谱CT扫描。根据Ki-67阳性率（Ki-67%）将患者分为以下两组：高表达组（Ki-67>20%，n = 42）；低表达组（Ki-67≤20%，n = 52）。评估的光谱参数包括40和70 keV时的CT值、碘浓度（IC）、光谱亨氏单位（HU）曲线的斜率（λHU）、动脉期（AP）和门静脉期（PVP）的归一化碘浓度（NIC）以及细胞外容积（ECV）分数。比较不同组间与Ki-67表达状态相关的光谱CT参数的统计学意义，并分析光谱CT参数与Ki-67表达水平之间的相关性。
低Ki-67表达组和高Ki-67表达组在年龄、甲胎蛋白（AFP）水平和包膜完整性方面存在显著差异（分别为P = 0.002、P = 0.013和P = 0.005）。肿瘤内NIC-AP、NIC-PVP、AP斜率、PVP斜率和ECV分数也存在显著差异（分别为P = 0.017、P = 0.005、P = 0.001、P<0.001和P = 0.001）。同时，在Ki-67低表达组和高表达组的比较分析中，肿瘤周围<1 cm的NIC-AP和NIC-PVP以及肿瘤内的NIC-AP和NIC-PVP水平无统计学显著差异（P>0.05）。HCC中的Ki-67表达与肿瘤内NIC-AP（r = -0.248；P = 0.016）、NIC-PVP（r = -0.291；P = 0.004）、AP斜率（r = -0.330；P = 0.001）、PVP斜率（r = -0.367；P<0.001）和ECV分数（r = -0.339；P = 0.001）呈负相关。
光谱CT的定性和定量参数为区分HCC中Ki-67的低表达和高表达提供了有价值的信息。
