Comparative Analysis of Amide Proton TransferMRIand Diffusion-Weighted Imaging in Assessing p53 and Ki-67 Expression of Rectal Adenocarcinoma
Comparative Analysis of Amide Proton TransferMRIand Diffusion-Weighted Imaging in Assessing p53 and Ki-67 Expression of Rectal Adenocarcinoma
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酰胺质子转移mri与弥散加权显像评估直肠癌p53、Ki-67表达的比较分析
DOI：
10.1002/jmri.27212
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发表时间：
2020-06-10
影响因子：
4.4
通讯作者：
Liu, Xian
中科院分区：
文献类型：
--
作者：
Li, Ling;Chen, Weicui;Liu, Xian
背景直肠癌患者预后因素的评估具有重要的临床意义。P53状态和Ki-67指数是直肠癌的预后因素。酰胺质子转移（APT）成像在肿瘤诊断中显示出巨大的潜力。然而，很少有研究报道APT成像在评价直肠癌p53和Ki-67状态中的价值。目的探讨酰胺质子转移MRI评价直肠腺癌p53和Ki-67表达的可行性，并与常规扩散加权成像（DWI）进行比较。研究类型回顾性。人群43例直肠腺癌患者（年龄：34-85岁）。场强/序列3 T/APT成像，使用3D快速自旋回波（TSE）-狄克逊脉冲序列（具有化学位移选择性脂肪抑制）、2D DWI和2D T-2加权TSE。评估测量平均肿瘤APT信号强度（SI平均）和表观扩散系数（ADC（平均））。传统的肿瘤病理学分析包括WHO分级、pT（病理肿瘤）分期和pN（病理结）分期。免疫组化法检测p53和Ki-67的表达。统计学检验单因素方差分析（ANOVA）; Student检验;斯皮尔曼相关系数;受试者工作特征（ROC）曲线分析。结果高级别、中晚期和有淋巴结转移的肿瘤的APT SI值较高：高级别（n =15）vs.低级别（n =28），P < 0.001，pT 2（n =10）vs. pT 3（n =20）vs. pT 4（N =13），P= 0.021; pN0（n =24）vs. pN1-2（n =19），P= 0.019。在不同pT分期的肿瘤中发现ADC（平均值）差异：pT 2（n =10）vs. pT 3（n =20）vs. pT 4（N =13），P= 0.013，但在不同组织学分级的肿瘤中没有发现差异：高级别（n =15）vs.低级别（n =28），P= 0.3536;或pN分期：pN0（n =24）vs. pN1-2（n =19），P= 0.624。p53阳性状态的肿瘤的APT SI（平均值）高于p53阴性状态的肿瘤（2.363 +/- 0.457 vs. 2.0150 +/-0.3552，P = 0.014）。p53状态的ADC（平均值）无差异（1.058 +/- 0.1163 10（-3）mm（2）/s vs. 1.055 +/- 0.128 10（-3）mm（2）/s，P= 0.935）。低Ki-67状态和高Ki-67状态的肿瘤的APT SI（平均值）和ADC（平均值）存在显著差异（分别为1.7882 +/- 0.11386 vs. 2.3975 +/-0.41586，P < 0.001; 1.1741 +/- 0.093 10（-3）mm（2）/s vs. 1.0157 +/- 0.10459 10（-3）mm（2）/s，P < 0.001）。APT SI（均值）与p53标记指数和Ki-67标记指数呈正相关（分别为r = 0.3741，P = 0.0135;r =0.7048;P < 0.001）。ADC值与p53标记指数无相关性，与Ki-67标记指数呈负相关（r =-0.5543，P < 0.0001）。ROC曲线显示APT SI（平均值）对直肠腺癌Ki-67高表达的鉴别诊断能力显著高于ADC（平均值）（81.2%vs.78.12%，90.91%vs.63.64;P <0.001vs.P = 0.017），而对p53状态的预测无差异（92.86%比71.4%，53.33%比66.7%;P < 0.001比P= 0.0471）。数据结论直肠腺癌中APT SI（mean）与p53和Ki-67表达水平相关，APT显像可作为评估直肠腺癌遗传预后因素的无创性生物标志物。
Background The evaluation of prognostic factors in rectal carcinoma patients has important clinical significance. P53 status and the Ki-67 index have served as prognostic factors in rectal carcinoma. Amide proton transfer (APT) imaging has shown great potential in tumor diagnosis. However, few studies reported the value of APT imaging in evaluating p53 and Ki-67 status of rectal carcinoma. Purpose To investigate the feasibility of amide proton transfer MRI in assessing p53 and Ki-67 expression of rectal adenocarcinoma, and compare it with conventional diffusion-weighted imaging (DWI). Study Type Retrospective. Population Forty-three patients with rectal adenocarcinoma (age: 34-85 years). Field Strength/Sequence 3T/APT imaging using a 3D turbo spin echo (TSE)-Dixon pulse sequence with chemical shift-selective fat suppression, 2D DWI, and 2D T-2-weighted TSE. Assessment Mean tumor APT signal intensity (SImean) and apparent diffusion coefficient (ADC(mean)) were measured. Traditional tumor pathological analysis included WHO grades, pT (pathologic tumor) stages, and pN (pathologic node) stages. Expression levels of p53 and Ki-67 were determined by immunohistochemical assay. Statistical Tests One-way analysis of variance (ANOVA); Student'st-test; Spearman's correlation coefficient; receiver operating characteristic (ROC) curve analysis. Results High-grade tumors, more advanced stage tumors, and tumors with lymph node involvement had higher APT SI(mean)values: high grade (n =15) vs. low-grade (n =28),P < 0.001; pT2 (n =10) vs. pT3 (n =20) vs. pT4 (N =13),P= 0.021; pN0 (n =24) vs. pN1-2 (n =19),P= 0.019. ADC(mean)differences were found in tumors with different pT stage: pT2 (n =10) vs. pT3 (n =20) vs. pT4 (N =13),P= 0.013, but not in tumors with different histologic grade: high grade (n =15) vs. low-grade (n =28),P= 0.3536; or pN stage: pN0 (n =24) vs. pN1-2 (n =19),P= 0.624. Tumor with p53 positive status had higher APT SI(mean)than tumor with negative p53 status (2.363 +/- 0.457 vs. 2.0150 +/- 0.3552,P= 0.014). There was no difference in ADC(mean)with p53 status (1.058 +/- 0.1163 10(-3) mm(2)/s vs. 1.055 +/- 0.128 10(-3) mm(2)/s,P= 0.935). APT SI(mean)and ADC(mean)were significantly different in tumors with low and high Ki-67 status (1.7882 +/- 0.11386 vs. 2.3975 +/- 0.41586,P < 0.001; 1.1741 +/- 0.093 10(-3) mm(2)/s vs. 1.0157 +/- 0.10459 10(-3) mm(2)/s,P < 0.001, respectively). APT SI(mean)exhibited a positive correlation with p53 labeling index and Ki-67 labeling index (r =0.3741,P= 0.0135;r =0.7048;P < 0.001, respectively). ADC(mean)showed no correlation with p53 labeling index, but a negative correlation with Ki-67 labeling index (r = -0.5543,P < 0.0001). ROC curves demonstrated that APT SI(mean)had significantly higher diagnostic ability for differentiation of high Ki-67 expression of rectal adenocarcinoma than ADC(mean)(81.2% vs. 78.12%, 90.91% vs. 63.64;P < 0.001 vs.P= 0.017), while no difference was found in predicting p53 status (92.86% vs. 71.4%, 53.33% vs. 66.7%;P < 0.001 vs.P= 0.0471). Data Conclusion APT SI(mean)was related to p53 and Ki-67 expression levels in rectal adenocarcinoma.APT imaging may serve as a noninvasive biomarker for assessing genetic prognostic factors of rectal adenocarcinoma.Level of Evidence 3 Technical Efficacy Stage 2