摘要
目的探讨磁共振成像(MRI)检查体素内不相干运动(IVIM)成像及纹理分析对直肠癌BRAF基因突变的预测价值。方法采用临床诊断性试验研究方法。收集2016年1月至2021年6月商丘市第一人民医院收治的36例直肠癌患者的临床病理资料;男28例,女8例;年龄为(50±4)岁。36例患者均经病理学检查确诊,经基因检测后,将12例BRAF基因突变型(均为BRAF V600E突变)设为突变组,24例BRAF野生型设为未突变组。患者术前均行MRI检查,采用Function Tool后处理软件分析得到IVIM相关后处理图。观察指标:(1)IVIM参数及纹理参数观察者一致性检验。(2)两组患者MRI检查IVIM参数比较。(3)两组患者MRI检查纹理参数比较。(4)IVIM参数与纹理参数的诊断效能。采用组内相关系数(ICC)评估参数观察者一致性(ICC>0.80为一致性良好),取ICC>0.80参数的平均值进一步分析。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用Mann⁃Whitney U检验。计数资料以绝对数表示,组间比较采用χ^(2)检验。等级资料比较采用非参数秩和检验。采用Logistic回归联合纹理参数,采用受试者工作特征(ROC)曲线分析预测性能,并计算灵敏度、特异度。结果(1)IVIM参数及纹理参数观察者一致性检验:两名观察者记录IVIM参数表观扩散系数、扩散相关系数、灌注相关扩散系数、灌注相关参数的ICC值分别为0.91、0.90、0.91、0.89。纹理参数中最小值、最大值、第10百分位数、第25百分位数的ICC值均<0.80,平均值、第50百分位数、第75百分位数、第90百分位数、能量值、熵值、偏度、峰度的ICC值均>0.80。(2)两组患者MRI检查IVIM参数比较:突变组患者MRI检查IVIM参数中扩散相关系数、灌注相关参数分别为(0.70±0.13)×10^(-3) mm^(2)/s、0.39±0.30;未突变组上述指标分别为(0.79±0.12)×10^(-3) mm^(2)/s、0.17±0.10;两组患者上述指标比较,差异均有统计学意义(t=-2.17、2.46,P<0.05)。(3)两组患者MRI检查纹理参数比较:突变组患者扩散相关系数图纹理参数中平均值和能量值分别为0.54±0.23和0.00(0.00,0.01);未突变组上述指标分别为0.77±0.34和0.01(0.00,0.01);两组患者上述指标比较,差异均有统计学意义(t=-2.12,Z=-1.35,P<0.05)。(4)IVIM参数与纹理参数的诊断效能。ROC分析结果显示:MRI检查扩散相关系数、灌注相关参数、IVIM参数联合、扩散相关系数图平均值、扩散相关系数图能量值、纹理参数联合曲线下面积分别为0.69[95%可信区间(CI)为0.52~0.84]、0.76(95%CI为0.59~0.88)、0.79(95%CI为0.62~0.91)、0.71(95%CI为0.52~0.85)、0.79(95%CI为0.62~0.91)、0.84(95%CI为0.68~0.94),均小于IVIM参数联合纹理参数曲线下面积0.92(95%CI为0.79~0.99)。结论MRI检查IVIM参数和纹理参数分析可无创预测直肠癌BRAF基因突变状态,且将两者联合诊断的预测效能更优。
Objective To investigate the value of intravoxel incoherent motion(IVIM)magnetic resonance imaging(MRI)and texture analysis for predicting BRAF gene mutation in rectal cancer.Methods The clinical diagnositic trial was conducted.The clinicopathological data of 36 rectal cancer patients who were admitted to the First People's Hospital of Shangqiu from January 2016 to June 2021 were collected.There were 28 males and 8 females,aged(50±4)years.All the 36 patients were confirmed by pathological examination.After genetic testing,12 patients with BRAF mutant type of BRAF V600E mutation were allocated into the mutation group,and 24 patients with BRAF wild type were allocated into the non-mutation group.All patients underwent MRI scan before surgery,and IVIM related post-processing images were received by Function Tool postprocessing software.Observation indicators:(1)consistency test between observers of IVIM parameters and texture parameters;(2)comparison of IVIM parameters on MRI between the two groups;(3)comparison of texture parameters on MRI between the two groups;(4)diagnostic efficacy of IVIM and texture parameters.The intraclass correlation coefficient(ICC)was used to evaluate the consistency between observers,with ICC>0.80 as good consistency.The average values of parameters with ICC>0.80 were included for further analysis.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by the independent sample t test.Measurement data with skewed distribution were represented as M(Q_(1),Q_(3)),and comparison between groups was analyzed using the Mann-Whitney U test.Count data were described as absolute numbers,and comparison between groups was analyzed by the chi-square test.Comparison of ordinal data was analyzed by the non-parameter rank sum test.The texture parameters were combined using the Logistic regression model.Receiver operating characteristic curve was used to analyze the predictive performance and calculate the sensitivity and specificity.Results(1)Consistency test between observers of IVIM parameters and texture parameters:the ICCs between two observers of IVIM parameters including apparent diffusion coefficient,diffusion related coefficient,perfusion-related diffusion coefficient and perfusion-related parameter were 0.91,0.90,0.91,0.89,respectively.The ICCs of texture parameters including the minimum value,the maximum value,the 10th percentile and the 25th percentile between two observers were<0.80 while the ICCs of texture parameters including mean value,the 50th percentile,the 75th percentile,the 90th percentile,energy,entropy,skewness and kurtosis between two observers were>0.80.(2)Comparison of IVIM parameters on MRI between the two groups:IVIM parameters of diffusion related coefficient and perfusion-related parameter on MRI were(0.70±0.13)×10^(-3)mm^(2)/s and 0.39±0.30 for the mutation group,versus(0.79±0.12)×10^(-3)mm^(2)/s and 0.17±0.10 for the non-mutation group,showing significant differences between the two groups(t=-2.17,2.46,P<0.05).(3)Comparison of texture parameters on MRI between the two groups:the texture parameters of mean value and energy on diffusion related coefficient image were 0.54±0.23 and 0.00(0.00,0.01)for the mutation group,versus 0.77±0.34 and 0.01(0.00,0.01)for the non-mutation group,showing significant differences between the two groups(t=-2.12,Z=-1.35,P<0.05).(4)Diagnostic efficacy of IVIM and texture parameters:the areas under the curve(AUCs)of diffusion related coefficient,perfusion-related parameter,IVIM parameters combination,mean value of diffusion related coefficient image,energy value of diffusion related coefficient image,texture parameters combination were 0.69[95% confidence interval(CI)as 0.52-0.84],0.76(95%CI as 0.59-0.88),0.79(95%CI as 0.62-0.91),0.71(95%CI as 0.52-0.85),0.79(95%CI as 0.62-0.91),0.84(95%CI as 0.68-0.94),which were all lower than the AUC of IVIM and texture parameters combination as 0.92(95%CI as 0.79-0.99).Conclusions IVIM parameters and texture parameters of MRI can noninvasively predict the mutation status of BRAF gene in rectal cancer.The combination of IVIM and texture parameters has a better predictive efficacy.
作者
乔树林
葛大赫
韩祥松
穆速
李依明
Qiao Shulin;Ge Dahe;Han Xiangsong;Mu Su;Li Yiming(Department of Radiation Oncology,the First People's Hospital of Shangqiu,Shangqiu 476105,He'nan Province,China;Department of Gastroenterology,the First People's Hospital of Shangqiu,Shangqiu 476105,He'nan Province,China;Department of Gastrointestinal Hepatobiliary Surgery,the First People's Hospital of Shangqiu,Shangqiu 476105,He'nan Province,China;Imaging Center of the First People's Hospital of Shangqiu,Shangqiu 476105,He'nan Province,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2022年第3期415-422,共8页
Chinese Journal of Digestive Surgery
基金
河南省医学科技攻关计划项目(LHGJ20191496)。
关键词
直肠肿瘤
磁共振成像
体素内不相干运动
纹理分析
BRAF
Rectal neoplasms
Magnetic resonance imaging
Intravoxel incoherent motion
Texture analysis
BRAF
