双能CT定量参数联合细胞外容积分数术前预测肺腺癌Ki-67表达水平

Dual-energy CT quantitative parameters combined with extracellular volume fraction for preoperative predicting Ki-67 expression in lung adenocarcinoma

摘要

目的 探讨双能CT(DECT)定量参数联合细胞外容积分数(ECV)在术前预测肺腺癌Ki-67表达水平中的价值。方法 回顾性收集2024年12月至2025年12月于我院行胸部DECT增强扫描并经手术病理证实的原发性肺腺癌患者153例。根据术后免疫组化Ki-67表达水平分为高表达组(Ki-67>25%,80例)和低表达组(Ki-67≤25%,73例)。测量动脉期、静脉期碘浓度(IC)、标准化碘浓度(NIC)、有效原子序数(Zeff)、能谱曲线斜率(λ)及延迟期ECV。采用Spearman相关分析评估各参数与Ki-67表达的相关性,多因素logistic回归筛选独立预测因子并构建联合预测模型,采用ROC曲线及DeLong检验评估模型预测效能。结果 Ki-67表达与ECV(r=0.525)、淋巴结转移(r=0.506)呈正相关(P<0.001),与静脉期Zeff(r=-0.342)、静脉期NIC(r=-0.291)、静脉期λ(r=-0.168)、动脉期IC(r=-0.161)呈负相关(P<0.05)。多因素分析显示,ECV(OR=2.356,95%CI:1.742~3.187,P<0.001)、静脉期NIC(OR=0.283,95%CI:0.092~0.871,P=0.027)及静脉期Zeff(OR=0.279,95%CI:0.079~0.988,P=0.048)是Ki-67高表达的独立预测因子。联合模型预测Ki-67高表达的AUC为0.853(95%CI:0.787~0.905),敏感度77.50%,特异度80.82%,显著高于ECV(AUC=0.803)、静脉期NIC(AUC=0.668)及静脉期Zeff(AUC=0.698)(DeLong检验,均P<0.05)。结论 DECT定量参数联合ECV可在术前无创预测肺腺癌Ki-67表达水平,ECV、静脉期NIC及静脉期Zeff的联合模型具有较高的诊断效能,可为临床术前决策提供有价值的参考依据,有助于指导个体化治疗方案的制定。

Abstract

Objective To investigate the value of dual-energy CT (DECT) quantitative parameters combined with extracellular volume fraction (ECV) in preoperatively predicting Ki-67 expression in lung adenocarcinoma. Methods A retrospective collection was conducted on 153 patients with primary lung adenocarcinoma confirmed by surgery and pathology who underwent chest DECT enhanced scanning in our hospital from December 2024 to December 2025. Patients were divided into high expression group (Ki-67>25%,n=80) and low expression group (Ki-67≤25%,n=73) according to postoperative immunohistochemical Ki-67 expression level. Iodine concentration (IC),normalized iodine concentration (NIC),effective atomic number (Zeff),spectral curve slope (λ) in arterial and venous phases,as well as ECV in delayed phase,were measured. Spearman correlation analysis was used to assess the correlation between each parameter and Ki-67 expression. Multivariate Logistic regression was used to screen independent predictors and construct a combined prediction model. The predictive efficacy of the model was evaluated using ROC curve and DeLong test. Results Ki-67 expression was positively correlated with ECV (r=0.525) and lymph node metastasis (r=0.506) (both P<0.001),and negatively correlated with venous phase Zeff (r=-0.342),venous phase NIC (r=-0.291),venous phase λ (r=-0.168),and arterial phase IC (r=-0.161) (all P<0.05). Multivariate analysis showed that ECV (OR=2.356,95%CI:1.742~3.187,P<0.001),venous phase NIC (OR=0.283,95%CI:0.092~0.871,P=0.027),and venous phase Zeff (OR=0.279,95%CI:0.079~0.988,P=0.048) were independent predictors of high Ki-67 expression. The combined model yielded an AUC of 0.853 (95%CI:0.787~0.905),with sensitivity 77.50% and specificity 80.82%,significantly higher than that of ECV (AUC=0.803),venous phase NIC (AUC=0.668),and venous phase Zeff (AUC=0.698) (DeLong test,all P<0.05). Conclusion DECT quantitative parameters combined with ECV can non-invasively predict Ki-67 expression in lung adenocarcinoma preoperatively. The combined model of ECV,venous phase NIC,and venous phase Zeff has high diagnostic efficacy and can provide valuable reference for clinical preoperative decision-making,facilitating the formulation of individualized treatment stratigies.

关键词

肺腺癌 / 双能CT / 细胞外容积分数 / Ki-67 / 预测模型

Key words

Lung adenocarcinoma / Dual-energy CT / Extracellular volume fraction / Ki-67 / Predictive model

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基金资助

济宁市重点研发计划项目(2024YXNS109)