| Objective:To evaluate the value of the IVIM,DKI parameters in predicting the expression level of Ki-67 in STSs based on MRI-Pathology.Materials and Methods:1.Case data:21 cases of STSs in limbs,trunk,pelvic and abdominal cavity were chosen from March 2018 to April 2019 in The Second Hospital of Dalian Medical University.14 males and 7 famales age 27-76.21 cases of all STSs contained liposarcoma?10/21?,synovial sarcoma?3/21?,malignant gastrointestinal stromal tumor?3/21?,malignant peripheral nerve sheath tumor?2/21?,fibrosarcoma?1/21?,,leiomyosarcoma?1/21?,chondrosarcoma?1/21?.2.MR technology1)MR equipment and technology:The American GE Discovery 750 3.0 T MR and16 channel abdomen phased array coil was selected for all patients with conventional MR imaging,IVIM,DKI.IVIM and DKI was scanned before the enhanced MRI.2)Post-processing and data collection:IVIM and DKI images were sent to the ADW4.6 workstation.Functool functional software was used to post-process the original image.The regions of interest were the areas with the most obvious enhancement and the highest signal intensity of IVIM or DKI.Obtaining the parameters of IVIM and DKI.3.Comparison method between MRI and Pathology1)Compare the image surface with the pathological section2)Compare ROI of the image slice with the pathological sampling spot3)Tissue section observation and Ki-67 detection4.Observation index1)The Conventional MRI manifestations:the location of tumor,morphology,size,boundary,signal and enhancement.2)The IVIM and DKI parameters:Standard ADC,D,D*,f,DDC,?,MK,MD,FA values.3)Histopathological characteristics:cell morphology,structural features,interstitial properties,nuclear atypia,mitosis,necrotic area.4)Patients were grouped according to Ki-67 LI of STSs:high expression of Ki-67?Ki-67?25%?and low expression of Ki-67?Ki-67<25%?.5.Statistical analysis:Using SPSS 21.0 software to statistical analyze all the data.Normal distribution measurement data are expressed as mean±standard deviation?x±s?.The non-normal distribution measurement data is expressed as the median(P25-P75).1)When the normal distribution data are homogeneous in variance,two independent sample t test was used to compare the parameters of IVIM,DKI between two groups of STSs.The non-normal distribution data are tested by non-parametric Wilcoxon rank sum test.2)When the normal distribution data are homogeneous in variance,we used the Spearman correlation method to analyze the correlation between the parameters of IVIM,DKI and Ki-67.3)Using Receiver Operator Characteristic Curve?ROC?to analyze the threshold,sensitivity and specificity of the meaningful parameters in STSs.Results:1.The MRI findings of 21 cases of STSs1)Conventional MRI manifestations:1.The location of tumor:11 cases of limb,2 cases of buttock,4 cases of trunk,4cases of pelvic and abdominal cavity;2.Mmorphology:7 cases are round shape,14 cases are irregularity3.Size:9 cases of tumor diameter<5cm,12 cases of?5cm;4.Boundary:clear in 16 cases,fuzzy in 5 cases;5.Signal:uniform or hypointense on T1WI in 21 cases;hyperintense on T2WI in 5cases,heterogeneous signal in 16 cases;6.Enhancement:heterogeneous enhancement in 18 cases,uniform enhancement in3 cases.2)IVIM and DKI:hyperintense in 14 cases,slightly increased in 7 cases.The signal intensity is decreased with the increasing b value.2.The pathological observation of 21 cases of STSs:12 cases are high expression of Ki-67?Ki-67?25%?and 9 cases are low expression of Ki-67.3.Comparison between the parameters of IVIM,DKI and the expression of Ki-671)Comparison of IVIM,DKI parameters between Ki-67 high and low expression groupsIn 21 cases of STSs,the Standard ADC,D,DDC,MK,MD values are significantly different?t=4.018?4.077?3.905?-5.696?6.220 p<0.05?in Ki-67 high and low expression groups of STSs.Standard ADC,D,DDC,MD values in Ki-67 high expression group are lower than in low expression group,MK values are higher than in low expression group.2)Correlation between IVIM,DKI parameters and the expression of Ki-67There is a negative correlation between Standard ADC,D,DDC,MD values and the expression of Ki-67 in STSs,and there is a positive correlation between MK values and the expression of Ki-67.MD values have the best correlation with the expression of Ki-67?r=-0.811 p<0.05?.3)Diagnostic efficacy of IVIM,DKI parameters on the expression of Ki-67In 15 cases of STSs,the AUC of the Standard ADC,D,DDC,MK,MD values are0.907,0.954,0.917,0.963,0.972.The threshold of differential Ki-67 high and low expression groups is 1.422×10-3mm2/s,1.100×10-3mm2/s,1.403×10-3mm2/s,0.654,1.720?m2/ms.The sensitivity of the threshold is 88.9%,100%,88.9%,91.7%,88.9%,and the specificity is 91.7%,83.3%,91.7%,88.9%,100%.Conclusions:Based on MRI-Pathology,21 cases of STSs functional MR imaging IVIM and DKI were compared with the expression level of Ki-67,a pathological and immunohistochemical index,we draw the following preliminary conclusions:1.Standard ADC,D,DDC values of IVIM parameters can be used to identify the expression of Ki-67,and they are negatively correlated with the expression of Ki-67.The D values has the best diagnostic efficiency.2.MK and MD values of DKI parameters can be used to identify the expression of Ki-67.The MD values is negatively correlated with the expression of Ki-67.The MK values is positively correlated with the expression of Ki-67,and the MD values is the best.3.The diagnostic performance of MK and MD values is better than Standard ADC,D,DDC values.Thus,DKI is better than IVIM in predicting the expression of Ki-67. |
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