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    动态增强磁共振成像结合DWI与非小细胞肺癌恶性生物学行为的关系及预测预后的价值

    Relationship between dynamic enhanced magnetic resonance imaging combined with DWI and malignant biological behavior of non-small cell lung cancer and the value of predicting prognosis

      摘要
    • 摘要: 目的：探究动态增强磁共振成像（DCE-MRI）、磁共振扩散加权成像（DWI）参数与非小细胞肺癌（NSCLC）恶性生物学行为的关系及联合预测NSCLC 预后的价值。方法：选取2020 年1 月至2022 年1 月江苏省连云港市第一人民医院120 例NSCLC 患者作为研究组，另选同期、同年龄段120 例良性肺结节患者作为对照组，均行DCE-MRI、DWI 检查；比较两组DCEMRI参数〔容积转移常数（Ktrans）、速率常数（Kep）、血管外细胞外间隙体积百分比（Ve）〕、DWI参数〔表观弥散系数（ADC）〕，并比较研究组不同恶性生物学行为患者DCE-MRI、DWI参数，分析DCE-MRI、DWI参数与研究组恶性生物学行为的相关性；比较研究组1年后不同预后患者临床资料及DCE-MRI、DWI参数，通过Lasso回归及logistic回归分析预后不良的预测因素，根据预测因素构建预后不良的Nomogram 预测模型，并对该模型进行验证。结果：研究组Ktrans、Kep、Ve较对照组高，ADC 较对照组低（P< 0.05）；不同肿瘤直径、淋巴结转移、临床分期、Ki-67 指数患者Ktrans、Kep、Ve、ADC 比较，差异有统计学意义（P< 0.05）；研究组Ktrans、Kep、Ve与肿瘤直径、淋巴结转移、临床分期、Ki-67 指数呈正相关关系，ADC 与肿瘤直径、淋巴结转移、临床分期、Ki-67指数呈负相关关系（均P< 0.05）；预后不良患者肿瘤直径、淋巴结转移、临床分期、Ki-67 指数、Ktrans、Kep、Ve、ADC 与预后良好患者比较，差异有统计学意义（P< 0.05）；Lasso 回归选出6 个预测因素：淋巴结转移、临床分期、Ktrans、Kep、Ve、ADC，logistic回归证实淋巴结转移、临床分期、Ktrans、Kep、Ve、ADC均与NSCLC预后不良显著相关（P< 0.05）；将以上因素构建NSCLC患者预后不良的Nomogram 预测模型，预测预后不良的AUC 为0.915，校准度、临床决策曲线（DCA）显示具有较好的一致性和临床效用。结论：DCE-MRI（Ktrans、Kep、Ve）、DWI参数（ADC）与患者淋巴结转移、临床分期有关，以上因素构建的预后不良Nomogram 预测模型具有良好的预测价值。

       

      Abstract: Objective: To investigate the relationship between dynamic enhanced magnetic resonance imaging(DCE-MRI) and diffusion-weighted magnetic resonance imaging (DWI) parameters and malignant biological be-havior of non-small cell lung cancer (NSCLC) and the value of combination in predicting the prognosis of NSCLC.Methods: A total of 120 patients with NSCLC in the First People’s Hospital of Lianyungang from Janu-ary 2020 to January 2022 were selected as the study group, and another 120 patients with benign pulmonary nod-ules in the same period and age group were selected as the control group, all of whom underwent DCE-MRI and DWI.The DCE-MRI parameters volume transfer constant (Ktrans), rate constant (Kep), percentage of extracellular space volume outside the blood vessel (Ve) and DWI parameters apparent diffusion coefficient (ADC) between the two groups were compared, the DCE-MRI and DWI parameters of patients with different malignant biological behaviors in the study group were com-pared, and the relationship between DCE-MRI and DWI parameters and malignant correlation of biological behaviors was analyzed.The clinical data, DCE-MRI and DWI parameters of patients with different prognosis in the research group after one year were compared, the predictive factors for poor prognosis were analyzed through Lasso regression and logistic regression, a Nomo-gram prediction model was constructed for poor prognosis based on the predictive factors, and the model was val-idated.Results: Ktrans, Kep, and Ve were higher and ADC was lower in the study group compared with the control group (P< 0.05); there were statistically significant differences in Ktrans, Kep, Ve and ADC among patients with dif-ferent tumor diameter, lymph node metastasis, clinical stage and Ki-67 index (P< 0.05).In the study group, Ktrans, Kep and Ve were positively correlated with tumor diameter, lymph node metastasis, clinical stage and Ki-67 index, while ADC was negatively correlated with tumor diameter, lymph node metastasis, clinical stage and Ki-67 index(all P< 0.05).There were statistically significant differences in tumor diameter, lymph node metastasis, clinical stage, Ki-67 index, Ktrans, Kep, Ve, and ADC in patients with poor prognosis compared with those with good progno-sis (P< 0.05).Six predictors were selected by Lasso regression: lymph node metastasis, clinical stage, Ktrans, Kep, Ve, and ADC, and logistic regression confirmed a significant correlation between lymph node metastasis, clinical stage, Ktrans, Kep, Ve, ADC and poor prognosis of NSCLC (P< 0.05).The Nomogram prediction model for poor prognosis of NSCLC patients was constructed based on the above factors, the AUC for predicting poor prognosis was 0.915, and the calibration and clinical decision curve (DCA) showed good consistency and clinical efficacy.Conclusion: DCE-MRI(Ktrans, Kep, Ve)and DWI(ADC)parameters are related to lymph node metastasis and clini-cal stage of patients.This Nomogram model for predicting poor prognosis constructed by the above factors has good predictive value.

       

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