[Correlation analysis of dynamic enhanced energy spectrum CT parameters with Ki-67 high expression in hepatocellular carcinoma].

Objective: To investigate the correlation between dynamic enhanced energy spectral CT parameters and Ki-67 high expression in hepatocellular carcinoma (HCC). Methods: A cross-sectional study. This retrospective case-control study analyzed the clinical data of 101 patients with pathologically confirmed HCC in Xiamen Hospital of Traditional Chinese Medicine and Zhongshan Hospital of Xiamen University from December 2017 to March 2023. These 101 patients included 84 males and 17 females, and the age[M(Q1, Q3)] was 59.0(49.0,66.0)years. These patients were divided into two groups according to the immunohistochemical Ki-67 expression levels in tumor tissues: the high expression group (Ki-67%>20%, n=59) and the low expression group (Ki-67%≤20%, n=42).CT values on 70 keV and 140 keV monochromatic energy images (HU70 keV-a, HU140 keV-a, HU70 keV-p, HU140 keV-p) and water density (Dwater-a, Dwater-p) were measured in arterial phase and portal vein phase, and the difference of HU70 keV, HU140 keV, Dwater values between portal vein and arterial phase (ΔHU70 keV, ΔHU140 keV, ΔDwater), as well as ratio of HU70 keV, HU140 keV, Dwatervalues between portal vein and arterial phase (HU70 keVratio, HU140 keVratio, Dwaterratio) were calculated. Spearman correlation analysis was used to analyze the correlation between the CT spectral parameters and Ki-67%. Multivariate logistic regression model was used to determine the factors associated with high expression of Ki-67. The receiver operating characteristics (ROC) curves were used to indicate the efficacy of dynamic enhanced spectral CT in evaluating Ki-67 high expression in HCC. Results: The high Ki-67 expression group revealed higher alpha fetal protein levels, larger tumor diameter and more irregular tumor shape compared with the low Ki-67 expression group,and the differences were statistically significant (all P<0.05). Spearman correlation analysis showed that the HU140 keV-p, Dwater-p, HU70 keV ratio, HU140 keV ratio, Dwater ratio, ΔHU70 keV, ΔHU140 keV, ΔDwater were positively correlated with Ki-67 positivity rate (r:0.31-0.50, all P<0.05). The spectral CT parameters (HU70 keV-p, HU140 keV-p, Dwater-p, HU70 keV ratio, HU140 keV ratio, Dwater ratio, ΔHU70 keV, ΔHU140 keV, ΔDwater) in high Ki-67 expression group were significantly higher than those in low Ki-67 expression group (all P<0.05). Multivariate logistic regression model shows that Dwater-p(OR=1.16, 95%CI: 1.05-1.29, P=0.005), ΔHU140 keV(OR=1.39, 95%CI: 1.20-1.62, P<0.001) and irregular tumor morphology (OR=5.25, 95%CI: 1.61-17.12, P=0.006) were correlative factors for high Ki-67 expression. The HU140 keV ratio and ΔHU140 keV alone evaluated the highest AUC of high Ki-67 high expression in HCC, which were 0.82 (95%CI: 0.74-0.90), the sensitivity were 61.0%, and the specificity were 88.1% and 85.7%. The combined analysis of Dwater-p, ΔHU140 keV and irregular tumor morphology had an increased AUC of 0.88 (95%CI: 0.81-0.95) in assessment high Ki-67 expression, with the sensitivity of 84.7% and the specificity of 78.6%. Conclusions: Dynamic enhanced spectral CT parameters were positively correlated with the Ki-67 expression in HCC. Spectral CT provides a non-invasive method to evaluate the proliferation status of HCC cells, and the efficiency could be improved by multi-parameter analysis combining spectral CT parameters and morphologic features.目的： 探讨基于动态增强能谱CT参数与肝细胞癌（HCC）中Ki-67高表达的相关性。 方法： 横断面研究。回顾性分析2017年12月至2023年3月在厦门市中医院和厦门大学附属中山医院就诊并病理证实的101例HCC患者的临床资料，其中男84例，女17例，年龄［M（Q1，Q3）］为59.0（49.0，66.0）岁。根据患者肿瘤组织免疫组化Ki-67的表达情况将患者分为高表达组（Ki-67阳性率>20%，n=59）和低表达组（Ki-67阳性率≤20%，n=42）。分别测量两组HCC患者的动脉期及门静脉期病灶70 keV、140 keV单能量CT值（HU70 keV-a、HU140 keV-a、HU70 keV-p、HU140 keV-p）和水密度值（Dwater-a、Dwater-p），并计算相应参数门静脉期和动脉期的差值（ΔHU70 keV、ΔHU140 keV、ΔDwater）和比值（HU70 keV比值、HU140 keV比值、Dwater比值）。采用Spearman相关分析评估CT能谱参数与Ki-67表达的相关性。采用多因素logistic回归模型来确定Ki-67高表达的相关因素。采用受试者工作特征（ROC）曲线下面积（AUC）表示动态增强能谱CT各参数评估HCC中Ki-67高表达的效能。 结果： 与Ki-67低表达组比高表达组甲胎蛋白更高、肿瘤直径更大、肿瘤形态更不规则，差异均有统计学意义（均P<0.05）。Spearman相关分析显示，HU140 keV-p、Dwater-p、HU70 keV比值、HU140 keV比值、Dwater比值、ΔHU70 keV、ΔHU140 keV、ΔDwater与Ki-67阳性率呈正相关（r：0.31~0.50，均P<0.05）。Ki-67高表达组的HU70 keV-p、HU140 keV-p、Dwater-p及其相应的比值和差值均高于低表达组，差异均有统计学意义（均P<0.05）。多因素logistic回归模型显示，Dwater-p（OR=1.16，95%CI：1.05~1.29，P=0.005）、ΔHU140 keV（OR=1.39，95%CI：1.20~1.62，P<0.001）和肿瘤形态不规则（OR=5.25，95%CI：1.61~17.12，P=0.006）是HCC中Ki-67高表达的相关因素。HU140 keV比值和ΔHU140 keV单独评估HCC中Ki-67高表达的AUC最高，均为0.82（95%CI：0.74~0.90），灵敏度均为61.0%，特异度分别为88.1%和85.7%；Dwater-p、ΔHU140 keV和肿瘤形态不规则联合评估HCC中Ki-67高表达的AUC为0.88（95%CI：0.81~0.95），灵敏度为84.7%，特异度为78.6%。 结论： 动态增强能谱CT参数与HCC中Ki-67的表达正相关，可以提供一种新的无创方法评估HCC肿瘤细胞的增殖情况，结合能谱CT参数和肿瘤形态学特征的多变量分析可以提高评估效能。.