双能CT定量参数联合细胞外容积分数预测肺腺癌Ki-67表达水平

张君香; 孙占国; 王唯伟; 王科鑫; 吕新; 吕四强

文章摘要

双能CT定量参数联合细胞外容积分数预测肺腺癌Ki-67表达水平

Dual-Energy CT Quantitative Parameters Combined with Extracellular Volume Fraction for Predicting Ki-67 Expression Level in Lung Adenocarcinoma

投稿时间：2026-04-08 修订日期：2026-07-09

DOI：

中文关键词: 肺腺癌双能CT 细胞外容积分数 Ki-67 预测模型

英文关键词: Lung Adenocarcinoma Dual-Energy CT Extracellular Volume Fraction Ki-67 Predictive Model

基金项目:济宁市重点研发计划项目（2024YXNS109）

作者	单位	邮编
张君香	济宁医学院附属医院	272029
孙占国^*	济宁医学院附属医院	272029
王唯伟	济宁医学院附属医院
王科鑫	济宁医学院附属医院
吕新	济宁医学院附属医院
吕四强	济宁医学院附属医院

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中文摘要:

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。

英文摘要:

Objective To investigate the value of dual-energy CT (DECT) quantitative parameters combined with extracellular volume fraction (ECV) in preoperatively predicting Ki-67 expression level 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 AUC of the combined model for predicting high Ki-67 expression was 0.853 (95%CI: 0.787-0.905), with a sensitivity of 77.50% and specificity of 80.82%, which was 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 level 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 plans.

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