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Non-invasive preoperative prediction of histological differentiation and Ki-67 expression level in pancreatic ductal adenocarcinoma based on mDixon-Quant sequence
CHEN Kun  RUAN Zhibing  SHI Shihan  CHEN Huilin  WEN Feng  XU Maoli  TANG Geya 

Cite this article as: CHEN K, RUAN Z B, SHI S H, et al. Non-invasive preoperative prediction of histological differentiation and Ki-67 expression level in pancreatic ductal adenocarcinoma based on mDixon-Quant sequence[J]. Chin J Magn Reson Imaging, 2025, 16(5): 30-36. DOI:10.12015/issn.1674-8034.2025.05.005.


[Abstract] Objective To investigate the feasibility and clinical value of quantitative parameters derived from the mDixon-Quant sequence in preoperative non-invasive prediction of histological differentiation grade and Ki-67 expression level in patients with pancreatic ductal adenocarcinoma (PDAC).Materials and Methods A retrospective analysis was conducted on the clinical, radiological, and a cohort of 57 cases exhibiting pathologically confirmed PDAC. According to the histological differentiation degree, 57 patients were divided into well-differentiated group (n = 30) and poorly differentiated group (n = 27). The basic clinical data of the two groups (age, gender, abdominal pain, jaundice, preoperative CA19-9 level, etc.), conventional imaging features (location, morphology, boundary, long and short diameters of the tumor, whether there is dilation of the pancreatic duct, vascular invasion, etc.) and quantitative parameters [water phase value, fat phase value, T2* value, R2* value and fat fraction (FF)] were analyzed. The quantitative parameter values of healthy pancreases were collected for normal control according to the ratio of the case group to the normal group (1∶1). At the same time, 31 cases with Ki-67 expression level results were analyzed, and they were divided into high expression (Ki-67 ≥ 50%) and low expression groups (Ki-67 < 50%). The intra-class correlation coefficient (ICC) was used to evaluate the repeatability. The Mann-Whitney U test, t test or χ2 test was used to compare the differences of various parameters between the two groups. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate the predictive efficacy of relevant indicators. The efficacy of different AUCs was compared by employing the DeLong test.Results A statistically significant age disparity was observed between the well-differentiated and poorly differentiated subgroups. Patients with poorly differentiated demonstrated a modestly younger compared to the well-differentiated cohort (P = 0.006). However, there were no statistically significant differences in gender, symptoms, CA19-9 level, mass morphology, location, and whether there was dilation of the pancreatic duct, etc. Except for the water phase value, there were statistically significant differences between the healthy pancreas group and the PDAC group, as well as between the patient's lesion and the normal pancreatic area (P < 0.05). Furthermore, the well-differentiated and poorly differentiated cohorts demonstrated significantly divergent T2* and R2* parameters (P < 0.05). Compared with the well-differentiated group, the T2* value of the poorly differentiated group was higher [(58.92 ± 7.84) ms vs. (47.87 ± 6.76) ms]; and the R2* value was lower [17.73 (15.62, 19.77) s-1 vs. 21.57 (19.65, 24.69) s-1]. The AUCs of the T2* and R2* values for predicting the histological differentiation degree were 0.866 and 0.827, respectively. The sensitivity and specificity of T2* were 77.8% and 74.1%, respectively, while those of R2* were 80.0% and 83.3%, respectively. The combined diagnostic AUC of T2* and R2* values predicted pathological differentiation grade was 0.863.There were statistically significant differences in the T2* and R2* values between the high and the low Ki-67 expression group (P < 0.05). The T2* value of the high expression group was higher than that of the low expression group [(55.57 ± 8.77) ms vs. (49.23 ± 6.09) ms], and the R2* value was lower [18.48 (16.45, 22.05) s-1 vs. 20.87 (19.56, 22.03) s-1]. The AUCs of the T2* and R2* values for predicting the Ki-67 expression level were 0.727 and 0.662, respectively. The sensitivity and specificity of T2* were 71.4% and 64.7%, respectively, while those of R2* were 64.3% and 70.6%, respectively. The combined diagnostic AUC of T2* and R2* values predicted Ki-67 expression level was 0.752. Compared with individual parameters, the combined use of T2* and R2* values showed no statistically significant difference in predictive efficacy for both pathological differentiation and Ki-67 expression level in PDAC.Conclusions The T2* and R2* values have good predictive value for the pathological differentiation degree of PDAC and the expression level of Ki-67 among the quantitative parameters of the mDixon-Quant sequence; except for the water phase value, each quantitative parameter can effectively distinguish between the PDAC lesion and the normal pancreatic area.
[Keywords] pancreatic ductal adenocarcinoma；magnetic resonance imaging；mDixon-Quant；histological differentiation；Ki-67

CHEN Kun1   RUAN Zhibing1*   SHI Shihan2   CHEN Huilin1   WEN Feng2   XU Maoli1   TANG Geya1  

1 Department of Radiology, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China

2 Guizhou Medical University, Guiyang 550001 China

Corresponding author: RUAN Z B, E-mail: 1368105787@qq.com

Conflicts of interest   None.

Received  2025-02-28
Accepted  2025-05-10
DOI: 10.12015/issn.1674-8034.2025.05.005
Cite this article as: CHEN K, RUAN Z B, SHI S H, et al. Non-invasive preoperative prediction of histological differentiation and Ki-67 expression level in pancreatic ductal adenocarcinoma based on mDixon-Quant sequence[J]. Chin J Magn Reson Imaging, 2025, 16(5): 30-36. DOI:10.12015/issn.1674-8034.2025.05.005.

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