Nomogram development and validation to predict Ki-67 expression of hepatocellular carcinoma derived from Gd-EOB-DTPA-enhanced MRI combined with T1 mapping

Ziwei Liu; Shaomin Yang; Xinjie Chen; Chun Luo; Jieying Feng; Haixiong Chen; Fusheng Ouyang; Rong Zhang; Xiaohong Li; Wei Liu; Baoliang Guo; Qiugen Hu

doi:10.3389/fonc.2022.954445

Nomogram development and validation to predict Ki-67 expression of hepatocellular carcinoma derived from Gd-EOB-DTPA-enhanced MRI combined with T1 mapping

Front Oncol. 2022 Oct 14:12:954445. doi: 10.3389/fonc.2022.954445. eCollection 2022.

Authors

Ziwei Liu¹, Shaomin Yang^{1

2}, Xinjie Chen¹, Chun Luo³, Jieying Feng⁴, Haixiong Chen¹, Fusheng Ouyang¹, Rong Zhang¹, Xiaohong Li¹, Wei Liu¹, Baoliang Guo¹, Qiugen Hu¹

Affiliations

¹ Department of Radiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China.
² Department of Radiology, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China.
³ Department of Radiology, The First People's Hospital of Foshan, Foshan, China.
⁴ Department of Radiology, The Sixth Affiliated Hospital, South China University of Technology, Foshan, China.

Abstract

Objective: As an important biomarker to reflect tumor cell proliferation and tumor aggressiveness, Ki-67 is closely related to the high early recurrence rate and poor prognosis, and pretreatment evaluation of Ki-67 expression possibly provides a more accurate prognosis assessment and more better treatment plan. We aimed to develop a nomogram based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) combined with T1 mapping to predict Ki-67 expression in hepatocellular carcinoma (HCC).

Methods: This two-center study retrospectively enrolled 148 consecutive patients who underwent preoperative Gd-EOB-DTPA-enhanced MRI T1 mapping and surgically confirmed HCC from July 2019 to December 2020. The correlation between quantitative parameters from T1 mapping, ADC, and Ki-67 was explored. Three cohorts were constructed: a training cohort (n = 73) and an internal validation cohort (n = 31) from Shunde Hospital of Southern Medical University, and an external validation cohort (n = 44) from the Sixth Affiliated Hospital, South China University of Technology. The clinical variables and MRI qualitative and quantitative parameters associational with Ki-67 expression were analyzed by univariate and multivariate logistic regression analyses. A nomogram was developed based on these associated with Ki-67 expression in the training cohort and validated in the internal and external validation cohorts.

Results: T1rt-Pre and T1rt-20min were strongly positively correlated with Ki-67 (r = 0.627, r = 0.607, P < 0.001); the apparent diffusion coefficient value was moderately negatively correlated with Ki-67 (r = -0.401, P < 0.001). Predictors of Ki-67 expression included in the nomogram were peritumoral enhancement, peritumoral hypointensity, T1rt-20min, and tumor margin, while arterial phase hyperenhancement (APHE) was not a significant predictor even included in the regression model. The nomograms achieved good concordance indices in predicting Ki-67 expression in the training and two validation cohorts (0.919, 0.925, 0.850), respectively.

Conclusions: T1rt-Pre and T1rt-20min had a strong positive correlation with the Ki-67 expression in HCC, and Gd-EOB-DTPA enhanced MRI combined with T1 mapping-based nomogram effectively predicts high Ki-67 expression in HCC.

Keywords: Gd-EOB-DTPA; Ki-67; T1 mapping; hepatocellular carcinoma; nomogram.