Abstract
Gastric cancer is one of the main diseases leading to cancer-related death. The recently introduced dual-energy spectral CT (DEsCT), allows to obtain many quantitative measurements from iodine-based material decomposition (MD) images, which contribute to improve the accuracy of staging of GC comparing to multidetector spiral CT. And Ki-67 is a well-recognized nuclear antigen-specific biomarker reflecting cellular proliferation for estimating growth fractions of various tumor types. In the present study we analyzed the features of quantitative measurements (the curve slope (λHU), IC, normalized iodine concentrations (NIC)) obtained from DEsCT and levels of Ki-67 protein expression. We demonstrated that the values between advanced gastric cancer (AGC) and early gastric cancer (EGC) were significantly different both in venous phase (VP) and delayed phase (DP). The values of different level of Ki-67 expression grade were significantly different both in VP and DP. The rank correlation analysis between Ki-67 grade and IC, NIC and λHU values showed significantly positive correlation in VP and DP. These results suggested that quantitative parameters (IC, NIC and λHU) in dual-energy CT imaging can be used to differentiate EGC from AGC, and have significantly positive correlation with Ki-67 antigen expression levels in gastric cancer for indicating tumor cellular proliferation.
Highlights
Gastric cancer is one of the main diseases leading to cancer-related death with estimated 951,600 new cases and 723,100 deaths in 2012, a decreasing trend has been observed in stomach cancer incidence and mortality rates worldwide[1]
The virtual monochromatic computed Tomography (CT) images at the 70 keV energy level, iodine-based material decomposition (MD) images in the three phases and histopathological images of the HE-staining and immumohistochemical staining of Ki-67 of a patient with advanced gastric cancer (AGC) and early gastric cancer (EGC) are shown in Figs 1 and 2, respectively
With the advantage of rapid imaging and good low contrast resolution, CT examination becomes a routine method of preoperative evaluation in clinical use
Summary
Gastric cancer is one of the main diseases leading to cancer-related death with estimated 951,600 new cases and 723,100 deaths in 2012, a decreasing trend has been observed in stomach cancer incidence and mortality rates worldwide[1]. One of the objectives of the present study was to identify whether DEsCT imaging could reveal significant differences between EGC and AGC with the application of quantitative iodine concentration measurements from MD images during the arterial phase (AP), venous phase (VP) and delayed phase (DP) Another objective was to explore the potential of DEsCT measurements as prognostic indicators by establishing probable correlation with Ki-67 protein expression in gastric cancers. Ki-67 is a well-recognized nuclear antigen-specific biomarker reflecting cellular proliferation for estimating growth fractions of various tumor types[16] It is still inconclusive, expression of Ki-67 antigen is considered to be associated with clinicopathological characteristics of gastric adenocarcinoma such as size of tumor, depth of invasive, grade of histology, metastasis in regional lymph nodes, clinical stage and prognosis[17,18,19,20,21]. From the two above-mentioned aspects, the purpose of this work was to assess the feasibility and clinical value of DEsCT imaging in diagnosing gastric cancers with different Ki-67 antigen expressions
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