Abstract
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant and aggressive tumor, and high Ki-67 expression indicates poor histological differentiation and prognosis. Therefore, one of the challenges in diagnosing preoperatively patients with PDAC is predicting the degree of malignancy. Dynamic contrast-enhanced ultrasonography (DCE-US) plays a crucial role in abdominal tumor diagnosis, and can adequately show the microvascular composition within the tumors. However, the relationship between DCE-US and the Ki-67 labelling index remains unclear at the present time. AIM: To predict the correlation between Ki-67 expression and the parameters of DCE-US. METHODS: Patients with PDAC who underwent DCE-US were retrospectively analyzed. Patients who had received any treatment (radiotherapy or chemotherapy) prior to DCE-US; had incomplete clinical, imaging, or pathologic information; and had poor-quality image analysis were excluded. Correlations between Ki-67 expression and the parameters of DCE-US in patients with PDAC were assessed using Spearman's rank correlation analysis. The diagnostic performances of these parameters in high Ki-67 expression group were evaluated according to receiver operating characteristic curve. RESULTS: Based on the Ki-67 labelling index, 30 patients were divided into two groups, i.e., the high expression group and the low expression group. Among the relative quantitative parameters between the two groups, relative half-decrease time (rHDT), relative peak enhancement, relative wash-in perfusion index and relative wash-in rate were significantly different between two groups (P = 0.018, P = 0.025, P = 0.028, P = 0.035, respectively). The DCE-US parameter rHDT was moderately correlated with Ki-67 expression, and rHDT ≥ 1.07 was more helpful in accurately diagnosing high Ki-67 expression, exhibiting a sensitivity and specificity of 53.8% and 94.1%, respectively. CONCLUSION: One parameter of DCE-US, rHDT, correlates with high Ki-67 expression. It demonstrates that parameters obtained noninvasively by DCE-US could better predict Ki-67 expression in PDAC preoperatively.