Prediction Model of Ki67 Proliferation Level in Hepatocellular Carcinoma Based on Contrast-Enhanced Ultrasound.

To investigate the correlation between contrast-enhanced ultrasound (CEUS) features and Ki-67 expression in patients with hepatocellular carcinoma (HCC). It was a retrospective analysis involving 94 patients with HCC receiving surgeries and diagnosed by postoperative pathology from January 2020 to December 2021. All patients were examined by preoperative CEUS and postoperative Ki-67 immunohistochemistry. Divided by the cut-off of the Ki-67 labeling index, HCC patients were assigned into the low (n = 46) and high Ki-67 expression groups (n = 48). Clinical data and imaging features of CEUS were compared between groups. Finally, a CEUS-based model in predicting abnormal Ki-67 expression in HCC was created. Significant differences showed in the age of onset, alpha fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), number of lesions, maximum diameter, peripheral hypoechoic halo, boundary, morphology, serrated edge, and internal necrosis between groups (p < 0.05). TIC analysis showed significant differences in the ascending slope (AS), half of the decay time (DT/2), descending slope (DS) and area under the curve (AUC) between groups as well (p < 0.05). Multivariate logistic regression analysis revealed that the number of lesions (OR = 3.845, 95% CI 1.315-11.248, p = 0.014), maximum diameter (OR = 1.064, 95% CI 1.030-1.098, p < 0.001), boundary (OR = 7.017, 95% CI 1.638-30.072, p = 0.009), and morphology (OR = 5.970, 95% CI 1.154-30.879, p = 0.03) were significantly correlated with Ki-67 expression in HCC patients. DS was negatively correlated with Ki-67 expression (OR = 0.000, 95% CI 0.000-0.108, p = 0.013). The AUC of the CEUS-based prediction model was 0.949 (95% CI 0.906-0.992). CEUS images plus TIC analysis provide valuable information to predict preoperative Ki-67 expression in HCC patients, thus favoring clinical management to improve patients' prognosis.