Multimodal functional magnetic resonance imaging combined with Ki-67 index for assessing pathological typing of head and neck rhabdomyosarcoma

doi:10.3969/j.issn.1674-8115.2026.09.010

Abstract

Abstract:

Objective ·To investigate the clinical value of multimodal functional MRI combined with the cell proliferation marker Ki‑67 in the preoperative pathological classification of head and neck rhabdomyosarcoma (RMS), based on the apparent diffusion coefficient (ADC) derived from diffusion‑weighted imaging (DWI) and time‑intensity curve (TIC) types obtained from dynamic contrast‑enhanced magnetic resonance imaging (DCE‑MRI). Methods ·Patients diagnosed with head and neck RMS who underwent surgical resection at Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine between January 2015 and March 2026 were retrospectively enrolled. Demographic, clinical, and imaging data of all patients were collected. According to postoperative pathological types, patients were divided into three groups: embryonal RMS (n=21), alveolar RMS (n=14), and spindle cell/sclerosing RMS (n=15). Intergroup differences in multimodal functional MRI parameters (ADC values and TIC types), age, sex, and Ki‑67 index were analyzed, and the correlation between ADC values and Ki‑67 index was analyzed. Intraclass correlation coefficient (ICC) and Cohen′s κ coefficient were calculated to assess the inter‑ and intra-reader consistency of multimodal functional MRI parameters. Multinomial Logistic regression was performed to evaluate the predictive value of ADC values, TIC types, and Ki-67 index for the three pathological types, and a confusion matrix was used to assess model performance. Results ·Both ADC values and TIC types exhibited good inter‑reader and intra‑reader consistency. Statistically significant differences were observed among the three RMS pathological types in ADC values (P<0.001), Ki‑67 index (P<0.001), and TIC types (P=0.031). Spearman correlation analysis revealed a significant negative correlation between ADC value and Ki‑67 index (r=-0.362, P=0.010). Multinomial Logistic regression demonstrated that, using the embryonal RMS as the reference, the ADC value was independently associated with both the alveolar RMS and the spindle cell/sclerosing RMS, while the Ki-67 index was independently associated with the spindle cell/sclerosing RMS. The predictive accuracy of the model for embryonal, alveolar, and spindle cell/sclerosing RMS was 66.7%, 57.1%, and 93.3%, respectively, with an overall predictive accuracy of 72.0%. Conclusion ·The combination of multimodal functional MRI and Ki‑67 index enables effective prediction of pathological types of head and neck RMS, and has crucial clinical value for preoperative risk stratification and prognostic assessment.

Key words: rhabdomyosarcoma (RMS), head and neck, multimodal functional MRI, pathological classification

CLC Number:

R445.2

Xiao Hua, Zhang Zimin, Jiang Mengda, Guo Jiuhong. Multimodal functional magnetic resonance imaging combined with Ki-67 index for assessing pathological typing of head and neck rhabdomyosarcoma[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(9): 1252-1259.

Figures/Tables 7

TrendMD

References 27

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Pathological type	E-RMS (n=21)	A-RMS (n=14)	SS-RMS (n=15)
Age/year	13.3±8.7	21.8±12.8	17.4±15.2
Sex/n(%)
Female	9 (42.9)	4 (28.6)	2 (13.3)
Male	12 (57.1)	10 (71.4)	13 (86.7)
Location/n(%)
Masticator space	7 (33.3)	1 (7.1)	8 (53.3)
Orbit	9 (42.9)	2 (14.3)	2 (13.3)
Nasal cavity & paranasal sinuses	0 (0)	8 (57.1)	0 (0)
Nasal region	0 (0)	0 (0)	3 (20.0)
Masseter muscle	0 (0)	1 (7.1)	1 (6.7)
Buccal region	2 (9.5)	0 (0)	0 (0)
Lip	0 (0)	2 (14.3)	0 (0)
Parotid gland	1 (4.8)	0 (0)	0 (0)
Mandible	0 (0)	0 (0)	1 (6.7)
Palate	1 (4.8)	0 (0)	0 (0)
Temporal bone	1 (4.8)	0 (0)	0 (0)

Pathological type	E-RMS (n=21)	A-RMS (n=14)	SS-RMS (n=15)
Age/year	13.3±8.7	21.8±12.8	17.4±15.2
Sex/n(%)
Female	9 (42.9)	4 (28.6)	2 (13.3)
Male	12 (57.1)	10 (71.4)	13 (86.7)
Location/n(%)
Masticator space	7 (33.3)	1 (7.1)	8 (53.3)
Orbit	9 (42.9)	2 (14.3)	2 (13.3)
Nasal cavity & paranasal sinuses	0 (0)	8 (57.1)	0 (0)
Nasal region	0 (0)	0 (0)	3 (20.0)
Masseter muscle	0 (0)	1 (7.1)	1 (6.7)
Buccal region	2 (9.5)	0 (0)	0 (0)
Lip	0 (0)	2 (14.3)	0 (0)
Parotid gland	1 (4.8)	0 (0)	0 (0)
Mandible	0 (0)	0 (0)	1 (6.7)
Palate	1 (4.8)	0 (0)	0 (0)
Temporal bone	1 (4.8)	0 (0)	0 (0)

Parameter	ICC (95%CI)/κ (95%CI)
Parameter	Inter-reader	Intra-reader
ADC value	0.918 (0.866‒0.951)	0.902 (0.847‒0.941)
TIC type	0.876 (0.812‒0.940)	0.935 (0.891‒0.964)

Parameter	ICC (95%CI)/κ (95%CI)
Parameter	Inter-reader	Intra-reader
ADC value	0.918 (0.866‒0.951)	0.902 (0.847‒0.941)
TIC type	0.876 (0.812‒0.940)	0.935 (0.891‒0.964)

Parameter	E-RMS (n=21)	A-RMS (n=14)	SS-RMS (n=15)	H/χ² value	P value
ADC value/(×10^-3 mm²·s^-1)	0.890 (0.770, 1.060)	0.745 (0.658, 0.845)	1.010 (1.010, 1.300)	26.688	<0.001
TIC type/n(%)				6.845	0.031
Ⅰ	5 (23.8)	5 (35.7)	10 (66.7)
Ⅱ	16 (76.2)	9 (64.3)	5 (33.3)
Ki-67 index/%	40.000 (30.000, 60.000)	40.000 (37.500, 50.000)	20.000 (15.000, 30.000)	17.019	<0.001