磁共振弥散加权成像监测乳腺癌新辅助化疗疗效的应用价值  

Value of diffusion weighted imaging （DWI） chemotherapy in locally advanced breast cancer in evaluating early response to neoadjuvant

作　　者：汪晓红[1] 彭卫军[1] 谭红娜[1] 信超[1] 顾雅佳[1] 唐峰[1] 毛健[1] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中华肿瘤杂志》2010年第5期377-381,共5页Chinese Journal of Oncology

摘　　要：目的 探讨磁共振弥散加权成像（DWI）监测乳腺癌新辅助化疗的早期疗效及评估化疗后残留病灶的价值.方法 前瞻性选取88例术前进行新辅助化疗的乳腺癌患者的89个病灶,用DWI直方图分析化疗过程中肿瘤多层面表观弥散系数（ADC）值的变化,随访新辅助化疗的疗效.比较按DWI图重建所测肿瘤体积与术后病理测量肿瘤体积的相关性.结果 89个乳腺癌病灶中,化疗有效68个,无效21个.化疗有效组和无效组患者在化疗前的肿瘤ADC值分别为（1.049±0.135）× 10^-3 mm^2/s和（1.171±0.134）×10^-3mm^2/s,差异有统计学意义（t=-2.731,P=0.009）.全组患者化疗前的肿瘤ADC值为（1.087±0.146）×10^-3 mm^2/s,肿瘤退缩率为70.4%±55.1%,两者呈负相关（r=-0.430,P=0.025）.有效组化疗前、化疗1个疗程后和化疗结束时的肿瘤ADC值差异均有统计学意义（均P〈0.05）.无效组化疗前、化疗1个疗程后和化疗结束时的肿瘤ADC值差异均无统计学意义（均P〉0.05）.DWI监测化疗结束后残存肿瘤体积与病理结果高度相关（r=0.749,P〈0.01）.结论 DWI可在乳腺癌新辅助化疗早期通过ADC值变化来监测肿瘤对治疗的反应,评估残存肿瘤大小,从而评价或预测新辅助化疗的疗效.Objective To evaluate the role and the performance of diffusion weighted imaging （ DWI） for predicting the early response to neoadjuvant chemotherapy （ NAC） in lcal advanced breast cancer （LABC） and to assess the accuracy of DWI in evaluating residual lesion after NAC. Methods 88 women with LABC （89 lesions） underwent DWI before and after the first and final cycle of NAC. For each patient, the apparent diffusion coefficient （ADC） values were compared between the baseline and follow-up to predict the early response to NAC. The residual tumor volumes were obtained using 3 D maximum intensity projections （MIP） of DWI map, and were compared with pathological findings to assess the accuracy of DWI in detecting and measuring residual tumor. All results were proved or analyzed comparing with the data from histopathology. Results There were 68 lesions responding to NAC, while 21 non-responders. The baseline ADC values of responders and non-responders were （1.049 ±0. 135）× 10^-3 mm^2/s and （1. 171±0.134）×10^-3 mm^2/s, respectively, with a significant difference （t = -2.731, P=0.009 〈0.01）. The ADC value measured prior to treatment was （1. 087±0. 146） × 10^-3 mm^2/s,and the degree of the changes in tumor volume after NAC was （70. 4%±55. 1）%. A negative correlation was observed （r=-0. 430,P=0.025〈0.05 ）. In the response group, there was a significant difference in ADC value between prior to NAC and 1st cycle of NAC, the final cycle of NAC, respectively （P 〈 0. 001）. While no significant differences were found in non-responders during NAC （P 〉 0.05）. The tumor volume correlation coefficient between DWI and pathology measurements was very high （ r = 0. 749, P 〈 0. 01 ）. Conclusion DWI appears to provide functional information regarding changes in ADC value of tumors due to NAC. DWI may be useful in monitoring the early pathological response of tumor after the initiation of treatment and in evaluating the residual tumor after NAC.

关 键 词：乳腺肿瘤 磁共振成像 磁共振弥散加权成像 新辅助化疗 

分 类 号：R737.9[医药卫生—肿瘤]