MRI动态增强流出参数半定量分析对局部进展期乳腺癌新辅助化疗疗效评估的价值  

Semiquantitative assessment of wash out parameter in dynamic contrast enhanced MRI for evaluating therapeutic effect of locally advanced breast cancer after neoadjuvant chemotherapy

作　　者：石桥[1] 王霄英[1] 郭丽[1] 秦乃姗[1] 蒋学祥[1] 

机构地区：[1]北京大学第一医院医学影像科北京大学前沿交叉学科研究院功能成像研究中心,100034

出　　处：《中华放射学杂志》2013年第8期699-703,共5页Chinese Journal of Radiology

基　　金：基金项目：医学物理和工程北京市重点实验室开放课题资助项目（2008P03）

摘　　要：目的探讨MRI动态增强扫描时间-信号曲线（TIC）流出段斜率（Swash-out），对局部进展期乳腺癌新辅助化疗（NAC）疗效的评估效能。方法回顾性分析59例术后病理确诊为浸润性导管癌患者的资料，所有患者均接受4个周期吡喃阿霉素＋紫杉醇新辅助化疗。以改良病理反应性标准为金标准，分为组织学显著反应（MHR）与组织学非显著反应（NMHR）组。采用重复测量的方差检验分别对两组患者NAC不同周期后MRI动态增强扫描TIC曲线Swash-out进行比较，采用非参数检验Mann—Whitney法对两组NAC治疗不同周期后TIC曲线Swash-out进行比较。以病理反应性标准分组为金标准对NAC治疗2、4个周期后TIC曲线Swash-out进行ROC分析，分别计算曲线下面积（Az），评价其对NAC疗效的预测效能，并与常用TIC曲线半定量分析指标最大线性斜率（Smax）、增强峰值百分数（PPE）比较。结果MHR组34例，NMHR组25例。NAC前MHR组Swash-out中位数为-16．99，NAC治疗2个周期后为5．66，NAC治疗4个周期后为15．95；NMHR组NAC前Swash-out中位数为-23．08（-64．24～34．39），NAC治疗2个周期后为-23．01（-52．72—28．70），NAC治疗4个周期后Swash-out为-11．45（-50．49～50．93）。MHR组NAC治疗2个周期后及4个周期后Swash-out变化率分别为-1．18（-31．32～60．86）及1．50（-86．27～3．61），NMHR组NAC治疗2个周期后及4个周期后Swash-out变化率分别为-0．28（-3．24～9．46）及0．27（-5．34～3．11），NAC前MHR组Swash-out与NMHR组差异无统计学意义（Z=-0．97，P〉0．05）。NAC治疗2个周期后MHR组Swash-out及Swash-out变化率显著高于NMHR组（z值分别为-3．97与-3．02，P〈0．01）。NAC治疗4个周期后MHR组Swash-out及S…。。变化率显著高于NMHR组（Z值分别为-3．96与-3．16，P〈0．01）。以病理反应性分级为金标准，采用ROC评价Swash-out预测病理反应性的效能，NAC治疗2�Objective To study the value of the semiquantitative-parameter analysis of wash out index of time-intensity curve （Swash-out ） in evaluating the therapeutic effect of neoadjuvant chemotherapy for locally advanced breast cancer （LABC） . Methods Fifty-nine women with LABC underwent dynamic contrast enhancedt MRI examination before chemotherapy, after the 2nd cycle and the 4th cycle of chemotherapy. All patients were divided into major histological response group （MHR） and non-major histological response group （ NMHR ） according to the final pathologic response. Swash and the variancetrends of Swash-outbefore NAC ,after the 2nd cycle of NAC and after the 4th cycle of NAC were compared in each group and between the two groups. According to the gold standard of Miller ＆ Payne criterion, Receiver operating characteristic curve （ROC） analysis was performed to evaluate the predicting effect ofSwash-out for NAC response, and to compare it with Semi-quantitative TIC curve indicators Smax （steepest slope） and PPE （peak percent enhancement）. Results Fifty-nine patients of LABC patients were divided into a MHR group of 34 patients and a NMHR group of 25 patients. Swash-out before NAC of MHR group was - 16. 99 （ -56. 72 -41.20） ,Swash-out after the 2na cycle of NAC was 5.66（ -69.45 -53.08） ,Swash-out after 4th cycle of NAC was 15.95（ -7.80 - 54. 23）.Swash-outbefore NAC of NMHR group was - 23.08（ - 64. 24 - 34. 39） , Swash-on, after the 2na cycle of NAC of NMHR group was - 23.01 （ - 52.72 - 28.70）, Swash-out after 4th cycle of NAC of NMHR group was - 11.45 （ - 50.49 - 50. 93）. Swash-out variance rate of MHR group after the2nd and the 4th cycle of NAC were - 1.18（ - 31.32 -60.86） and 1.50 （ - 86.27 - 3.61）, respectively. Swash-out variance rate of NMHR group after the 2nd and the 4th cycle of NAC were -0. 28 （ - 3.24 - 9.46） and 0. 27 （ - 5.34 - 3.11 ）, respectively. Swash-out was not significantly different between the two groups before NAC （Z = -0. 97 ,P �

关 键 词：乳腺肿瘤 抗肿瘤联合化疗方案 磁共振成像 病理学 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]