磁共振三维氢质子波谱评估乳腺癌新辅助化疗疗效的临床应用价值  

Clinical Application of 3D-1H MR Spectroscopy in Assessing Therapeutic Effect of Neoadjuvant Chemotherapy for Beast Carcinoma

作　　者：谢瑜[1,2] 廖承德[1,2] 李卓琳[1,2] 李鵾[1,2] 丁莹莹[1,2] 

机构地区：[1]昆明医科大学第三附属医院 [2]云南省肿瘤医院放射科,昆明650118

出　　处：《临床放射学杂志》2014年第5期696-701,共6页Journal of Clinical Radiology

摘　　要：目的在乳腺癌患者中使用磁共振三维氢质子波谱,分析病灶内复合胆碱(tCho)水平在新辅助化疗前后的变化情况,了解其能否预测肿瘤在化疗后的病理反应,以及与肿瘤最大径的关系。方法前瞻性纳入28例经穿刺活检证实为乳腺癌的患者,分析病灶在新辅助化疗前、第一疗程及全程化疗后3次磁共振检查中tCho峰下面积值和最大径的变化。将所有病例的手术结果(按照Miller/Payne病理反应性分级标准)分为组织学显著反应组(MHR)与非组织学显著反应组(NMHR)。采用Mann-Whitney U检验法比较两组病灶在各阶段胆碱水平和最大径的差异;以肿瘤病灶的病理反应性分级作为金标准,采用受试者工作特征曲线(ROC)评价磁共振三维氢质子波谱预测化疗疗效的效能。结果 28例患者中15例为MHR,13例为NMHR。化疗前及第一疗程后两组间的tCho峰下面积值及早期变化率均无统计学差异,但全程化疗后MHR组tCho峰下面积值(2.94±2.41)明显低于NMHR组(10.46±12.94,P=0.046);两组间tCho峰下面积值术前变化率分别为(83.30±15.81)%和(53.90±32.69)%,差异有统计学意义(P=0.006)。全程化疗后tCho峰下面积值及术前变化率的ROC曲线下面积分别为0.277(P=0.045)和0.800(P=0.007),而肿瘤最大径及其术前变化率的结果为0.064(P=0.000)和0.964(P=0.000),其中tCho峰下面积值术前变化率最佳预测值为67.34%,其诊断全程化疗后化疗有效的敏感性为86.70%,特异性为69.20%。结论磁共振三维氢质子波谱tCho峰下面积值可评价乳腺癌新辅助化疗的最终疗效,并且价值高于肿瘤最大径,但并不足以在化疗早期做出预测。Objective To measure tCho level of breast cancer by using 3D-^1 MR spectroscopy in order to determine whether tCho level and its changes after neoadjuvant chemotherapy （NAC） can be used to predict pathologic response of locally advanced breast cancer and to analyze the correlation between tCho level and the maximal diameter of the lesion. Methods A total of 28 woman patients with pathologically-confirmed breast cancer underwent MRI scanning before NAC, after the first cycle of NAC and at the end of the treatment. The patients were divided into major histological response group （MHR） and non-major histological response group （NMHR） according to Miller and Payne pathologic classification. Preoperative and postoperative tCho levels and maximal diameter of the lesion were determined. The differences in maximal di-ameter of the lesions between MHR group and NMHR group were analyzed and compared by using Mann Whitney U test. ROC curve analysis was used to assess the diagnostic performance and to identify whether tCho level could be used to pre- dict the pathologic response to NAC and to find out the optimal cut off value for MHR prediction. Results After NAC, 15 patients were classified to MHR group and 13 to NMHR group. Before and after one cycle of NAC, all parameters between the two groups showed no significant differences. After NAC, the differences in tCho levels and their changes were statisti-cally significant between MHR group （2.94 ± 2.41, 83.30 ± 15.81% ） and NMHR group （ 10.46 ± 12.94, 53.90 ± 32.69% ）, （P = 0. 046 and 0.006）. All the parameters of the two groups at different points of time were determined andanalyzed using ROC. The tCho level and their changes after the first cycle of NAC could not be able to make the diagnosis of MHR. After NAC, the area under curve of tCho and its change were 0. 277 （P = 0. 045 ） and 0. 800 （ P = 0. 007 ） respectively. The area under curve of D and its change were 0.064 （P = 0. 000） and 0. 964 （P = 0.000） respectively. Using 67.

关 键 词：乳腺癌 新辅助化疗 磁共振成像 磁共振波谱 

分 类 号：R737.9[医药卫生—肿瘤]