比较扩散加权成像单指数模型和扩散峰度成像模型在预测局部晚期乳腺癌新辅助化疗疗效中的价值  

The comparison of the value of mono-exponential mode and diffusion kurtosis imaging mode in predicting the response to neoadjuvant chemotherapy for locally advanced breast carcinoma using diffusion-weighted imaging

作　　者：李相生[1] 冯瑞[2] 王东[1] 祝红线[1] 孟利民[1] 任娥[1] 方红[1] 周纯武[3] Li Xiangsheng;Feng Rui;Wang Dong;Zhu Hongxian;Meng Limin;Ren E;Fang Hong;Zhou Chunwu(Department of MRI,PLA Air Force General Hospital,Beijing 100142,China;Department of Radiology, Dongfang Hospital of Beijing University of Chinese Medicine,Beijing 100078,China;Department of Imaging Diagnosis,Peking Union Medical College Cancer Hospital,Cancer Research Institute,Chinese Academy of Medical Sciences,Beijing 100021,China)

机构地区：[1]解放军空军总医院磁共振科,北京100142 [2]北京中医药大学东方医院放射科,100078 [3]中国医学科学院,中国协和医科大学肿瘤研究所,肿瘤医院影像诊断科,北京100021

出　　处：《中华放射学杂志》2019年第1期26-32,共7页Chinese Journal of Radiology

摘　　要：目的探讨扩散加权成像单指数DWI模型和扩散峰度成像(DKI)模型在预测局部晚期乳腺癌的新辅助化疗(NAC)疗效中的价值。方法前瞻性收集2013年1月1日至2016年12月31日解放军空军总医院临床怀疑为乳腺癌,诊断最终经组织病理结果证实,临床分期处于Ⅱ或Ⅲ期,在NAC后行保乳手术的80例局部晚期乳腺癌患者。患者均行乳腺常规单指数DWI序列和DKI序列扫描,测量参数包括ADC值、平均扩散系数(MD)和平均扩散峰度(MK)值。MRI扫描完成前后1~3d,患者行穿刺活检,然后接受4~8周期的NAC,而后行手术治疗。根据化疗前穿刺活检的组织分级,将患者分为分化较好组和分化较差组。根据术后病理结果,与化疗前穿刺活检切片对比,按NAC疗效分为病理完全缓解组和非完全缓解组。完全缓解组和非完全缓解组之间MRI参数的比较使用计量资料的t检验,采用ROC来确定不同扩散加权成像参数预测化疗疗效的效能,使用logistic回归分析探讨扩散加权成像参数与化疗疗效的相关性,进一步使用Wald检验方法对回归模型进行统计学分析。结果完全缓解组30例,非完全缓解组50例。完全缓解组的ADC、MD值低于非完全缓解组,完全缓解组的MK值高于非完全缓解组,差异均有统计学意义(P均<0.05)。ADC、MD和MK值预测疗效的ROC下面积分别为0.732、0.866和0.683。logistic回归分析显示,根据预测效能大小,MD、ADC和MK值依次是NAC疗效的独立预测参数。结论DKI模型比单指数扩散模型更适合作为NAC疗效预测的成像技术。Objective To compare the value of diffusion kurtosis imaging(DKI)mode and mono-exponential mode in predicting the response to neoadjuvant chemotherapy(NAC)for locally advanced breast carcinoma using DWI.Methods From January 1,2013 to December 31,2016,eighty patients with locally advanced breast carcinoma were enrolled into this prospective clinical study.The diagnosis was confirmed on the basis of histopathological results.The clinical stage stayed at Ⅱ or Ⅲ.The patients would receive breast-conserving surgery after NAC.All the patients underwent DWI examination by using both mono-exponential mode and DKI mode before chemotherapy was initiated.The parameters included ADC,mean diffusivity(MD)and mean kurtosis(MK).Within 1 to 3 days before or after MRI examination,the patients underwent aspiration biopsy,received 4 to 8 cycles of NAC and followed by surgery.According to histologic grading before NAC,the patients were classified into well-differentiated and poor-differentiated group.According to the comparison between pathological results acquired from biopsy before NAC and specimen acquired after surgery,the patients were classified into pathologic complete response(pCR)and pathologic non-complete response(non-pCR)according to treatment effect.The imaging parameters were compared between the pCR and the non-pCR group using t test.The predicting ability of two imaging modes was compared and analyzed with ROC analysis.The relationships between multiple imaging parameters,pathologic,clinical characteristics of tumor and treatment effect were analyzed using logistic multi-variate regression analysis,and further analyzed using Wald test.Results There were 30 cases of pCR and 50 cases of non-pCR.The ADC and MD values were lower in the pCR group than in the non-pCR group(P<0.05).MK value was higher in the pCR group than in the non-pCR group(P<0.05).ROC analysis showed that the area under ROC curve of ADC,MD and MK in predicting treatment effect were 0.732,0.866 and 0.683 respectively.Logistic regression analysis showe

关 键 词：乳腺肿瘤 新辅助化疗 扩散加权成像 单指数模型 扩散峰度成像模型 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]