核磁共振全身弥散加权成像(WB-DWI)在乳腺癌患者术前化疗疗效评估中的应用价值  

The Value of Diffusion-weighted Magnetic Resonance Imaging Body(WB-DWI) on the Preoperative Chemotherapy in Breast Cancer Patients

作　　者：朱振国[1] 姜熳[1] 

机构地区：[1]江苏省中医院,江苏南京210029

出　　处：《肿瘤学杂志》2016年第6期443-447,共5页Journal of Chinese Oncology

摘　　要：[目的]探讨核磁共振成像(MRI)全身弥散加权成像(WB-DWI)在评估乳腺癌术前实施新辅助化疗疗效中的应用价值。[方法]采用前瞻性研究方法,选取接受术前新辅助化疗的64例患者(64个病灶)作为研究对象,对患者化疗前、化疗一个疗程结束时及化疗结束时分别行DWI成像检查,测量病灶变化及表观系数(ADC)值的变化及其相互关系。[结果]新辅助化疗64例患者,其中有效48例(75%)(CR 6例、PR 23例、SD 19例),无效16例(25%)。化疗前ADC值为(1.024±0.132)×10^(-3)mm·s^(-2)与第一化疗疗程结束时的(1.065±0.121)×10^(-3)mm·s^(-2)差异不显著(P>0.05),但与化疗结束时的(1.225±0.127)×10^(-3)mm·s^(-2)差异显著(P<0.05)。化疗前肿瘤最大径线值为(43.62±17.63)mm与第一化疗疗程结束时的(41.77±16.94)mm差异不显著(P>0.05),但与化疗结束时的(36.82±16.05)mm差异显著(P<0.05)。ADC值变化率与肿瘤最大径线呈显著的负相关关系(r=-0.513,P<0.001)。有效组患者的化疗前ADC值为(1.068±0.127)×10^(-3)mm·s^(-2)、化疗一个疗程后(1.154±0.118)×10^(-3)mm·s^(-2)、化疗结束(1.299±0.124)×10^(-3)mm·s^(-2)、变化率为21.63+4.57均显著高于无效组患者。DC值判定新辅助化疗有效患者的灵敏度为91.67%、特异性为87.5%、误诊率为12.5%、漏诊率为8.33%,ROC曲线下面积AUC为0.931。[结论]乳腺癌术前实施新辅助化疗中应用MRI全身弥散加权成像对患者的化疗效果进行评估具有可行性和一定的临床价值。[Objective] To evaluate the value of magnetic resonance imaging（MRI） whole body diffusion weighted imaging（WB-DWI） on neoadjuvant chemotherapy in breast cancer before surgery. [Methods] A total of 64 patients with breast cancer accepted neoadjuvant chemotherapy before surgery were enrolled.The lesion changes and apparent coefficient（ADC） changes through DWI imaging were measured before chemotherapy,at the end of a course of chemotherapy and the whole chemotherapy. [Results] 48 cases（75%）（CR 6 cases,PR 23 cases,SD 19 cases） of 64 patients（64 lesions） were effective,and the other 16 cases（25%） were ineffective. ADC value before chemotherapy was（1.024±0.132）×10^（-3）mm·s^（-2）,which had no significantly difference with that at the end of the first course of chemotherapy（1.065±0.121）×10^（-3）mm·s^（-2）（P0.05）,but had significantly difference with that at the end of chemotherapy（1.225 ±0.127）×10^（-3）mm·s^（-2）（P0.05）.The tumor maximum diameter line was（43.62±17.63）mm before chemotherapy,which had no significantly difference with that at the end of the first course of chemotherapy（41.77 ±16.94）mm（P0.05）,but had significantly difference with that at the end of chemotherapy（36.82 ±16.05）mm（P0.05）. Change rate of ADC value had a significant negative correlation with tumor maximum diameter line（r=-0.513,P 0.001）. ADC value of effective group was（1.068±0.127）×10^（-3）mm·s^（-2） before chemotherapy,（1.154±0.118）×10^（-3）mm·s^（-2） at the end of a course of chemotherapy and（1.299 ±0.124） ×10^（-3）mm·s^（-2） at the end of chemotherapy. The change rate was 21.63＋4.57,which were significantly higher than those in ineffective group. The sensitivity of determination of neoadjuvant chemotherapy effectiveness by DC was 91.67%,specificity was 87.5%,the rate of misdiagnosis rate was 12.5% and missed diagnosis rate was 8.33%,the area under the ROC curve of AUC was 0.931.[Conclusion] MRI diffusi

关 键 词：核磁共振成像 全身弥散加权成像 乳腺肿瘤 新辅助化疗 

分 类 号：R737.9[医药卫生—肿瘤]