磁共振扩散加权成像评价恩度对乳腺癌的抗血管生成与抗肿瘤作用  

Application of DWI in evaluating anti-angiogenesis and anti-tumor effect of endostar in breast cancer

作　　者：郏潜新[1] 黄俊珊[1] 周丽娟[1] 何平[1] 陈懿[1] 肖玉辉[1] 

机构地区：[1]解放军第一七五医院,漳州363000

出　　处：《功能与分子医学影像学（电子版）》2016年第3期19-24,共6页Functional and Molecular Medical Imaging(Electronic Edition)

基　　金：漳州市自然科学基金(ZZ2014J30)

摘　　要：目的 探讨MR扩散加权成像评价恩度对乳腺癌抗血管生成与抗肿瘤作用的应用价值。方法选取2010年3月~2013年8月60例乳腺癌患者作为研究对象,随机分为实验组与对照组,分别接受恩度联合新辅助化疗、单独新辅助化疗治疗3个周期,分别在治疗前、后使用SIEMENS公司MAGNETOM Trio Tim 3.0 T超导型磁共振进行扫描,成像方法包括常规SE序列和扩散加权成像,治疗结束后一周内行手术切除病灶或者乳腺癌改良根治术。比较两组病例治疗后瘤灶扩散加权成像的影像学改变,并将影像学结果与手术病理结果相对照。结果 根据肿瘤治疗组织反应标准,实验组即恩度联合新辅助化疗组治疗后组织学反应评分4级以上的为23例,而对照组即新辅助化疗组则仅为18例,实验组高于对照组。组织学显著反应率为77﹪,高于对照组60﹪的反应率。治疗后两组病例的肿瘤微血管密度（Mv D）分别为3.7±1.7、5.1±2.8,两者之间的差异具有统计学意义（P〈0.05）。两组在治疗前表观弥散系数（ADC）值差异无统计学意义（P=0.86）,治疗后恩度组ADC值为（1.83±0.17）×10-3 mm2/s,较治疗前上升了42﹪（P〈0.05）。而新辅助化疗组ADC值为（1.66±0.24）×10-3 mm2/s,较治疗前上升了39﹪（P〈0.05）。治疗后恩度组ADC值上升了（0.62±0.21）×10-3 mm2/s,而新辅助化疗组ADC值上升了（0.47±0.15）×10-3mm2/s,两者之间差异无统计学意义（P=0.45）。结论 弥散加权成像（DWI）能在肿瘤治疗发生形态学改变之前检测出瘤灶内细胞外水分子扩散运动、肿瘤的微循环灌注等微环境的改变,能够更加早期、准确地评价肿瘤对于治疗的反应,但对于恩度在乳腺癌中的抗血管作用的观察能力有限。Objective To investigate the application of DWI in evaluating anti-angiogenesis and anti- tumor effect of endostar in breast cancer. Methods From March 2010 to August 2013, 60 breast cancer patients were enrolled in the study and randomly divided into experimental and control group. The experimental group was treated with endostar combined with neoadjuvant chemotherapy; the control group was treated with neoadjuvant chemotherapy for 3 cycles. We scanned all patients with MAGNETOM Tim Trio 3.0 T scanner （SIEMENS, Germany） before and after the treatment. Imaging methods included conventional SE sequence and diffusion- weighted imaging. All patients received either surgical resection of lesions or modified radical mastectomy in one week after the end of treatment. The diffusion weighted images were compared between two groups and against the pathological results. Results According to tissue response to cancer therapy standard, 23 cases histological response scored higher than grade 4 in the experimental group, while only 18 cases in the control group scored higher than grade 4. Major histological response rate was 77 % in the experimental group, which is significantly higher than major histological response rate in the control group. After treatment, the MVD of tumor were （3.7 ± 1.7） in the experiment group, and （5.1 ±2.8） in the control group. The difference between these two groups was statistically significant （P 〈 0.05 ）. ADC values of the two groups before treatment had no significant difference （P = 0.86）. After treatment, ADC values in the experiment group were （ 1.83 ± 0.17） × 10^-3 mm2/s, increased by 42 % （P 〈 0.05 ）. ADC value in the contol group were （ 1.66 ±0.24） × 10^-3mm2/s, increased by 39 %. Increased ADC value in the experiment group was （0.62± 0.21 ） ×10^3mmZ/s, and the increased ADC value in the control was （0.47 ± 0.15 ） × 10^-3 mm2/s, and there was no significant difference between them （P = 0.45 ）. Conclusion DWI imaging can be used to

关 键 词：乳腺癌 磁共振 扩散加权像 恩度 新辅助化疗 

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