扩散峰度成像与扩散加权成像对乳腺癌诊断价值的对比研究  

Comparative study of diffusion kurtosis imaging model and diffusion weighted imaging model in diagnosis of breast cancer

作　　者：李婷[1] 鲁伦博 卓瑶瑶 连靖阁 孔德兴[2] 熊赟[3] 李康安[1] 

机构地区：[1]上海市第一人民医院放射科,200080 [2]浙江大学数学科学学院 [3]复旦大学计算机科学技术学院上海数据科学重点实验室

出　　处：《中华放射学杂志》2018年第3期177-182,共6页Chinese Journal of Radiology

基　　金：上海市科委科技创新项目（17441900700）;专科疾病临床“五新”转化项目（16CR3091B）;科技部863计划（2015AA020105-10）

摘　　要：目的 探讨扩散峰度成像（DKI）与DWI模型参数诊断乳腺癌的效能，以及各参数与乳腺癌分子亚型和预后因素的相关性。方法 回顾性分析2016年11月至2017年5月上海市第一人民医院，经病理证实并获得病理分型，且病理检查前2周内进行过乳腺DKI及DWI扫描的64例乳腺疾病患者。恶性肿瘤30例，良性病变34例。浸润性导管癌Ⅰ、Ⅱ、Ⅲ级分别1、7、13例。乳腺癌Luminal A型乳腺癌10例，Luminal B型乳腺癌11例，人类表皮生长因子受体2（HER-2）阳性型乳腺癌4例，三阴性乳腺癌5例；雌激素受体（ER）、孕激素受体（PR）、HER-2阳性者分别为20、14和15例；Ki67高表达24例，低表达6例。所有患者均行乳腺平扫和增强扫描，测量扩散峰度值（MK）、平均扩散率（MD）和ADC值，按照病灶最大径（〉2 cm、≤2 cm）、脉管或神经侵犯（是、否）、淋巴结转移（是、否）、ER（阳性、阴性）、PR（阳性、阴性）、HER-2（阳性、阴性）、Ki67（阳性、阴性）、病理分级（Ⅰ级＋Ⅱ级、Ⅲ级）进行预后因素分析。采用两独立样本t检验比较良恶性病变组间的DKI和DWI参数。采用ROC评估各参数鉴别诊断乳腺良、恶性病变的效能。对于不同预后因素或分子亚型间各参数的比较分别采用Mann-Whitney U和Kruskal-Wallis H检验。评价不同预后因素与DKI和DWI参数间的相关性采用Spearman秩相关分析。结果 恶性组MK值高于良性组，MD值及ADC值低于良性组，差异均有统计学意义（P〈0.05）。MK、MD及ADC值鉴别诊断乳腺良、恶性病变的ROC下面积分别为0.897、0.827及0.776，3个参数联合的ROC下面积为0.935。ER阳性组病灶的MK高于阴性组，差异有统计学意义（P〈0.05）；其余各预后因素组间的MK、MD和ADC差异均无统计学意义（P均〉0.05）。ER与MK值呈低度正相关（r=0.417，P=0.022），其余预后因素和MK、MD、ADC间均不具有相关性（Objective To compare the value of diffusion kurtosis imaging （DKI） model with single-index DWI model parameters in the differential diagnosis of benign and malignant breast lesions, and to explore the correlation between the parameters and molecular subtypes and prognostic factors of breast cancer.Methods A retrospective analysis was performed with inclusion of 64 cases of breast diseases from January 2016 to May 2017 in Shanghai First People＇s Hospital. The patients were pathologically confirmed and typed, 30 cases are malignant tumors and 34 cases are benign lesions. DKI and DWI were performed within 2 weeks before the pathological examination. Invasive ductal carcinoma of grade Ⅰ, Ⅱ and Ⅲ were revealed in 1, 7 and 13 cases respectively. Luminal A breast cancer was found in 10 cases, Luminal B breast cancer was diagnosed in 11 cases, HER-2 positive breast cancer was 4 cases and triple negative breast cancer was 5 cases. The expressions of estrogen receptor （ER）, Progesterone receptor （PR）, and HER-2 positive were found in 20, 14 and 15 cases respectively. Ki67 was highly expressed in 24 cases and low expression in 6 cases. All patients underwent both plain and enhanced mammography scanning. The kurtosis （MK）, mean diffusivity （MD） and ADC value were measured. Prognosis analysis was performed according to the maximum diameter （〉2 cm, ≤2 cm）, vascular or neurological invasion （positive, negative）, lymph node metastasis （positive, negative）, ER （positive, negative）, PR （positive, negative）, HER-2 （positive, negative）, Ki67 （positive, negative）, pathological grade （grade Ⅰ＋Ⅱ,Ⅲ）. Two independent samples t test was used to compare DKI and DWI parameters between benign and malignant lesions. ROC analysis was performed for assessing the values of parameters in discriminating benign and malignant breast lesions. Mann-Whitney U and Kruskal-Wallis H tests were used for the comparison of various prognostic factors or molecular subtypes. Spearman rank c

关 键 词：乳腺肿瘤 磁共振成像 扩散峰度成像 

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]