基于分段读出DWI序列ADC图的全肿瘤直方纹理分析参数与乳腺癌预后因子的相关性研究  

Correlation of whole-tumor histogram and texture parameters based on the apparent diffusion coefficient map of readout-segmented diffusion-weighted echo-planar imaging with prognostic factors of breast cancers

作　　者：李雪 朱宏[1] 孙琨[1] 柴维敏[1] 傅彩霞 严福华[1] LI Xue;ZHU Hong;SUN Kun Sun(Department of Radiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,上海200025 [2]西门子(深圳)磁共振有限公司应用开发部,深圳518057

出　　处：《放射学实践》2021年第1期53-59,共7页Radiologic Practice

摘　　要：目的:探讨基于分段读出扩散加权成像序列(rs-EPI-DWI)的全肿瘤直方纹理分析参数与乳腺癌预后因子的相关性。方法:搜集123例术前行乳腺MRI检查,术后经组织病理证实为乳腺癌的女性患者。在1.5T MR扫描仪上采用rs-EPI-DWI序列获得DWI及相应ADC图,经全肿瘤直方纹理分析软件得到全肿瘤直方图参数及纹理参数。将手术标本送病理检查并进行免疫组化分析,记录每例患者雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体-2(HER-2)和细胞增殖抗原标志物(Ki-67)的表达情况。采用t检验比较预后因子不同表达状态间全肿瘤直方纹理分析参数的差异,采用组间及组内相关系数评价全肿瘤直方纹理分析的可重复性。结果:除组间及组内的ADC Kurtosis、组间的ADC Skewness具有中等的可重复性外,其余直方纹理分析参数均具有较好或极好的可重复性(相关系数为0.801~0.987)。除PR阳性组的ADC Kurtosis值大于PR阴性组外,ER、PR阳性组中各定量参数值均小于ER、PR阴性组,其中ADC 95th和ADC Skewness在ER阳性与阴性组、PR阴性与阳性组间差异均有统计学意义[ADC 95th:ER阴性组和阳性组分别为(1513.09±390.47)和(1327.71±290.36),PR阴性组和阳性组分别为(1481.95±371.58)和(1323.28±294.63);ADC Skewness:ER阴性组和阳性组分别为(0.73±0.61)和(0.32±0.66),PR阴性组和阳性组分别为(0.61±0.63)和(0.34±0.68),P值均<0.05];除ADC Meadian、ADC 5th外,Ki-67高表达组中各直方纹理分析参数值均大于Ki-67低表达组,其中ADC Diffentropy和ADC Entropy值在两组间的差异具有统计学意义[ADC Diffentropy值分别为(1.75±0.29)和(1.89±0.25),ADC Entropy值分别(2.73±0.35)和(2.88±0.29),P值均<0.05];各定量参数与HER-2表达状态无明显相关性(P>0.05)。结论:基于分段读出扩散加权成像序列的全肿瘤直方纹理分析参数与乳腺癌预后因子ER、PR、Ki-67具有一定相关性,提示其在乳腺癌个体化治疗Objective:To investigate the correlation between prognostic factors of breast cancer and whole-tumor histogram and texture parameters based on the apparent diffusion coefficient(ADC)map of readout-segmented diffusion-weighted echo-planar imaging sequence(rs-EPI-DWI).Methods:This retrospective study included 123 patients who underwent preoperative breast MRI and confirmed as breast carcinoma by histopathology.DWI and ADC images were obtained using rs-DWI-EPI sequence on a 1.5T MR scanner.Whole-tumor histogram and texture parameters were extracted by using a prototype MR multiparametric analysis software.The surgical specimens were sent for pathological examination and immunohistochemical analysis,and the expressions of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor-2(HER-2)and cell proliferation antigen markers(KI-67)were recorded in each patient.T-test was used for statistical analysis.Intra-and interclass agreement were used to evaluate the reliability for the measurement of each parameter from the whole-tumor histogram and texture analysis.Results:The intra-and interclass agreement of kurtosis and the interclass agreement of skewness were of moderate reliability,other parameters showed good-to-excellent repeatability(ICC,0.801~0.987).Except for ADC Kurtosis value,all the other ADC-derived histogram and texture parameters in ER-positive group and PR-positive group were lower than those in ER-negative group and PR-negative group,among which the differences of ADC 95th and ADC Skewness were significant(ADC 95th:1513.09±390.47 vs.1327.71±290.36,1481.95±371.58 vs.1323.28±294.63;ADC Skewness:0.73±0.61 vs.0.32±0.66,0.61±0.63 vs.0.34±0.68;P<0.05).Except ADC Meadian and ADC 5th,all the ADC-derived histogram and texture parameters in Ki-67 positive group were higher than those in Ki-67 negative group,among which the differences of ADC Diffentropy and ADC Entropy were significant(ADC Diffentropy:1.75±0.29 vs.1.89±0.25;ADC Entropy:2.73±0.35 vs.2.88±0.29;P<0.05).There was

关 键 词：乳腺肿瘤 磁共振成像 扩散加权成像 表观扩散系数 预后因子 纹理分析 

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