基于动态增强磁共振成像对乳腺癌浸润程度的研究  

Study Oninvasion Degree of Breast Cancer Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging

作　　者：郭浩东 李海歌[1] 李燕[1] 朱建国[1] 陈建秋 张紫燕 侯佳音 GUO Haodong;LI Haige;LI Yan(Department of Medical Imaging,The Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 210011,P.R.China)

机构地区：[1]南京医科大学第二附属医院医学影像科,210011 [2]南京医科大学第二临床医学院病理科,210011

出　　处：《临床放射学杂志》2022年第2期260-264,共5页Journal of Clinical Radiology

摘　　要：目的评价基于动态增强磁共振成像(DCE-MRI)的定量、半定量参数在对乳腺癌浸润程度判别中的作用。方法采用回顾性研究方法,搜集女性乳腺癌患者147例,平均年龄(52.91±28.09)岁。所有患者接受3.0 T MRI检查,采集DCE-MRI的参数包括容积转运常数(K^(trans))、速率常数(K_(ep))、血管外细胞外容积分数(V_(e))、血浆容积分数(V_(p)) 4个定量参数以及达峰时间(TTP)、最大浓度(Conc_(max))、增强曲线下初始面积(AUC)、最大斜率(Slope_(max))4个半定量参数。依据病理结果将患者分为三组(原位癌及浸润性癌1级组、浸润性癌2级组、浸润性癌3级组)。运用Kruskal-Wallis H检验比较DCE-MRI参数组间差异;DCE-MRI参数和病理指标细胞增殖抗原标记物(Ki-67)相关性检验采用Spearman检验;将多参数纳入有序Logistic回归分析,研究在乳腺癌浸润程度判别中的作用。结果随病变浸润程度加深,年龄(47.84岁vs.55.00岁vs.56.50岁,P=0.001)、K^(trans)(0.063 min^(-1)vs.0.777 min^(-1)vs.1.163 min^(-1),P<0.001)、K_(ep)(0.120 min^(-1)vs.0.312 min^(-1)vs.0.484 min^(-1),P<0.001)、V_(p)(0.008 vs.0.154 vs.0.258,P<0.001)、TTP(0.930 s vs.1.476 s vs.1.864 s,P<0.001)、Conc_(max)(0.538 vs.1.720 vs.1.632,P<0.001)、AUC(1.497 vs.6.909 vs.8.452,P<0.001)和Slope_(max)(0.533 s^(-1)vs.4.243 s^(-1)vs.5.539 s^(-1),P<0.001)显著升高。DCE-MRI参数K^(trans)(r=0.349,P=0.005)、K_(ep)(r=0.282,P=0.024)、V_(p)(r=0.428,P<0.001)、TTP(r=0.418,P=0.001)与Ki-67计数呈统计学正相关。有序Logistic回归显示K^(trans)、K_(ep)、V_(p)及TTP是区分乳腺癌浸润程度的独立影响指标。结论 DCE-MRI定量、半定量参数与癌细胞增殖分化有关,有助于对乳腺癌浸润程度的判别。Objective To evaluate the role of quantitative and semi quantitative parameters based on dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) in the differentiation of invasion degree of breast cancer. Methods A retrospective study was conducted in 147 women patients with breast cancer(mean age 52.91 ±28.09 years).All patients were examined with 3.0 T MRI.The parameters of DCE-MRI included four quantitative parameters: volume transport constant(K^(trans)),rate constant(K_(ep)),extracellular volume fraction(V_(e)),plasma volume fraction(V_(p)),and four semi-quantitative parameters: time to peak(TTP),maximum concentration( Conc_(max)),initial area under enhancement curve( AUC),maximum slope(Slope_(max)).According to the pathological results, patients were divided into three groups(carcinoma in situ and invasive grade 1 group, invasive carcinoma grade 2 group and invasive carcinoma grade 3 group).Kruskal-Wallis H test was used to compare the differences of DCE-MRI parameters among groups;Spearman test was used to test the correlation among DCE-MRI parameters and Ki-67;Multiple parameters were analyzedby the ordinal Logistic regression analysis to assess the role in the discrimination of breast cancer invasion degree. Results Age(P=0.001),K^(trans)(P< 0.001),K_(ep)(P< 0.001),V_(p)(P< 0.001),TTP(P=< 0.001),Conc_(max)(P< 0.001),AUC(P< 0.001) and Slope_(max)(P< 0.001) were significantly increased with the degree of infiltration.K^(trans)(r=0.349,P=0.005),K_(ep)(r=0.282,P=0.024),V_(p)(r=0.428,P< 0.001) and TTP(r=0.418,P=0.001) were positively correlated with Ki-67 count. Ordinal Logistic regression showed that K^(trans),K_(ep),V_(p)and TTP were independent risk factors for breast cancer invasion. Conclusion The quantitative and semi-quantitative parameters of DCE-MRI can help to distinguish the degree of invasion of breast cancer, and can be applied to the evaluation of cell differentiation.

关 键 词：动态增强磁共振成像 浸润性乳腺癌 病理分级 KI-67 

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