DKI联合DCE-MRI对乳腺癌HER-2基因表达的诊断价值  

Prediction of the expression of HER-2 in breast cancer based on diffusion kurtosis imaging and dynamic contrast-enhanced magnetic resonance imaging

作　　者：刘庆旭 安丽华[1] 赵凡 陈月芹[1] 周哲 王唯伟 LIU Qingxu;AN Lihua;ZHAO Fan;CHEN Yueqin;ZHOU Zhe;WANG Weiwei(Department of Imaging,Affiliated Hospital of Jining Medical University,Jining 272029,China;Department of Qucotogy,Affiliated Hospital Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院影像科,山东济宁272029 [2]济宁医学院附属医院肿瘤科,山东济宁272029

出　　处：《医学影像学杂志》2022年第9期1530-1534,共5页Journal of Medical Imaging

摘　　要：目的探讨扩散峰度成像(DKI)联合动态增强成像(DCE-MRI)对乳腺癌人类表皮生长因子受体2(HER-2)基因表达状态的诊断价值。方法回顾性分析本院经病理证实的乳腺癌患者103例,HER-2阳性组54例,HER-2阴性组49例,所有病例均行DKI、DCE-MRI检查。分析两组间的临床病例资料和平均扩散峰度值(MK)、平均扩散率(MD)、容量转移常数(K^(trans))、血管外细胞外间隙容积比(V_(e))、和速率常数(K_(ep))。计数资料的差异性分析采用χ^(2)检验;计量资料的差异性分析采用独立样本t检验;运用二元logistic回归分析及受试者工作特征曲线分析独立影响因素的诊断效能。结果HER-2阳性组淋巴结转移及Ki-67高表达(Ki-67>14%)多见,两组间差异有统计学意义(P<0.05)。HER-2阳性组的MK及V_(e)值小于阴性组,而K^(trans)、K_(ep)值高于阴性组,差异有统计学意义(P<0.05)。当MK≤0.637、V_(e)≤0.462、K^(trans)≥0.230/min、K_(ep)≥0.472/min时,倾向于HER-2基因阳性表达,均为其鉴别诊断的独立影响因素,但诊断效能差异无统计学意义(Z=0.039~0.647;P>0.05)。而将MK+K^(trans)+K_(ep)+V_(e)联合,AUC为0.803,诊断效能均高于单一参数(Z=2.116~2.963;P<0.05),敏感度为87.8%,特异度为66.7%,准确度为72.8%。结论DKI联合DCE-MRI可用于HER-2阳性表达的预测,可为临床治疗及预后评估提供参考。Objective To investigate predictive value of diffusion kurtosis imaging(DKI)and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)for the expression of HER-2 in breast cancer.Methods A total of 103 of breast cancer patients confirmed by pathology were collected,including 54 cases in the positive HER-2 group and 49 cases in the negatve HER-2 group.DKI and DCE-MRI scanning were performed in all patients.The clinicopathological characteristics and mean diffusion rate(MD),mean kurtosis value(MK),volume transfer constant(K^(trans)),extravascular extracellular space distribute volume per unit tissue volume(V_(e))and rate constant(K_(ep))were analyzed.The χ^(2) test was used to analyze the difference of categorical variables;the independent sample t test was used to analyze the difference of continuous variables;the diagnostic power of independent influencing factors was analyzed by binary logistic regression analysis and receiver operating characteristic curve.Results The lymph node metastasis and Ki-67 high expression(Ki-67>14%)were more common in the HER-2 positive group(P<0.05).The values of MK and V_(e)in the HER-2 positive group were lower than those in the negative group,while the values of K^(trans),K_(ep)were higher than those in the negative group,with statistical significance(P<0.05).When MK≤0.637,V_(e)≤0.462,K^(trans)≥0.230/min,K_(ep)≥0.472/min,it was an independent factor in the diagnosis of the positive expression of HER-2 gene,but the difference in diagnostic efficiency was not statistically different(Z=0.039~0.647;P>0.05).The combination of MK+K^(trans)+K_(ep)+V_(e)had an AUC of 0.803,and the diagnostic efficiency was higher than a single parameter(Z=2.116~2.963;P<0.05),the sensitivity was 87.8%,the specificity was 66.7%,and the accuracy was 72.8%.Conclusion DKI combined with DCE-MRI can be used to predict the positive expression of HER-2,which can provide reference for clinical treatment and prognosis evaluation.

关 键 词：乳腺癌 磁共振成像 扩散峰度成像 动态增强磁共振成像 人类表皮生长因子受体2 

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