体素内不相干运动联合动态对比增强磁共振成像对乳腺癌HER-2基因表达的诊断价值  

Prediction of the Expression of HER-2 in Breast Cancer Based on Intravoxel Incoherent Motion and Dynamic Contrast Enhanced Magnetic Resonance Imaging

作　　者：冯海霞[1] 顾龙[2] 安丽华[1] 李静[1] 王唯伟 FENG Haixia;GU Long;AN Lihua(Department of Radiology,The Affiliated Hospital of Jining Medical University,Jining,Shandong Province 272029,P.R.China)

机构地区：[1]济宁医学院附属医院影像科,272029 [2]济宁市中医院放射科,272000

出　　处：《临床放射学杂志》2022年第8期1432-1437,共6页Journal of Clinical Radiology

摘　　要：目的探讨体素内不相干运动(IVIM)联合动态对比增强磁共振成像(DCE-MRI)对乳腺癌人表皮生长因子受体-2(HER-2)表达状态的诊断价值。方法回顾性分析经病理证实的乳腺癌患者113例,HER-2阳性组61例,HER-2阴性组52例,所有患者均行IVIM及DCE-MRI检查。分析两组间的临床病理资料、时间-信号强度曲线(TIC)和真实扩散系数(D),灌注相关扩散系数(D^(*)),灌注分数(f),容积转运常数(K^(trans)),血管外细胞外间隙容积分数(Ve),和速率常数(K_(ep));运用χ2检验分析临床病理资料及TIC曲线的差异性;采用两独立样本t检验比较IVIM和DCE-MRI诸参数的差异,绘制受试者工作特征曲线(ROC)比较其诊断效能。结果HER-2阳性组乳腺癌边界欠清,脉管或神经侵犯多见,淋巴结转移及Ki-67高表达(Ki-67>14%)亦多见,两组间差异有统计学差异(P<0.05)。HER-2阳性组的D小于阴性组,而D^(*)和K^(trans)、K_(ep)高于阴性组,差异有统计学意义(P<0.05)。D值与HER-2表达呈轻度负相关,而D^(*)和K^(trans)、K_(ep)值与HER-2表达呈正相关(|r|为0.194~0.323)。当D≤0.68×10^(-3)mm^(2)/s、D^(*)≥16.4×10^(-3)mm^(2)/s、K^(trans)≥0.182 min^(-1)、K_(ep)≥0.453 min^(-1)时,倾向于HER-2基因阳性表达,其中IVIM的D^(*)的曲线下面积(AUC)数值较大,为0.684,敏感度最高,为73.8%。IVIM模型AUC为0.743;DCE-MRI模型AUC为0.674。IVIM+DCE-MRI的AUC为0.778,诊断效能均高于单一模型(Z=1.909,2.595;P<0.05),敏感度为72.1%,特异度为73.1%,准确率70.8%。结论IVIM联合DCE-MRI可用于HER-2阳性表达的预测,有利于患者的个体化治疗。Objective To investigate predictive value of intravoxel incoherent motion(IVIM)and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)for the expression of HER-2 in breast cancer.Methods A total of 113 cases of breast cancer patients confirmed by pathology were collected,including 61 cases in the positive HER-2 group and 52 cases in the negative HER-2 group.IVIM and DCE-MRI scanning were performed in all patients.The clinicopathological characteristics,time signal intensity curve and true diffusion coefficient(D),perfusion-related diffusion coefficient(D^(*)),perfusion fraction(f),volume transfer constant(K^(trans)),extravascular extracellular space distribute volume per unit tissue volume(Ve)and rate constant(K_(ep))were analyzed.The differences of clinicopathological data and TIC were analyzed byχ2 test.The t test of two independent samples was used to compare the differences of IVIM and DKI parameters,and the ROC was plotted to compare the diagnostic efficiency.Results The boundary of breast cancer in the HER-2 positive group was not clear,vascular and nerve invasion were more common,lymph node metastasis and Ki-67 high expression(Ki-67>14%)were also common,and the difference between the two groups was statistically significant(P<0.05).The values of D in the HER-2 positive group were lower than those in the negative group,while the values of D^(*)and K^(trans),K_(ep)were higher than those in the negative group,with statistical significance(P<0.05).D value was negatively correlated with HER-2.D^(*)and K^(trans),K_(ep)were positively correlated with HER-2(|r|=0.194~0.323).When D≤0.68×10^(-3)mm^(2)/s、D^(*)≥16.4×10^(-3)mm^(2)/s、K^(trans)≥0.182 min-1、K_(ep)≥0.453 min-1,tending to the positive expression of the HER-2,among which the AUC of D^(*)was the largest(0.684).AUC of IVIM model was 0.743.AUC of DCE-MRI model was 0.674.The AUC of IVIM+DCE-MRI was 0.778,and the diagnostic efficiency was higher than that of the single index(Z=1.909~2.595,P<0.05).The sensitivity,specificity and accuracy

关 键 词：乳腺癌 磁共振成像 体素内不相干运动 动态对比增强磁共振成像 

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]