基于扩散加权成像MR模型对乳腺癌基因分型及预后的判断价值  

Multiparametric diffusion-weighted imaging in breast neoplasms:association with genotypes and prognostic factors

作　　者：寻静[1] 王唯伟 朱来敏[1] 于昊 周哲 陈月芹[1] 孙占国[1] XUN Jing;WANG Weiwei;ZHU Laimin;YU Hao;ZHOU Zhe;CHEN Yueqin;SUN Zhanguo(Department of Imaging,Affiliated Hospital of Jining Medical University,Jining 270029,China)

机构地区：[1]济宁医学院附属医院影像科,山东济宁272029

出　　处：《医学影像学杂志》2022年第11期1923-1929,共7页Journal of Medical Imaging

基　　金：国家自然科学基金项目(编号:82001805);山东省医药卫生科技发展计划项目(编号:202009011151);山东省济宁市重点研发计划项目(编号:2020YXNS012)。

摘　　要：目的探讨基于扩散加权成像的多功能MR模型对乳腺癌基因分型及预后的判断价值。方法选取157例经手术病理证实的乳腺癌的临床、影像资料,均行扩散加权成像及体素内不相干运动扩散加权成像、扩散峰度成像扫描,分析其定量参数表观扩散系数(ADC)、真实扩散系数(ADC_(slow))、灌注相关扩散系数(ADC fast)和灌注分数(f)及平均扩散率(MD)及平均峰度值(MK);运用多因素logistic回归分析及受试者工作特征曲线分析独立影响因素对Nottingham指数的诊断效能。结果ER及PR阳性组的的MK值高于阴性组,且ER与MK呈轻度正相关;Her-2阴性组的ADC、ADC_(slow)高于阳性组,且呈极弱负相关;Ki-67与ADC、ADC_(slow)呈轻度负相关,与f值呈极弱正相关;淋巴结转移阳性组ADC、ADC_(slow)较小,呈轻度负相关,与MK呈极弱正相关;ADC、ADC_(slow)及MD与病理分级呈负相关,而MK值与病理分级呈轻度负相关;ADC_(slow)值与TNM分期呈轻度负相关;Nottingham指数与ADC_(slow)值呈轻度正相关,与MK值与呈极弱正相关。Luminal A型的ADC、MD高于Luminal B型、HER-2阳性型、三阴性型(P<0.05);Luminal A型的f值小于Luminal B型、三阴性型(P<0.05);Luminal A型的MK值小于HER-2阳性型、三阴性型,Luminal B型的MK值小于三阴性型(P<0.05)。四组ADC_(slow)两两比较差异均有统计学意义(P<0.05);ADC_(fast)在四组之间差异均无统计学意义(P>0.05)。ADC_(slow)(OR=0.092,P=0.001)、MD(OR=17.087,P=0.006)为鉴别预后良好组(NPI评分<3.4)、预后不良组(NPI评分≥3.4)的独立影响因素。当ADC_(slow)≤0.70×10^(-3) mm^(2)/s、MK≥0.68时,对于Nottingham指数预后不良组诊断效能最佳,ADC_(slow)联合MK后的诊断效能高于ADC_(slow)(Z=2.317,P=0.021)、MK(Z=2.621,P=0.009)。结论基于扩散加权成像的DWI、IVIM-DWI及DKI联合运用对乳腺癌基因分型及预后有较好的判断价值,值得临床推广。Objective To explore the value of multifunctional magnetic resonance model based on diffusion weighted imaging for estimating genotypes and prognostic factors of breast cancer.Methods A total of 157 breast cancer patients confirmed by pathology were collected,DWI,IVIM-DWI and DKI scanning were performed in all patients.The ADC,true diffusion coefficient(ADC_(slow)),perfusion-related diffusion coefficient(ADC fast),perfusion fraction(f),mean diffusion rate(MD)and mean kurtosis value(MK)were analyzed.Multivariate Logistic regression analysis and receiver operating characteristic curve were used to analyze the diagnostic efficacy of independent influencing factors on Nottingham index.Results The MK value of ER and PR positive group was higher than that of negative group,and there was a slight positive correlation between ER and MK.The ADC and ADC_(slow) of the negative HER-2 group were higher than those of the positive group.Ki-67 was slightly negatively correlated with ADC and ADC_(slow),and extremely weakly positively correlated with f value.In the group with positive lymph node metastasis,ADC and ADC_(slow) were smaller,showing slight negative correlation,and extremely weak positive correlation with MK.ADC,ADCS low and MD were negatively correlated with pathological grade,while MK was slightly negatively correlated with pathological grade.ADC_(slow) was slightly negatively correlated with TNM stage.Nottingham index was slightly positively correlated with ADC_(slow),and extremely weakly positively correlated with MK.ADC and MD of Luminal A were higher than those of Luminal B,HER-2 positive and triple negative(P<0.05).The f value of Luminal A was lower than that of Luminal B and triple negative(P<0.05).The MK of Luminal A was lower than that of positive HER-2 and triple negative,and the MK of Luminal B was lower than that of triple negative(P<0.05).Pairwise comparison of ADC_(slow) among the four groups showed statistical difference(P<0.05).There was no statistical difference in ADC fast among four groups(P>0.05).W

关 键 词：乳腺癌 磁共振成像 扩散加权成像 体素内不相干运动 扩散峰度成像 

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