平扫MRI和DCE-MRI对乳腺癌新辅助化疗疗效的预测价值比较  

Comparison of the value of unenhanced MRI and DCE-MRI in predicting the efficacy of neoadjuvant chemotherapy in breast cancer

作　　者：贺春燕 吉茹[1] 刘兵[1] HE Chun-yan;JI Ru;LIU Bing(Department of Radiology,People's Hospital Affiliated to Inner Mongolia Medical University,Hohhot O10020,China)

机构地区：[1]内蒙古医科大学附属人民医院放射科,内蒙古呼和浩特010020

出　　处：《中国临床医学影像杂志》2023年第1期24-27,32,共5页Journal of China Clinic Medical Imaging

基　　金：内蒙古医科大学科技百万工程联合项目(基金编号YKD2018KJBW(LH)054);内蒙古医科大学青年创新基金(基金号YKD2018QNCX074);内蒙古医科大学青年项目(编号YKD2022QN043)。

摘　　要：目的:通过回顾性分析比较平扫MRI和DCE-MRI序列对乳腺癌新辅助化疗(NAC)疗效的评估,并讨论评估乳腺癌患者NAC后的疗效时,平扫MRI是否可以替代DCE-MRI序列。方法:选择2019年1月—2021年6月在我院就诊的经穿刺活检或手术病理证实的乳腺癌女性患者175例作为研究对象,且所有患者均接受完整周期的NAC,所有患者在每次NAC治疗前和治疗结束时都进行乳腺DCE-MRI检查。使用配对样本t检验比较平扫MRI与DCE-MRI序列乳腺癌病变大小及NAC前和NAC后的乳腺癌的ADC。以术后病理学结果为金标准,分析平扫MRI、DCE-MRI序列检测乳腺癌NAC后残留肿瘤的准确度(ACC)、敏感度、特异度、阳性预测值(PPV)及阴性预测值(NPV)。结果:平扫MRI和DCE-MRI序列检测乳腺癌NAC后残留肿瘤的敏感度分别为90.2%和92.7%,特异度分别为90.3%和88.8%,ACC分别为90.3%和89.7%,PPV分别为74.0%和71.7%,NPV分别为96.8%和97.5%。平扫MRI和DCE-MRI序列在NAC前后对于病灶大小的评估在统计学上无显著差异。整个研究组、pCR组的平均ADC在NAC前后有显著差异,而非pCR组在NAC前后无显著差异。结论:平扫MRI和DCE-MRI序列对乳腺癌患者NAC后疗效的评估价值具有可比性,所以对于接受NAC治疗的乳腺癌患者,为了降低检查成本和避免重复使用钆对比剂可能造成的潜在人体组织损伤,平扫MRI是DCE-MRI序列不错的替代选择。Objective:To retrospectively analyze and compare the efficacy of unenhanced MRI and DCE-MRI in evaluating the efficacy of neoadjuvant chemotherapy(NAC)in breast cancer patients,and to discuss whether unenhanced MRI can replace DCE-MRI when evaluating the efficacy of breast cancer patients after NAC.Methods:A total of 175 female patients with breast cancer confirmed by needle biopsy or surgical pathology who were treated in our hospital from January 2019 to June 2021 were selected as the research subjects,and all patients received a complete cycle of NAC.Breast DCE-MRI was performed before and at the end of NAC treatment.Paired-samples t-tests were used to compare unenhanced MRI versus DCE-MRI breast cancer lesion size and ADC in pre-and post-NAC breast cancers.Taking postoperative pathological results as the gold standard,the accuracy(ACC),sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of unenhanced MRI and DCE-MRI in detecting residual tumor after NAC in breast cancer were analyzed.Results:The sensitivity,specificity,ACC,PPV and NPV of unenhanced MRI and DCE-MRI in detecting residual tumor after NAC in breast cancer were 90.2%and 92.7%,90.3%and 88.8%,90.3%and 89.7%,74.0%and 71.7%,96.8%and 97.5%,respectively.There was no statistically significant difference in the assessment of lesion size before and after NAC between unenhanced MRI and DCE-MRI enhanced sequences.The mean ADC of the whole study group and pCR group was significantly different before and after NAC,while there was no significant difference in non-pCR group before and after NAC.Conclusion:The evaluation value of unenhanced MRI and DCE-MRI sequence for breast cancer patients after NAC is comparable,so for breast cancer patients receiving NAC,in order to reduce the cost of examination and avoid the potential human tissue damage caused by repeated use of gadolinium contrast agent,unenhanced MRI is a good alternative to DCE-MRI enhanced sequences.

关 键 词：乳腺肿瘤 磁共振成像 

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