多模态MRI定量参数与乳腺癌HER-2表达状态的相关性分析  

Correlation between multiple parameters of magnetic resonance imaging and HER-2 expression status of breast cancer

作　　者：杨自力[1] 邵凯 朱来敏[1] 于昊 王唯伟 YANG Zhi-li;SHAO Kai;ZHU Lai-min(Imaging Department,the Affiliated Hospital of Jining Medical University,Shandong 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：《放射学实践》2023年第8期1006-1012,共7页Radiologic Practice

基　　金：国家自然科学基金(82001805);济宁医学院附属医院博士科研启动基金(2018-BS-010);山东省中医药科技项目(Q-2022132);济宁市重点研发计划项目(2021YXNS035)。

摘　　要：目的:探讨多模态MRI(IVIM+DKI+DCE-MRI)定量参数对乳腺癌HER-2表达状态的预测价值。方法:回顾性分析本院经病理证实的97例乳腺癌患者的临床和影像学资料。其中,HER-2阳性组51例,HER-2阴性组46例。所有患者行IVIM-DWI、DKI及DCE-MRI检查。采用χ^(2)检验或t检验比较两组的临床资料、时间-信号强度曲线(TIC)的类型及多模态MRI定量参数值[真实扩散系数(ADC slow)、灌注相关扩散系数(ADC fast)、灌注分数(f)、平均扩散峰度(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)]的差异。将组间差异有统计学意义的各序列MRI定量参数分别构建IVIM-DWI、DKI和DCE-MRI预测模型,采用ROC曲线分析各个模型的诊断效能。结果:HER-2阳性组中病灶边界欠清、脉管和/或神经侵犯、淋巴结转移及Ki-67高表达(Ki-67>14%)的出现率均较HER-2阴性组更高,且组间差异均有统计学意义(P<0.05)。HER-2阳性组的ADC slow和MK值低于阴性组,而ADC fast、K trans、K ep和V e值高于阴性组,且组间差异均有统计学意义(P<0.05)。ADC slow和MK值与HER-2阳性表达呈轻度负相关,而ADC fast、K trans、K ep和V e值与HER-2阳性表达呈正相关(|r|为0.209~0.383,P均<0.05)。当ADC slow≤0.68×10-3 mm^(2)/s、ADC fast≥16.4×10-3 mm^(2)/s、MK≤0.61、K trans≥0.259/min、K ep≥0.453/min和V e≥0.447时,提示HER-2基因阳性表达的可能性大,其中以DCE-MRI定量参数V e的AUC最大,为0.724。DCE-MRI模型(K trans+K ep+V e)的AUC为0.791,高于IVIM-DWI(ADC slow+ADC fast)模型(0.728)和DKI(MK)模型(0.625)。IVIM-DWI+DKI+DCE-MRI联合模型的AUC为0.852,高于各单一模型(Z=1.908~3.595,P均<0.05),相应的诊断敏感度为84.3%、特异度为69.6%、符合率为75.3%。结论:IVIM-DWI联合DKI、DCE-MRI定量参数构建联合模型可用于HER-2阳性表达的预测,有利于患者的个体化治疗。Objective:The purpose of this study was to investigate predictive value of quantitative parameters of multi-model MRI including intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI),diffusion kurtosis imaging(DKI)and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)for the expression level of HER-2 in breast cancer.Methods:A total of 97 cases of breast cancer patients confirmed by pathology were collected,including 51 cases in the positive HER-2 group and 46 cases in the negative HER-2 group.All patients underwent MRI scan with sequences of IVIM-DWI,DKI and DCE-MRI.The differences of the clinicopathological characteristics,time signal intensity curve(TIC)type and multi-model MRI quantitative parameters between the po-sitive HER-2 group and the negative HER-2 group were analyzed byχ^(2)-test or t-test of two indepen-dent samples,including true diffusion coefficient(ADC slow),perfusion-related diffusion coefficient(ADC fast),perfusion fraction(f),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).The parameters with statistically significant differences between the two groups were formed into IVIM-DWI,DKI,and DCE-MRI models,and the diagnostic efficacy of these models were analyzed by ROC curves.Results:The boundary of breast cancer in the HER-2 positive group was not clear,vascular and nerve invasions were more common,lymph node metastasis and Ki-67 high expression(Ki-67>14%)were also more common,and the difference between the two groups was statistically significant(P<0.05).The values of ADC slow and MK in the HER-2 positive group were lower than those in the negative group,while the values of ADC fast,K trans,K ep and V e were higher than those in the negative group,with statistical significance(P<0.05).ADC slow and MK were negatively correlated with HER-2.The ADC fast and K trans,K ep and V e values were positively correlated with HER-2(|r|=0.209~0.383).Wh

关 键 词：乳腺癌 磁共振成像 体素内不相干运动 扩散峰度成像 动态增强扫描 人类表皮生长因子受体-2 

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]