体素内不相干运动扩散加权成像在乳腺癌腋窝转移性小淋巴结中的研究价值  

Clinical value of intravoxel incoherent motion diffusion-weighted imaging in the diagnosis of small metastatic axillary lymph nodes in breast cancer

作　　者：蒋伟[1] 邓虹[1] 张翔[1] 贺绍云 赵雅琪 高明[1] JIANG Wei;DENG Hong;ZHANG Xiang;HE Shaoyun;ZHAO Yaqi;GAO Ming(Department of Radiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院放射科,广州510120

出　　处：《磁共振成像》2023年第9期70-75,80,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：广东省自然科学基金(编号:2021A1515010385)。

摘　　要：目的探讨体素内不相干运动扩散加权成像(intravoxel incoherent motion diffusion-weighted imaging,IVIM-DWI)的定量参数在诊断乳腺癌腋窝转移性小淋巴结(small metastatic lymph nodes,SMLN)中的临床价值。材料与方法收集经病理确诊的乳腺癌腋窝SMLN患者80例(SMLN组)和乳腺良性病变患者55例[良性淋巴结(benign lymph nodes,BLN)组],所有患者均行双侧乳腺及腋窝部常规MRI序列和IVIM-DWI序列扫描。比较乳腺癌腋窝SMLN组与乳腺良性病变腋窝BLN组之间IVIM-DWI参数在真实扩散系数(true diffusion coefficient,D)、灌注相关扩散系数(perfusion related diffusion coefficient,D^(*))、灌注分数(perfusion fraction,f)及表观扩散系数(apparent diffusion coefficient,ADC)值中的差异。绘制双指数非线性模型参数(D、D^(*)和f值)及ADC值鉴别乳腺癌腋窝SMLN组与乳腺良性病变腋窝BLN组的ROC曲线,通过曲线下面积(area under the curve,AUC)分析乳腺癌腋窝SMLN组和腋窝BLN中各参数的诊断效果。结果乳腺癌腋窝SMLN组与乳腺良性病变腋窝BLN组之间的D值(F=6.975,P<0.01)、D^(*)值(F=3.206,P<0.01)和ADC值(F=5.117,P<0.01)差异均有统计学意义,两组之间的f值(F=-0.171,P>0.05)差异无统计学意义。乳腺癌腋窝SMLN组的D值和ADC值均低于乳腺良性病变腋窝BLN组(P<0.001),D^(*)值高于乳腺良性病变腋窝BLN组(P=0.002),D、D^(*)、ADC值及ADC与D联合预测用于鉴别乳腺癌腋窝SMLN与乳腺良性病变腋窝BLN的AUC分别为0.817、0.643、0.734、0.833。D、D^(*)及ADC值的诊断阈值分别为0.750×10-3、17.500×10-3、0.836×10-3 mm2/s,其敏感度分别为81.8%、52.7%、78.2%,特异度分别为80.0%、75.0%、61.3%。结论D值在诊断乳腺癌腋窝SMLN中具有较好的诊断效能且明显优于ADC值,对诊断腋窝SMLN有一定的意义。Objective:To investigate the clinical value of quantitative parameters of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)in axillary small metastatic lymph nodes(SMLN)of breast cancer.Materials and Methods:Eighty patients with pathologically confirmed breast cancer with axillary SMLN(SMLN group)and 55 patients with benign lymph nodes(BLN)(BLN group)were collected.Conventional MRI and IVIM-DWI sequence scans of bilateral breast and axilla were perform for all patients.The differences in IVIM-DWI parameters true diffusion coefficient(D),perfusion related diffusion coefficient(D^(*)),perfusion fraction(f)and apparent diffusion coefficient(ADC)value between SMLN group and BLN group were analyzed and measured accurately.The double exponential nonlinear model parameters(D,D^(*)and f values)and ADC values were drawn to distinguish the ROC curve between the SMLN group and the BLN group with benign breast lesions.The diagnostic effects of axillary SMLN group and axillary BLN in breast cancer were analyzed by area under curve(AUC).Results:The D value(F=6.975,P<0.01),D^(*)value(F=3.206,P<0.01)and ADC value(F=5.117,P<0.01)were significantly different,while the f value(F=-0.171,P>0.05)showed no significant difference between SMLN group and BLN group.D value and ADC value were significantly lower in SMLN group than that in BLN group(P<0.001),and D^(*)value was significantly higher in SMLN group than that in BLN group(P=0.002).The AUC values of D,D^(*),ADC value and the ADC and D combined prediction probability were 0.817,0.643,0.734 and 0.833 for differentiating axillary SMLN of breast cancer from BLN of benign breast lesions,respectively.The diagnostic thresholds of D,D^(*)and ADC value were 0.750×10-3 mm2/s,17.500×10-3 mm2/s,and 0.836×10-3 mm2/s,respectively.The sensitivities were 81.8%,52.7%,78.2%,and the specificities were 80.0%,75.0%and 61.3%,respectively.Conclusions:The D value in the diagnosis of breast cancer axillary SMLN has a better diagnostic efficiency and is obviously better than ADC value,wh

关 键 词：乳腺癌 磁共振成像 体素内不相干运动 扩散加权成像 腋窝 淋巴结转移 

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]