扩散峰度联合动态增强磁共振成像对乳腺癌预后因子的鉴别诊断价值  

Differential Diagnostic Value of Diffusion Kurtosis Combined with Dynamic Enhanced Magnetic Resonance Imaging for Prognostic Factors in Breast Cancer

作　　者：杨自力[1] 邵凯 赵凡 于昊 王唯伟 YANG Zili;SHAO Kai;ZHAO Fan(Department of Radiology,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医学影像科,272029 [2]济宁医学院附属医院肿瘤科,272029

出　　处：《临床放射学杂志》2023年第12期1876-1881,共6页Journal of Clinical Radiology

基　　金：山东省中医药科技项目(编号:Q-2022132);济宁市重点研发计划项目(编号:2021YXNS035)。

摘　　要：目的探讨扩散峰度成像(DKI)联合动态对比增强磁共振成像(DCE-MRI)对乳腺癌预后因子的鉴别诊断价值。方法回顾性分析本院经病理证实的乳腺癌患者150例,所有病例均行DKI、DCE-MRI检查。分析两组间的平均扩散峰度值(MK)、平均扩散率(MD)、容积转运常数(Ktrans)、血管外细胞外间隙容积分数(Ve)、速率常数(Kep)。运用受试者工作特征曲线(ROC)分析诊断效能。结果雌激素受体(ER)阴性组的MD、Ktrans值高于阳性组(P<0.05);人表皮生长因子受体-2(HER-2)阳性组的Ktrans值大于阴性组,而Ve值小于阴性组(P<0.05);MD、MK及Ktrans、Kep值在腋窝淋巴结转移方面差异有统计学意义(P<0.05);病理高级别组的MK及Ktrans、Kep值大于低级别组,而MD值小于低级别组(P<0.05);TNM高分期的MK、Kep值较低分期组大(P<0.05);增殖细胞核抗原(Ki-67)高表达组的MK及Ktrans、Kep值大于低表达组,而MD小于低表达组(P<0.05);预后不良组[Nottingham指数(NPI)≥3.4]的MK及Ktrans、Kep值高于预后良好组(NPI<3.4),而MD小于预后良好组(P<0.05)。MD、MK和Ktrans、Kep的联合模型与NPI呈中度正相关(r=0.612,P<0.01),曲线下面积(AUC)为0.887,诊断效能高于单一参数(Z=3.403,P=0.001;Z=2.716,P=0.007;Z=1.986,P=0.047;Z=2.420,P=0.016),敏感度为75.0%,特异度为89.5%,准确率85.3%。结论DKI联合DCE-MRI可用于乳腺癌预后因子的预测,为临床治疗及预后评估提供参考。Objective To investigate the predictive value of diffusion kurtosis imaging(DKI)and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)for the prognostic factors in breast cancer.Methods A total of 150 cases of breast cancer patients confirmed by pathology were collected.DKI and DCE-MRI scanning were performed in all patients.The mean diffusion rate(MD),mean kurtosis value(MK),volume transfer constant(Ktrans),extravascular extracellular space distribute volume per unit tissue volume(Ve)and rate constant(Kep)were analyzed.The diagnostic the diagnostic efficacy was analyzed by receiver operating characteristic curve.Results MD and Ktrans values in the ER negative group were higher than that of positive group(P<0.05).The HER-2 positive group had higher Ktrans value and lower Ve value than that of the negative group(P<0.05).MD,MK,Ktrans,Kep values were significantly different between the axillary lymph node metastasis and non-metastasis groups(P<0.05).MK and Ktrans and Kep in high-grade group were higher than that of the low-grade group,while MD was lower than low-grade group(P<0.05).The MK and Kep values of high-stage TNM group were higher than those of the low-stage group(P<0.05).MK and Ktrans and Kep values were higher in the Ki-67 high expression group than those of the lower expression group,while MD was smaller than that of the low expression group(P<0.05).MK and Ktrans and Kep values in high-grade Nottingham group(NPI≥3.4)were higher than those of the low-grade Nottingham group(NPI<3.4)and MD was less than the low-grade Nottingham group(P<0.05).The combination of MD+MK+Ktrans+K ep showed moderate positive correlation with Nottingham index(r=0.612,P<0.01).The AUC was 0.887,which was higher than a single parameter(Z=1.986-3.403;P<0.05),the sensitivity is 75.0%,the specificity is 89.5%,and the accuracy is 85.3%.Conclusion DKI combined with DCE-MRI can be used to predict prognostic factors in breast cancer and provide a reference for clinical treatment and prognostic evaluation.

关 键 词：乳腺癌 磁共振成像 扩散峰度成像 动态对比增强磁共振成像 预后因子 

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]