动态对比增强磁共振成像联合体素内不相干运动技术对乳腺癌腋窝淋巴结转移的预测价值  

The Value of Predicting Axillary Lymph Node Metastasis in Patients with Breast Cancer Based on Dynamic Contrast-Enhanced Magnetic Resonance Imaging and Intravoxel Incoherent Motion

作　　者：李美芹[1] 宋伟伟[2] 赵凡 朱来敏[1] 王唯伟 LI Meiqin;SONG Weiwei;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1882-1887,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：目的探讨动态对比增强磁共振成像(DCE-MRI)联合体素内不相干运动(IVIM)技术预测乳腺癌腋窝淋巴结(ALN)转移的价值。方法回顾性分析本院经病理证实的166例乳腺癌患者,77例有ALN转移,89例无ALN转移,术前乳腺病灶均行DCE-MRI及IVIM检查。分析两组间的临床病理资料和容积转运常数(K^(trans)),血管外细胞外间隙容积分数(V_(e)),速率常数(K_(ep))及真实扩散系数(D),灌注相关扩散系数(D^(*)),灌注分数(f);运用χ^(2)检验分析临床病理资料的差异性;采用两独立样本t检验及Mann-Whitney U检验比较DCE-MRI和IVIM诸参数的差异,绘制受试者工作特征曲线(ROC)比较其诊断效能。结果乳腺癌ALN转移组脉管、神经侵犯征象较非ALN转移组多见,且Ki-67多呈高表达(P<0.001)。ALN转移组患者D值小于无ALN转移组(P<0.001),且呈低度负相关(r=-0.422);ALN转移组K^(trans)、K_(ep)及D^(*)值大于无ALN转移组(P=0.016,P=0.004,P<0.001),其中K^(trans)值与ALN转移呈中度正相关(r=0.516),K_(ep)及D^(*)值与ALN转移呈低度正相关(r=0.223,r=0.187)。DCE-MRI模型的K^(trans)值及IVIM模型的D值的诊断效能较高,曲线下面积(AUC)分别为0.799、0.744,其中K^(trans)的敏感度为68.54%,准确率为72.30%,高于D值。DCE-MRI模型为K^(trans)+K_(ep),AUC为0.848;IVIM模型为D+D^(*),AUC为0.758;两模型之间的ROC差异不具有统计学意义(Z=0.784,P=0.433)。而将DCE-MRI、IVIM模型联合,AUC为0.848,诊断效能均高于单一模型(Z=2.271,P=0.023;Z=2.902,P=0.004)。结论DCE-MRI和IVIM模型可用于预测乳腺癌ALN转移,其中以DCE-MRI模型的K^(trans)值诊断准确率较高,且DCE-MRI联合IVIM模型在乳腺癌ALN结性质上的鉴别能力优于单一模型。Objective To assess the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and Intravoxel incoherent motion(IVIM)for predicting the risk of axillary lymph node(ALN)metastasis in patients with breast cancer.Methods A total of 166 cases of breast cancer patients confirmed by pathology were collected.Seventy-seven patients had axillary lymph node metastasis(axillary lymph node,ALN),and 89 patients had no axillary lymph node metastasis.DCE-MRI and IVIM scanning were performed in all patients.The volume transfer constant(K^(trans)),extravascular extracellular space distribute volume per unit tissue volume(Ve)and rate constant(K_(ep))and true diffusion coefficient(D),perfusion-related diffusion coefficient(D^(*)),perfusion fraction(f)were analyzed.The diagnostic performance of these models was evaluated by Receiver Operating Characteristic Curve(ROC)analysis.Results Symptoms of vascular and nerve invasion in breast cancer with ALNmetastasis were more common than those of non-metastases,and Ki-67 was more highly expressed(P<0.001).The D value of the ALN metastasis group was lower than that of the non-ALN metastasis group(P<0.001),showing a low degree of negative correlation(r=-0.422,P<0.001).The D^(*),K^(trans),and K_(ep)values of the ALN metastasis group were higher than those of the non-ALN metastasis group(P=0.016,P=0.004,P<0.001).The K^(trans)value was moderately positively correlated with ALN metastasis(r=0.516),and the K_(ep)and D^(*)values were low-grade positively correlated with ALN metastasis(r=0.223;r=0.187).Conclusion The features of DCE-MRI and IVIM parameters can be used to predict the ALN metastasis in patients with breast cancer.K^(trans)has higher diagnostic accuracy.DCE-MRI combined with IVIM showed higher diagnostic efficiency for ALN metastasis in breast cancer than single model.

关 键 词：乳腺癌 腋窝淋巴结 动态对比增强磁共振成像 体素内不相干运动 

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]