DWI、DCE联合APT成像在鉴别乳腺良恶性病变中的价值研究  

Value of DWI, DCE and APT Imaging in Identifying Benign and Malignant Breast Lesions

作　　者：赵傲 武新英[1] 付彤[1] 王培炎 李可 申璐璐 林海 刘林栋[1] ZHAO Ao;WU Xinying;FU Tong;WANG Peiyan;LI Ke;SHEN Lulu;LIN Hai;LIU Lindong(Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing Jiangsu 210006,China;Central Research Institute,United Imaging Healthcare,Shanghai 201800,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)医学影像科,江苏南京210006 [2]上海联影中央研究院,上海201800

出　　处：《中国医疗设备》2024年第6期124-130,155,共8页China Medical Devices

基　　金：南京市科技计划项目(202002056)。

摘　　要：目的对比磁共振酰胺质子转移(Amide Proton Transfer,APT)成像、扩散加权成像(Diffusion Weighted Imaging,DWI)和动态增强(Dynamic Contrast-Enhanced,DCE)成像以及3者联合应用在鉴别乳腺良恶性病变中的诊断价值。方法纳入55例乳腺疾病患者,均进行APT、DWI以及DCE扫描,测量非对称磁化转移(Magnetization Transfer Asymmetry,MTRasym)率和表观扩散系数(Apparent Diffusion Coefficient,ADC)值,并记录乳腺影像报告和数据系统的分类。分析乳腺良恶性病变各参数之间的差异,使用Logistic回归建立联合诊断模型,采用受试者工作特征曲线(Receive Operating Characteristic,ROC)计算各诊断模型在乳腺良恶性病变中的诊断价值,并比较恶性病变中不同病理因素组间的差异以及各病理因素与APT之间的相关性。结果恶性组中MTRasym和ADC值均小于良性组,差异具有统计学意义(均P<0.05),DWI、APT、DCE以及APT+DCE、APT+DWI、DCE+DWI、DWI+APT+DCE联合模型鉴别乳腺良恶性病变的曲线下面积(Area Under Curve,AUC)分别为0.804、0.723、0.741以及0.782、0.895、0.897、0.970;DWI+APT+DCE联合诊断模型的AUC显著大于DWI、APT、DCE以及任意两者联合诊断模型(均P<0.05)。Ki-67高表达组的MTRasym值较低表达组高[(3.934%±0.883%)v s.(3.192%±0.949%)],乳腺癌浸润程度组织学分级Ⅲ级组的M T R a s y m值较Ⅱ级组高[(4.225%±0.932%)vs.(3.451%±0.873%)],差异均有统计学意义(均P<0.05),并且APT与两者均呈中度正相关(r=0.627、0.537,均P<0.05)。结论APT成像技术在乳腺良恶性病变的鉴别中具有较好的诊断价值,与常规DWI、DCE成像无显著差异,并且三者联合应用的诊断价值更高。Objective To compare the value of magnetic resonance amide proton transfer(APT)imaging,diffusion weighted imaging(DWI),dynamic contrast-enhanced(DCE)imaging and used in combination in the identification of benign and malignant breast lesions.Methods A total of 55 patients with breast disease were included,APT,DWI and DCE scans were performed to measure the magnetization transfer asymmetry(MTRasym)rate and apparent diffusion coefficient(ADC)values,and then the classification of breast imaging reporting and data system were recorded.The differences between the parameters of benign and malignant breast lesions were analyzed,the combined diagnostic model was established by Logistic regression,and the receiver operating characteristic(ROC)curve was used to calculate the diagnostic value of various diagnosis model in benign and malignant breast lesions,and the differences between different pathological factors in malignant lesions and the correlation between the pathological factors and APT were compared.Results The MTRasym and ADC values in the breast malignant group were smaller than those in the benign group,and the difference was statistically significant(all P<0.05),and the area under curve(AUC)of DWI,APT,DCE and APT+DCE,APT+DWI,DCE+DWI,DWI+APT+DCE were 0.804,0.723,0.741 and 0.782,0.895,0.897,0.970,respectively;the AUC of DWI+APT+DCE was significantly greater than DWI,APT,DCE and any two combined diagnosis models(all P<0.05).The MTRasym value in the Ki-67 high expression group was higher than that in the low expression group[(3.934%±0.883%)vs.(3.192%±0.949%)].The MTRasym value of the breast cancer infiltration degree histological gradingⅢgroup is higher than that of theⅡgroup[(4.225%±0.932%)vs.(3.451%±0.873%)],and APT was moderately positive with both(r=0.627,0.537,both P<0.05).Conclusion APT imaging has good diagnostic value in the identification of benign and malignant breast lesions,with no significant difference from conventional DWI and DCE imaging,and the diagnostic value of the combination of the th

关 键 词：乳腺良恶性病变 酰胺质子转移成像 扩散加权成像 动态对比增强 磁共振成像 

分 类 号：R737.9[医药卫生—肿瘤]