酰胺质子转移加权成像与时间依赖性扩散MRI诊断乳腺恶性病变的效能比较  

Comparison of the efficacy of amide proton transfer-weighted imaging and time-dependent diffusion MRI for the diagnosis of malignant breast lesions

作　　者：王晓艳[1] 张焱[1] 程敬亮[1] 林良杰 武志刚 胡瑛[1] 张勇[1] 王岸飞[1] 李莹[1] 王如华 张坤 张文华 王保茎 Wang Xiaoyan;Zhang Yan;Cheng Jingliang;Lin Liangjie;Wu Zhigang;Hu Ying;Zhang Yong;Wang Anfei;Li Ying;Wang Ruhua;Zhang Kun;Zhang Wenhua;Wang Baojing(Department of Magnetic Resonance Imaging,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院核磁共振科,郑州450052

出　　处：《中华放射学杂志》2024年第6期611-619,共9页Chinese Journal of Radiology

摘　　要：目的比较酰胺质子转移加权(APTw)成像与时间依赖性扩散MRI(td-dMRI)诊断乳腺恶性病变的效能。方法该文为横断面研究。前瞻性分析2023年3月至8月在郑州大学第一附属医院就诊的乳腺病变患者的临床、病理及影像资料。所有患者首先接受T2WI、扩散加权成像,然后接受动态对比增强MRI(DCE-MRI),最后以DCE-MRI为参考对乳腺病变进行APTw成像、td-dMRI。通过APTw成像的重建图像测量病变的频率偏移为3.5 ppm的不对称性磁化转移率[MTR_(asym)(+3.5 ppm)],通过td-dMRI的重建图像测量不同振荡频率梯度下的表观扩散系数(ADC)值(ADC_(PGSE)、ADC_(17 Hz)、ADC_(33 Hz))。采用独立样本t检验比较乳腺良性与恶性病变、乳腺恶性病变不同分子分型[雌激素受体(ER)阴性与阳性、孕激素受体(PR)阴性与阳性、人表皮生长因子受体(HER-2)阴性与阳性、增殖指数(Ki-67)低表达与高表达]及不同组织学分级(Ⅱ级与Ⅲ级)的APTw成像、td-dMRI参数差异。采用受试者操作特征曲线和曲线下面积(AUC)评估APTw成像、td-dMRI参数鉴别乳腺肿瘤良性与恶性、乳腺恶性病变不同分子分型和组织学分级的效能。结果171例患者共171个病灶,恶性病变103例、良性病变68例。89例浸润性癌中,组织学分级Ⅱ级51例、Ⅲ级38例。98例恶性病变纳入分子分型分析,ER阴性36例、阳性62例;PR阴性51例、阳性47例;HER-2阴性33例、阳性65例,Ki-67低表达50例、高表达48例。乳腺恶性病变的MTR_(asym)(+3.5 ppm)值高于良性病变(t=5.76,P<0.001),ADC_(PGSE)、ADC_(17 Hz)、ADC_(33 Hz)值均低于乳腺良性病变(t分别为4.84、4.62、4.01,P均<0.001);其中MTR_(asym)(+3.5 ppm)鉴别诊断的AUC值最大(0.83)、特异度最高(90.38%),ADC_(PGSE)的灵敏度最高(85.86%)。乳腺恶性病变组织学分级Ⅱ级与Ⅲ级的MTR_(asym)(+3.5 ppm)、ADC_(PGSE)、ADC_(17 Hz)和ADC_(33 Hz)值差异均无统计学意义(P均>0.05)。乳腺恶性病变ER阴性的ADC_(PGSE)Objective To compare the efficacy of amide proton transfer-weighted(APTw)imaging with time-dependent diffusion MRI(td-dMRI)in the diagnosis of malignant breast lesions.Methods This study was a cross-sectional study.The clinical,pathological and imaging data of patients with breast lesions admitted to the First Affiliated Hospital of Zhengzhou University from March to August 2023 were prospectively analyzed.All patients firstly underwent T2WI,diffusion-weighted imaging,followed by dynamic contrast-enhanced MRI(DCE-MRI),and finally APTw imaging and td-dMRI were performed for breast lesions using DCE-MRI as reference.Reconstructed images from APTw imaging measured lesions with a frequency shift of 3.5 ppm asymmetric magnetic susceptibility MTR_(asym)(+3.5 ppm).The apparent diffusion coefficient(ADC)values at different oscillating frequency gradients(ADC_(PGSE),ADC_(17 Hz),ADC_(33 Hz)values)were measured using reconstructed td-dMRI images.Independent sample t-test was used to compare APTw imaging,td-dMRI parameter differences between benign and malignant breast tumors,breast malignant tumors with different molecular types[estrogen receptor(ER)negative and positive,progesterone receptor(PR)negative and positive,human epidermal growth factor receptor(HER-2)negative and positive,proliferation index(Ki-67)low and high expression]and different histological grades(gradeⅡandⅢ).Receiver operating characteristic curve and area under the curve(AUC)were used to evaluate the efficacy of APTw imaging and td-dMRI parameters in differentiating benign and malignant breast tumors,molecular classification and histological grading of malignant breast lesions.Results There were 171 lesions in 171 patients,including 103 malignant lesions and 68 benign lesions.Histological grades were gradeⅡin 51 cases and gradeⅢin 38 cases of 89 cases of invasive carcinoma.Totally 98 cases of malignant lesions were included in molecular typing analysis,36 cases were ER negative and 62 cases were ER positive.PR was negative in 51 cases and positiv

关 键 词：乳腺肿瘤 磁共振成像 酰胺质子转移 时间依赖扩散磁共振成像 

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]