多模态磁共振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 multi-modal magnetic resonance imaging

作　　者：党燕 韦艳艳 朱来敏[1] 邵凯 胡喜斌[1] 王唯伟 DANG Yan;WEI Yanyan;ZHU Laimin;SHAO Kai;HU Xibin;WANG Weiwei(Imaging department,Affiliated Hospital of Jining Medical Collage,Jining 270029,China)

机构地区：[1]济宁医学院附属医院影像科,山东济宁272029

出　　处：《医学影像学杂志》2024年第9期49-54,共6页Journal of Medical Imaging

基　　金：山东省中医药科技项目(编号:Q-2022132);山东省医药卫生科技发展计划项目(编号:202109010447);济宁医学院附属医院医学英才培养计划项目(编号:2022-yxyc-010)。

摘　　要：目的探讨动态增强MRI(DCE-MRI)联合体素内不相干运动(IVIM)及扩散峰度成像(DKI)技术预测乳腺癌腋窝淋巴结转移的价值。方法选取本院经病理证实的165例乳腺癌患者,77例有腋窝淋巴结转移(axillary lymph node,ALN),88例无腋窝淋巴结转移,术前乳腺病灶均行DCE-MRI及IVIM、DKI检查。分析临床资料、常规MRI征象和两组间的容量转移常数(K^(trans)),血管外细胞外间隙容积比(Ve),速率常数(Kep)及真实扩散系数(D),灌注相关扩散系数(D*),灌注分数(f)和平均扩散峰度值(MK)、平均扩散率(MD)。采用两独立样本t检验及Mann-Whitney U检验比较DCE-MRI和IVIM、DKI诸参数的差异,绘制ROC比较其诊断效能。结果ALN转移组边缘多较无转移组模糊(P=0.032);ALN转移组瘤内强化多不均匀,环形强化占比较大(P=0.012)。ALN转移组患者D、MD值低于无ALN转移组(P<0.01),且呈低度负相关(r=-0.441,r=-0.259);ALN转移组K^(trans)、Kep、D*及MK值高于无ALN转移组(P<0.01),其中K^(trans)值与ALN转移呈中度正相关(r=0.621),Kep、D*及MK值与ALN转移呈低度正相关(r=0.337;r=0.255,r=0.398)。DCE-MRI模型的K^(trans)值的诊断效能最高,ROC曲线下面积(AUC)为0.859,诊断效能高于其他定量参数(Z=2.275~4.028,P<0.05)。DCE-MRI模型为K^(trans)+Kep,AUC为0.868;IVIM模型为D+D*,AUC为0.781;DKI模型为MD+MK,AUC为0.730,其中DCE-MRI模型(AUC=0.868)的诊断效能高于IVIM(AUC=0.781)及DKI(AUC=0.730)模型,AUC差异有统计学意义(Z=2.001,P=0.046;Z=3.156,P=0.002)。而将DCE-MRI、IVIM、DKI模型联合,AUC为0.913,诊断效能均高于单一模型(Z=2.483~4.838,P<0.05),敏感度为90.9%,特异度为81.8%,准确率86.1%,亦高于单一模型。结论DCE-MRI和IVIM、DKI模型可用于预测乳腺癌腋窝淋巴结转移,其中DCE-MRI模型及其K^(trans)值诊断效能较高,且将DCE-MRI联合IVIM、DKI模型在乳腺癌腋窝淋巴结性质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),diffusion kurtosis imaging(DKI)for predicting the risk of axillary lymph node(ALN)metastasis in patients with breast cancer.Methods A total of 165 cases of breast cancer confirmed by pathology were collected.Seventy-seven patients had an axillary lymph node metastasis(axillary lymph node,ALN),and 88 patients had no axillary lymph node metastasis.DCE-MRI,IVIM and DKI scanning were performed in all patients.The clinicopathological characteristics and conventional MRI features and volume transfer constant(K^(trans)),extravascular extracellular space distribute volume per unit tissue volume(Ve)and rate constant(Kep)and true diffusion coefficient(D),perfusion-related diffusion coefficient(D*),perfusion fraction(f)and mean diffusion rate(MD),mean kurtosis value(MK)were analyzed.The diagnostic performance of these models was evaluated by Receiver Operating Characteristic Curve(ROC)analysis.Results The edge of the ALN metastasis group was more blurry than that of the non-ALN metastasis group(P=0.032).The ALN metastasis group had higher proportion of patients with heterogeneous enhancement and rim enhancement(P=0.012).The D and MD values of the ALN metastasis group were lower than those of the non-ALN metastasis group(P<0.01),showing a low degree of negative correlation(r=-0.441,-0.259).The D*,K^(trans),Kep and MK values of the ALN metastasis group were higher than those of the non-ALN metastasis group(P<0.01).The K^(trans) value was moderately positively correlated with ALN metastasis(r=0.621),and the Kep,D*and MK values were low-degree positively correlated with ALN metastasis(r=0.337;r=0.255,r=0.398).The K^(trans) value of the DCE-MRI model had the highest diagnostic efficacy,with the area under the ROC curve(AUC)of 0.859.The DCE-MRI model was K^(trans)+Kep,with an AUC of 0.868.The IVIM model was D+D*,with an AUC of 0.781.The DKI model was MD+MK,with an AUC of 0.730.The diagnostic efficie

关 键 词：乳腺癌 腋窝淋巴结 动态增强磁共振成像 体素内不相干运动 扩散峰度成像 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]