扩散峰度成像联合体素内不相干运动成像全域直方图参数预测乳腺浸润性导管癌新辅助化疗的疗效  

Diffusion kurtosis imaging combined with intravoxel incoherent motion imaging global histogram parameters to predict the efficacy of neoadjuvant chemotherapy for breast invasive ductal carcinoma

作　　者：陈祥龙 牟方胜 谢智铭 秦宇 杨红 曾文兵 CHEN Xianglong;MOU Fangsheng;XIE Zhiming;QIN Yu;YANG Hong;ZENG Wenbing(School of Medical Imaging,North Sichuan Medical College,Nanchong,Sichuan Province 637100,China;Department of Radiology,Chongqing University Three Gorges Hospital,Chongqing 404000,China;School of Medicine,Chongqing University,Chongqing 400000,China)

机构地区：[1]川北医学院医学影像学院,四川南充637100 [2]重庆大学附属三峡医院放射科,重庆404000 [3]重庆大学医学院,重庆400000

出　　处：《实用放射学杂志》2024年第10期1630-1635,共6页Journal of Practical Radiology

基　　金：重庆市区域医学重点学科建设项目(zdxk202116)。

摘　　要：目的探讨扩散峰度成像(DKI)及体素内不相干运动(IVIM)成像全域直方图参数对乳腺浸润性导管癌患者新辅助化疗(NAC)疗效的预测。方法回顾性选取69例经穿刺病理证实为乳腺浸润性导管癌的患者,并且所有患者NAC前行MR常规(T_(1)WI、T_(2)WI)、动态对比增强(DCE)、DKI及IVIM序列扫描,手术后依据Miller-Payne(MP)分级方法标准将患者分为NAC疗效显著组(40例)及疗效非显著组(29例)。采用两独立样本t检验或Mann-Whitney U检验比较NAC疗效显著组、疗效非显著组DKI[平均扩散(MD)、平均峰度(MK)]和IVIM[真扩散系数(D值)、灌注分数(f值)、伪扩散系数(D*值)]全域直方图参数的差异;绘制受试者工作特征(ROC)曲线,使用Spearman秩相关分析评价DKI、IVIM全域直方图参数预测NAC疗效的诊断效能及相关性。采用DeLong检验比较各直方图参数曲线下面积(AUC)差异有无统计学意义。结果乳腺浸润性导管癌患者NAC疗效显著组DKI的MD值(第90百分位数、均值、中位数、最大值、范围、均方根),IVIM的D值(均值、范围、均方根、中位数)、D*值(熵、第90百分位数)均高于疗效非显著组,DKI的MK值(均值、中位数)均低于疗效非显著组,差异均有统计学意义(P<0.05)。DKI联合IVIM全域直方图参数的AUC、敏感度及特异度最高,分别为0.816、72.41%、90.00%。MD值、D值和D^(*)值与乳腺浸润性导管癌NAC的疗效显著性呈负相关;MK值与疗效显著性呈正相关。结论DKI联合IVIM全域直方图参数能有效地预测乳腺浸润性导管癌患者NAC的疗效,对临床NAC术前疗效评估提供有效的价值。Objective To investigate the prediction of diffusion kurtosis imaging(DKI)and intravoxel incoherent motion(IVIM)imaging global histogram parameters for the efficacy of neoadjuvant chemotherapy(NAC)in patients diagnosed with breast invasive ductal carcinoma.Methods A total of 69 patients with breast invasive ductal carcinoma confirmed by penetration pathology were retrospectively selected.Prior to undergoing NAC,all patients underwent sequential scans including MR conventional(T_(1)WI,T_(2)WI),dynamic contrast enhancement(DCE),DKI,and IVIM.After surgery,the patients were divided into significant group(40 patients)and non-significant group(29 patients)based on the efficacy of NAC,which was evaluated using the Miller-Payne(MP)grading method criteria.The differences in global histogram parameters of DKI[mean diffusivity(MD),mean kurtosis(MK)]and IVIM(D value,f value,D*value)between the significant group and the non-significant group were compared by the two-independent sample t-test and Mann-Whitney U test.In addition,the receiver operating characteristic(ROC)curve was plotted,and Spearman rank correlation analysis was used to evaluate the diagnostic efficacy and correlation of DKI and IVIM global histogram parameters in predicting NAC efficacy.The DeLong test was used to compare whether there was statistical significance in area under the curve(AUC)differences among histogram parameters.Results The DKI MD value(90th percentile,mean,median,maximum,range,root mean square),IVIM D value(mean,range,root mean square,median)and D*value(entropy,90th percentile)of patients with breast invasive ductal carcinoma in the significant group with efficacy of NAC were higher than those in the non-significant group,while the DKI MK value(mean and median)were lower than those in the non-significant group,and all the differences mentioned above were statistically significant(P<0.05).The AUC,sensitivity and specificity of DKI combined with IVIM global histogram parameters were the highest,which were 0.816,72.41%and 90.00%,respectively.M

关 键 词：乳腺 浸润性导管癌 新辅助化疗 扩散峰度成像 体素内不相干运动 直方图参数 

分 类 号：R737.9[医药卫生—肿瘤] R453[医药卫生—临床医学] R445.2