数字乳腺断层合成摄影和对比增强乳腺 X 线摄影检查对乳腺 BI-RADS 4类病变的诊断价值  

Predictive value of intravoxel incoherent motion combined with diffusion kurtosis imaging for breast cancer axillary lymph node metastasis

作　　者：周哲 寻静[1] 于昊 孙占国[1] 陈月芹[1] 朱来敏[1] 王唯伟 ZHOU Zhe;XUN Jing;YU Hao;SUN Zhanguo;CHEN Yueqin;ZHU Laimin;WANG Weiwei(Department of Radiology,Affiliated Hospital of Jining Medical University,Jining 272029,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10期57-61,共5页Journal of Medical Imaging

基　　金：山东省济宁市重点研发计划项目(编号:2022YXNS076);济宁医学院附属医院“苗圃”科研计划项目(编号:MP-MS-2021-008)。

摘　　要：目的探讨评估体素内不相干运动(intravoxel incoherent motion,IVIM)联合扩散峰度成像(diffusional kurtosis imaging,DKI)预测乳腺癌腋窝淋巴结(ALN)转移的价值。方法选取经病理证实的157例乳腺癌患者,于术前行IVIM、DKI检查。对比两组间IVIM及DKI定量参数的差异性。将157例患者分为ALN转移组71例和无转移组86例,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)评估的诊断效能,曲线下面积(area under curve,AUC)的差异性分析采用Delong检验。结果乳腺癌ALN转移组与无转移组间患者年龄、病灶大小、病灶边缘、真性扩散系数(D)值、灌注相关扩散系数(D*)值、灌注分数(f)值、扩散峰度(MK)值、平均扩散率(MD)值比较差异有统计学意义(P<0.05)。Logistic回归分析表明,D值(OR=0.001,P<0.001)、D*值(OR=1.108,P=0.001)、f值(OR=1.326,P<0.001)、MD值(OR=0.001,P<0.001)及MK值(OR=588.98,P<0.001)是预测LAN转移的独立影响因素,其中D值的诊断效能最大,当D≤0.74×10^(-3)mm^(2)/s时AUC为0.886。IVIM联合DKI对预测乳腺癌ALN转移的效能最大,AUC为0.982,准确度、敏感度及特异度分别为90.14%、87.32%、84.51%。结论IVIM和DKI定量参数可用于预测乳腺癌ALN转移,其中D值诊断效能最高。IVIM联合DKI在乳腺癌ALN性质的鉴别能力优于单独应用IVIM或DKI。Objective To assess the value of intravoxel incoherent motion(IVIM)and diffusion kurtosis imaging(DKI)for predicting the risk of axillary lymph node(ALN)metastasis in patients with breast cancer.Methods A total of 157 patients with breast cancer confirmed by pathology were collected.All patients underwent IVIMand DKI examination.Quantitative param-eters of IVIM and DKI were compared between the two groups.The diagnostic performance of models was evaluated by Receiver Operating Characteristic Curve(ROC).The difference of area under the ROC curve(AUC)was analyzed by Delong test.Re⁃sults Age of patients,size and margin of the tumors and the D,D*,f,MK,MD were significantly associated with ALN metas-tasis(P<0.05).Logistic regression analysis showed that D(OR=0.001,P<0.001),D*(OR=1.108,P=0.001),f(OR=1.326,P<0.001),MD(OR=0.001,P<0.001)and MK(OR=588.98,P<0.001)were independent factors in predicting ALN metastasis.Dvalue had the greatest diagnostic performance.When D≤0.74×10^(-3)mm^(2)/s,the AUC was 0.886.IVIM combined with DKI showed the greatest efficacy in predicting ALN metastasis,with AUCof 0.982,accuracy of 90.14%,sensitivity of 87.32%,and specific-ity of 84.51%,respectively.Conclusion Quantitative parameters of IVIM and DKI can be used to predict the ALN metastasis in patients with breast cancer.The D value has the highest diagnostic efficiency.IVIM combined with DKI shows the highest diag-nostic efficiency for predicting ALN metastasis in breast cancer than IVIM or DKI alone.

关 键 词：乳腺癌 腋窝淋巴结 磁共振成像 体素内不相干运动 

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