扩散峰度联合动态增强磁共振成像对三阴性乳腺癌的诊断价值  

The values of diffusion kurtosis imaging and dynamic contrast enhancement imaging in the diagnosis of triple negative breast cancer

作　　者：尹思远 高缇 刘慧君[1] 胡喜斌[1] 王唯伟 YIN Siyuan;GAO Ti;LIU Huijun;HU Xibin;WANG Weiwei(Imaging department,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12期83-87,共5页Journal of Medical Imaging

基　　金：山东省中医药科技项目(编号:Q-2022132);济医附院医学英才培养计划项目(编号:2022-yxyc-010)。

摘　　要：目的探讨扩散峰度成像(DKI)联合动态增强磁共振成像(DCE-MRI)对三阴性及非三阴性乳腺癌的鉴别诊断价值。方法选取本院经病理证实的乳腺癌患者164例,其中三阴性组46例,非三阴性组118例,所有患者均行DKI及DCE-MRI检查。分析两组间的临床病例资料、常规MRI征象和平均扩散峰度值(MK)、平均扩散率(MD)及容量转移常数(K^(trans)),血管外细胞外间隙容积比(Ve)和速率常数(Kep),并运用受试者工作特征曲线(ROC)分析诸定量参数的诊断效能。结果三阴性组的病灶不规则形较非三阴性组少见,强化多不均匀,环形强化占比较大,两组间差异有统计学意义(P=0.022,P=0.043);三阴性组的MK、Ve值小于非三阴性组(P<0.05),呈低度负相关(r=-0.212,P=0.006;r=-0.480,P<0.001);而三阴性组的MD、K^(trans)、Kep值大于非三阴性组(P<0.05),呈低度正相关(r=0.209~0.294,P<0.05)。其中Ve值的曲线下面积(AUC)为0.808,大于其他定量参数(Z=2.192~2.895,P=0.028~0.038)。DCE-MRI模型的AUC为0.851,大于DKI模型(AUC=0.684)和常规MRI模型(AUC=0.645),差异具有统计学意义(Z=3.068;P=0.022;Z=3.546,P<0.001)。DKI联合DCE-MRI模型的AUC为0.885,诊断效能高于单一模型(Z=1.890~4.888,P<0.05)。结论DKI和DCE-MRI模型可用于三阴性乳腺癌的诊断,其中DCE-MRI模型的Ve值诊断效能最高,DKI联合DCEMRI模型对鉴别三阴性及非三阴性乳腺癌的诊断效能优于单一模型。Objective To explore the value of diffusion kurtosis imaging(DKI)combined with dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the differential diagnosis of triple negative and non-triple negative breast cancer.Methods A total of 164 breast cancer patients confirmed by pathology were collected,including 46 cases in the triple negative group and 118 cases in the non-triple negative group.DKI and DCE-MRI were performed in all patients.The clinicopathological characteristics and conventional MRI features and mean diffusion rate(MD),mean kurtosis value(MK),volume transfer constant(K^(trans)),extravascular extracellular space distribute volume per unit tissue volume(Ve)and rate constant(Kep)were analyzed.And the ROC was plotted to compare the diagnostic efficiency.Results Irregular lesions in the triple negative group were less common than those in the non-triple negative group.The triple negative group had higher proportion of patients with heterogeneous enhancement and rim enhancement(P=0.043).The MK and Ve values of the triple negative group were lower than those of the non-triple negative group(P<0.05),showing a low degree of negative correlation(r=-0.212,P=0.006;r=-0.480,P<0.001).The MD,K^(trans)and Kep values of the triple negative group were higher than those of the non-triple negative group(P<0.05),showing a low degree of positive correlation(r=0.209~0.294,P<0.05).The AUC of Ve value was 0.808,which was higher than the other quantitative parameters(Z=2.192~2.895,P=0.028~0.038).The AUC of the DCE-MRI model was 0.851,which was higher than that of the DKI model(AUC=0.684)and conventional MRI model(AUC=0.645),and the difference was statistically significant(Z=3.068,P=0.022;Z=3.546,P<0.001).The AUC of the combining DKI and DCE-MRI models was 0.885,the diagnostic performance was higher than the single model(Z=1.890~4.888,P<0.05).Conclusions DKI and DCE-MRI models can be used to diagnose the triple negative breast cancer.Among these,the Ve value of DCE-MRI model has the highest diagnostic efficiency.T

关 键 词：乳腺癌 三阴性 磁共振成像 扩散峰度成像 动态增强磁共振成像 

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