动态对比增强MRI和扩散加权成像预测肿块型浸润性乳腺癌Ki-67表达状态  

Exploration of Dynamic Contrast-Enhanced MRI and Diffusion Weighted Imaging in Predicting the Expression of Ki-67 State Value

作　　者：刘福军[1] 张书海 高照 李晓舒[1] 汪洁[1] 钱银锋[1] LIU Fujun;ZHANG Shuhai;GAO Zhao(Department of Radiology,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui Province 230022,P.R.China)

机构地区：[1]安徽医科大学第一附属医院放射科,合肥230022

出　　处：《临床放射学杂志》2025年第2期248-252,共5页Journal of Clinical Radiology

摘　　要：目的探讨动态对比增强磁共振成像(DCE-MRI)和扩散加权成像(DWI)预测乳腺癌患者治疗前Ki-67表达状态的可行性。方法搜集肿块型浸润性乳腺癌患者99例,分为Ki-67低表达组(41例)和Ki-67高表达组(58例)。采用独立样本t检验、χ^(2)检验或Mann-Whitney U检验对患者年龄、治疗前DCE-MRI特征、半定量参数和DWI表观扩散系数(ADC)进行两组间比较。基于组间差异有统计学意义的指标,应用多因素Logistics回归分析建立模型,并通过受试者工作特征曲线(ROC)分析各单一指标和联合模型的预测效能,采用Delong检验比较各单一指标和联合模型曲线下面积(AUC)之间的差异。结果患者年龄、DCE-MRI的病灶最大径、最大强化强度(ME)、相对强化强度(RE)、流出速率(WOR)的组间差异无统计学意义(P>0.05)。Ki-67低表达组和高表达组的最大相对强化强度(MRE)(t=2.169,P=0.033)、达峰时间(TTP)(Z=3.026,P=0.002)、ADC异质性(Z=-2.021,P=0.043)和“毛刺征”(χ^(2)=6.123,P=0.013)的组间差异具有统计学意义。多因素Logistics回归分析表明TTP(OR=0.994,P=0.046)、ADC值异质性(OR=106.184,P=0.041)和“毛刺征”(OR=2.768,P=0.039)是Ki-67表达状态的独立预测因素,其AUC值分别为0.679、0.620、0.616,三者联合AUC值为0.753,Delong检验显示TTP、ADC值异质性和“毛刺征”三者联合的AUC大于任一单独指标模型AUC(P<0.05)。结论DCE-MRI的乳腺肿块“毛刺征”、TTP值和DWI的ADC值异质性能有效预测肿块型浸润性乳腺癌治疗前Ki-67表达状态,三者联合预测效能更高。Objective To investigate the feasibility of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and diffusion weighted imaging(DWI)in prediction of Ki-67 expression in breast cancer patients before treatment.Methods Ninety-nine patients with invasive breast cancer like mass were divided into Ki-67 low expression group(41 cases)and Ki-67 high expression group(58 cases).Independent sample t test,Chi-square test or the Mann-Whitney U testwere used to obtain group differences in patients'age,characteristics of DCE-MRI and measurements between DCE-MRI and DWI.The model derived from multiplefactors regression analysiswas finally acquired based on indicatorswith statistically significant inter-groupdifferences.The receiver-operating characteristic curve(ROC)analysis was applied to explorethe predictive performance of each individualindicator and combined model,and DeLong’s test was used to compare the differences in AUC between each individual indicator and the combined model.Results There was no significant difference in age,maximum diameter,maximum enhancement intensity,relative enhancement intensity and outflow rate of lesions on DCE-MRI between the two groups(P>0.05).The differences about relative strengthening of maximum intensity(MRE)(t=2.169,P=0.033),time to peak(TTP)(Z=3.026,P=0.002)and the heterogeneity of ADC values(Z=-2.021,P=0.043)and burr sign(χ^(2)=6.123,P=0.013)were statistically significant(P<0.05)in group comparisons.Multivariate Logistic regression analysis showed that TTP(OR=0.994,P=0.046),heterogeneity of ADC value(OR=106.184,P=0.041)and spiculation(OR=2.768,P=0.039)were independent predictors of Ki-67 expression status,and the AUC values were 0.679,0.620 and 0.616,respectively.The AUC value of the combination of the three indicators was 0.753,which demonstrated better predictive performance than that of each individual indicator by DeLong’s test(P<0.05).Conclusion TTP,heterogeneity of ADC value and spiculation of masses could predict the expression state of Ki-67 in invasive breast can

关 键 词：乳腺癌 磁共振成像 KI-67 

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