能谱CT与MRI预测浸润性乳腺癌病理T分期的对比研究  

Preoperative Prediction of T Staging of Invasive Breast Cancer:A Comparison of Dual-Layer Spectral CT and Breast MRI

作　　者：李浦祯 周羽 周欣怡 王良 王欢 周玉容 周舟 徐丽莹[1] LI Puzhen;ZHOU Yu;ZHOU Xinyi(Department of Radiology,Zhongnan Hospital of Wuhan University,Wuhan,Hubei Province 430071,P.R.China)

机构地区：[1]武汉大学中南医院放射科,430071

出　　处：《临床放射学杂志》2025年第4期623-627,共5页Journal of Clinical Radiology

基　　金：国家自然基金项目(编号:82172055);武汉大学中南医院转化医学及交叉学科研究联合基金项目(编号:ZNJC202327)。

摘　　要：目的评估能谱CT与乳腺MRI术前预测浸润性乳腺癌病理T分期的价值。方法纳入2020年1月至2024年11月接受能谱CT和乳腺MRI检查的62例浸润性乳腺癌患者,所有患者均表现为肿块型强化,且临床病理资料完整。由两名高年资放射科医师采用双盲法分析40 keV单能级能谱CT和MRI图像,多平面观察病灶大小、范围等特征,记录肿瘤最大径。以术后病理结果作为参考标准,比较两种成像方式在肿瘤大小测量和术前病理T分期预测中的一致性。结果能谱CT与乳腺MRI的Bland-Altman一致性为0.16 mm,95%一致性界限为-4.20~4.53 mm。能谱CT测得的肿瘤大小为20.00 mm(16.00~25.00 mm),乳腺MRI测得的肿瘤大小为21.00 mm(15.75~24.25 mm),两者之间无显著统计学差异(P=0.445)。受试者工作特征(ROC)曲线显示,能谱CT在浸润性乳腺癌病理T分期的术前预测中表现良好[曲线下面积(AUC)=0.875],且与MRI的预测效能相比无显著差异(P=0.212)。结论能谱CT可用于术前预测浸润性乳腺癌患者的病理T分期,其在肿瘤大小测量和分期预测方面与MRI具有良好的一致性,表明能谱CT可作为MRI禁忌症患者的替代成像方式。Objective To compare the value of dual-layer spectral CT and breast MRI in preoperative prediction of the pathological T staging of invasive breast cancer.Methods A retrospective analysis was conducted on 62 patients with pathologically confirmed invasive breast cancer from January 2020 to November 2024.All patients underwent dual-layer spectral CT and breast MRIand presented with mass-like enhancement.Complete clinical and pathological data were available.Two senior radiologists analyzed the 40 keV virtual monoenergetic images and MRI images in a double-blind manner,assessed tumor size and location in multiple planes,and recorded the maximum diameter of the tumor.Furthermore,the postoperative pathological results were used as the reference standard to compare the consistency of the two imaging modalities in tumor size measurement and preoperative prediction of T staging.Results The Bland-Altman agreement between spectral CT and breast MRI was 0.16 mm,and the 95%agreement limit was-4.20-4.53 mm.There was no significant difference(P=0.445)between the tumor sizes measured by spectral CT(20.00 mm,range:16.00-25.00 mm)and breast MRI(21.00 mm,range:15.75-24.25 mm).The ROC curve analysis showed that spectral CT performed well in the preoperative prediction of the pathological T stage of invasive breast cancer(AUC=0.875),and there was no significant difference in predictive performance when compared with MRI(P=0.212).Conclusion Spectral CT can be used for the preoperative prediction of pathological T stage in breast cancer.It shows great consistency in tumor size measurement and staging prediction compared to breast MRI,indicating that spectral CT may serve as a potential alternative imaging modality for patients with contraindications to breast MRI.

关 键 词：能谱CT 磁共振成像 浸润性乳腺癌 术前T分期 

分 类 号：R73[医药卫生—肿瘤]