酰胺质子转移加权成像联合人表皮生长因子受体2状态预测乳腺癌新辅助化疗后病理完全缓解的价值  

The value of amide proton transfer weighted imaging combined with human epidermal growth factor receptor 2 status in predicting pathological complete response after neoadjuvant chemotherapy in breast cancer

作　　者：徐明哲 单东秋 曲金荣 许春苗 张仁知 吴越 李靖 沈智威 陈学军 Xu Mingzhe;Shan Dongqiu;Qu Jinrong;Xu Chunmiao;Zhang Renzhi;Wu Yue;Li Jing;Shen Zhiwei;Chen Xuejun(Department of Radiology,the Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital,Zhengzhou 450003,China;Department of Radiology,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Clinical&Technical Solutions,Philips(China)Investment Co.LTD,Beijing 100600,China)

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院医学影像科,郑州450003 [2]中国医学科学院北京协和医学院肿瘤医院放射科,北京100021 [3]飞利浦(中国)投资有限公司临床和技术解决方案团队,北京100600

出　　处：《中华放射学杂志》2025年第3期313-320,共8页Chinese Journal of Radiology

摘　　要：目的探讨酰胺质子转移加权成像(APTWI)联合人表皮生长因子受体2状态预测乳腺癌新辅助化疗(NAC)后病理完全缓解(pCR)的价值。方法该研究为横断面研究。回顾性分析2023年5月至2024年5月在河南省肿瘤医院经术前穿刺病理证实为乳腺浸润性导管癌的100例女性患者的临床病理[雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)、Ki-67状态及分子分型等]和影像资料。所有患者均在接受NAC前行乳腺MRI,包括增强MRI、APTWI和扩散加权成像(DWI)等。参照增强MRI图像采用阈值提取法进行病灶分割,由软件自动勾画肿瘤内三维感兴趣区,并复制于APTWI产生的酰胺质子转移图及DWI产生的表观扩散系数(ADC)图中,分别测量非对称磁化转移率(MTRasym)值和ADC值。根据Miller-Payne分级系统评估NAC后的反应,Miller-Payne 5级为病理完全缓解(pCR),Miller-Payne 1~4级定义为非pCR。使用独立样本t检验、χ^(2)检验比较pCR与非pCR患者各临床病理及影像学指标的差异,对差异有统计学意义的指标纳入多因素logistic回归分析,筛选影响NAC后pCR的独立预测因子。使用受试者操作特征曲线及曲线下面积(AUC)评价各指标单独及联合诊断NAC后pCR的效能。AUC的比较采用DeLong检验。结果pCR患者39例、非pCR患者61例。pCR与非pCR患者分子分型、ER状态、PR状态、HER2状态、Ki-67状态差异均有统计学意义(P<0.05)。pCR患者治疗前MTRasym值明显高于非pCR患者(P=0.005),但两者的ADC值差异无统计学意义(P=0.372)。多因素logistic回归分析显示HER2阳性(OR=5.87,95%CI 1.99~17.30,P=0.001)、MTRasym值>2.61%(OR=4.39,95%CI 1.37~14.08,P=0.013)是预测乳腺癌NAC后pCR的独立预测因子。HER2阳性联合MTRasym值>2.61%预测乳腺癌NAC后pCR的AUC为0.819,优于HER2阳性、MTRasym值单独预测效能(Z=3.91,P<0.001;Z=2.63,P=0.009)。结论治疗前APTWI的MTRasym值对预测乳腺癌NAC后pCR具有重要价值,APTWI联合HEObjectiveTo explore the value of amide proton transfer weighted imaging(APTWI)combined with human epidermal growth factor receptor 2(HER2)expression in predicting pathological complete response(pCR)after neoadjuvant chemotherapy(NAC)in breast cancer.MethodsThe study was a cross-sectional study.Clinicopathological[estrogen receptor(ER),progesterone receptor(PR),HER2,Ki-67 status,and molecular subtypes]and imaging data were retrospectively analyzed in 100 female patients who had invasive ductal carcinoma of the breast confirmed pathologically by preoperative puncture in the Henan Cancer Hospital from May 2023 to May 2024.All patients underwent MRI,including enhanced MRI,APTWI,and diffusion-weighted imaging(DWI)before NAC.The reference enhanced MRI images were segmented into lesions using the threshold extraction method,and the three-dimensional region of interest within the tumor was automatically outlined by the software and replicated in the amide proton transfer map generated by APTWI and the apparent diffuse coefficient(ADC)map generated by DWI.The magnetization transfer ratio asymmetry(MTRasym)value and the ADC value were measured,respectively.Tumor response to NAC was assessed using the Miller-Payne grading system,where Grade 5 indicated pCR and Grades 1-4 were classified as non-pCR.Independent sample t-tests andχ^(2)tests were used to compare clinical pathological and imaging parameters between pCR and non-pCR patients.Statistically significant variables were included in multivariate logistic regression to identify independent predictors of pCR.The diagnostic performance of individual and combined indicators for pCR was evaluated using receiver operating characteristic curves and the area under the curve(AUC).DeLong′s test was used to compare AUCs.ResultsThere were 39 pCR and 61 non-pCR patients.Significant differences were observed between the pCR and non-pCR patients in molecular subtypes,ER,PR,HER2,and Ki-67 statuses(P<0.05).Pre-treatment MTRasym values were significantly higher in the pCR patients com

关 键 词：乳腺肿瘤 磁共振成像 酰胺质子转移 新辅助化疗 

分 类 号：R73[医药卫生—肿瘤]