乳腺动态增强MRI参数与肿瘤血管的相关性及其鉴别诊断价值

Correlation between angiogenesis and multi-parameters of dynamic contrast enhancement MRI for assessments of benign and malignant breast lesions

目的探讨乳腺动态增强(DCE)MRI的各项参数:时间-信号强度曲线(TIC)、早期增强率(EER)、最大线性斜率(slope)、最大强化率(SImax)、达峰时间(Tpeak)、MIP图血管计数(NTV)与微血管密度(MVD)、血管内皮生长因子(VEGF)之间的相关性及其对乳腺良、恶性病变的鉴别价值。方法对52例确定一周内手术治疗的乳腺疾病患者行术前DCE-MRI扫描,记录上述参数。对切除病变行常规病理和免疫组化检查,观察边缘MVD(mMVD)、中心MVD(cMVD)和VEGF的表达。将DCE-MRI各项参数与免疫组化结果进行相关性分析。结果乳腺病变的mMVD、VEGF表达与TIC类型、Tpeak、及NTV有相关性;其中TIC类型与mMVD关系最为密切,Tpeak与VEGF之间的关系最密切;cMVD与各参数间无明显线性关系。52例患者中乳腺癌22例,良性病变30例。恶性病变的TIC呈Ⅲ或Ⅱ型,EER、NTV和MVD、VEGF的表达明显高于良性病变,而Tpeak及SImax显著低于良性病变(P<0.005)。Slope在良、恶性病变中无显著性差异。结论乳腺DCE-MRI多项参数中,TIC类型、NTV、Tpeak与MVD和VEGF有相关性,反映了良、恶性病变的血管生长差异,具有很大的鉴别诊断价值。

Objective： To explore the correlation between microvessel density （MVD）, vascular endothelial growth factor （VEGF） and multi-parameters of dynamic contrast- enhanced （DCE） MRI, and the parameters＇ value for assessments of benign/malignant breast lesions. The multi-parameters includes： the type of time-signal intensity curve （TIC）, early-phase enhancement rate （EER）, maximum linear slope rate （Slope）, maximum enhancement rate （SImax）, peak time （Tpeak）, the number of tumor vessels on maximum intensity projection map （NTV）. Materials and Methods： Fifty-two patients with breast lesions received preoperative DCE-MRI scans. All DCE parameters were recorded for correlation analysis. All patients were operated within I week after DCE-MRI. Histopathological and immunohistochemical exams were performed on the excisions to determine malignancy and the expression of marginal MVD, central MVD and VEGF. Correlations between DCE-MRI parameters and MVD, VEGF were analyzed. Results： The marginal MVD and VEGF demonstrated linear correlation with TI, Tpeak and NTV. Strongest correlation was found between TIC and marginal MVD, as well as between Tpeak and VEGF. Central MVD has no significant correlation with all DCE parameters. Among the 52 patients, there were 22 malignant and 30 benign lesions. In comparison with benign lesions, the malignant lesions showed a washout TIC type Ⅲ, higher EER, more NTV, and high expression of MVD and VEGF, but lower SImax and Tpeak （P〈0.005）. Slope has no significant difference between malignant and benign groups. Conclusion： Among the DCE-MRI parameters, TIC, Tpeak, and NTV demonstrated correlation with MVD and VEGF, those parameters may reflecting the different angiogenesis between malignant and benign breast lesions, and therefore are most meaningful for the diagnosis of breast lesions.