乳腺癌新辅助化疗前后DCE-MRI血流动力学与病理学对照

Study of hemokinetics of breast cancer before and after neoadjuvant chemotherapy with dynamic contrast enhanced MRI correlated with pathology

目的:探讨乳腺癌新辅助化疗前后动态增强MRI血流动力学变化特点,对新辅助化疗的疗效和预后的评价提供更多依据。方法:新辅助化疗的乳腺癌患者26例,新辅助化疗前后进行乳腺动态增强MRI检查。比较时间-信号强度曲线(TIC)及血流半定量参数在化疗前后变化;化疗后残留病灶的TIC类型与病理学评级进行对照研究。结果:新辅助化疗患者化疗前早期强化参数Efirst、Vfirst、Ee、Ve等的均值大于化疗后的残留病灶的早期强化参数(P<0.05);化疗前峰值强化参数Emax、Vmax、Slopemax等参数的均值大于化疗后残留病灶的均值,化疗前Tmax的均值小于化疗后的均值(P<0.05);新辅助化疗前流出参数Ewash、Vwash的值高于化疗后的残留病灶的流出参数(P<0.05)。新辅助化疗后22例患者TIC从Ⅲ/Ⅱ型转变为Ⅱ/Ⅰ型,3例保持不变,1例从Ⅱ型转变为Ⅲ型。新辅助化疗前后的TIC类型具有明显的差异(P=0.00<0.05)。不同病理反应类型与TIC类型之间具有统计学意义(P=0.04<0.05)。结论:乳腺癌新辅助化疗前后病灶的半定量增强参数显著降低,TIC类型具有由流出型向流入型转变的趋势。残留病灶TIC类型与病理学反应之间具有相关性,可能和患者预后之间具有相关性。

Objective： To study the changes of hemokinetic characteristics with dynamic contrast enhanced MRI （DCE-MRI） prior to and after neoadjuvant chemotherapy （NAC） of breast carcinoma,in order to provide more evidence in the evaluation of the therapeutic response and prognosis. Methods： In 26 patients with breast carcinoma receiving NAC, breast DCE-MRI were performed before and after NAC. The changes of time-signal intensity curve （TIC） and semi-quanti- tative parameters of DCE-MRI were compared before and after NAC. Patterns of TIC before and after NAC were correlated with pathology. Results~ All of the mean values of early enhanced parameters including Efirst, Vfirst, Ee, Ve, before NAC were higher than that of the residual tumor after NAC （P〈0.05）,The mean peak enhanced parameters including Emax, Vmax,Slopemax before NAC were higher than that of the residual tumor after NAC, the mean value of Tmax before NAC was lower than that after NAC （P〈0.05） . The washout parameters including Ewash, Vwash before NAC were higher than that of the residual tumor after NAC （P〈0.05）. The patterns of TIC in residual tumor after NAC changed from type Ill/II to typeII/ I in 22 of 26 cases,not changed in 3 cases and changed from typelI to type III in 1 case. Significant differ- ences before and after NAC were existed in patterns of TIC （P = 0.00 d0.05）. There were significant differences in the patterns of TIC and different types of pathology response （P= 0. 04〈0. 05）. Conclusion：The mean value of semi-quantita- tive parameters in residual breast tumor showed significant decrease after NAC. The pattern of TIC had a tendency to change from wash-out to wash in. There were significant correlation between the patterns of TIC and the pathology re- sponse within residual tumor,and that might provide a hint for the prognosis of the patient with breast carcinoma.