动态增强磁共振成像在乳腺癌诊断及疗效监测中的应用进展(英文)

Analysis of DCE-MRI for diagnosis and neoadjuvant chemotherapy monitoring of breast cancer

经过20余年的相关研究,MRI现已成为临床公认的用于检出和诊断乳腺疾病的影像检查手段之一。笔者简要阐述了乳腺动态增强(DCE)磁共振成像技术及其临床应用。详细介绍了动态增强中有关药代动力学的测量方法、各种相关参数的定性分析、以及Ktrans和kep等反应药代动力学特征参数的定量分析。笔者不但就当前"是否有必要对每位患者进行动脉输入函数进行测量"等有争议的话题进行了讨论,还在对当前广泛应用的各种动态增强MRI后处理软件进行了较详尽的描述之后,进一步对动态增强MRI在乳腺癌的诊断及疗效监测等方面的临床应用情况进行了详尽的回顾。作者认为:总体来讲,对于乳腺癌的诊断,关键在于关注病灶中最具侵袭性部分的MRI特征。而对于乳腺癌疗效的监测,则应该对整个病灶进行分析。最后,笔者就乳腺MRI对乳腺癌高危人群的筛查以及风险的处理等问题进行了讨论。笔者预测乳腺MRI在女性乳腺疾病尤其是乳腺癌的筛查、诊断、治疗及疗效监测等一系列问题上将继续发挥不可替代的重要作用。

With research being conducted over 2 decades, breast MRI has become an established clinical imaging modality for management of breast diseases. This review paper summarizes the analysis of breast MRI acquired using the dynamic-contrast enhanced （DCE） imaging protocol as well as its clinical applications. The measurement of DCE kinetics, the qualitative analysis to measure heuristic parameters, and the quantitative analysis to obtain pharmacokinetic parameters such as Ktrans and kep are described. The current debate about whether it is necessary to measure the arterial input function from each individual patient is discussed. The DCE-MRI analysis tools offered in several widely used commercial software are described. Then the clinical application of DCE-MRI for diagnosis and therapy monitoring of breast cancer are described. In general, for diagnosis of breast cancer, the hot spot approach to characterize tissues with the most aggressive pathology should be taken; but for therapy response monitoring, the whole tumor should be analyzed. Lastly, the application of breast MRI in high-risk screening and vey recently, risk management, is discussed. It is highly anticipated that breast MRI will continue to play a very important role in management and care of breast diseases for women in the entire clinical spectrum from risk management, screening, diagnosis, therapy, and surveillance