磁共振扩散加权成像早期预测乳腺癌新辅助化疗疗效价值研究

The Inchoate Predictive Value of Diffusion Weighted MR Imaging in Neoadjuvant Chemotherapy Effect of Breast Cancer

目的评价磁共振扩散加权成像(DWI)对乳腺癌新辅助化疗(NAC)疗效的早期预测价值。方法对35例病理证实的乳腺癌,在化疗前、化疗2个疗程、化疗后术前进行MRI检查,做扩散加权成像(DWI)和动态增强,按手术病理分为组织学显著反应组(MHR组)和非组织学显著反应组(N-MHR组),比较两组表观扩散系数(ADC)、肿瘤最大径及体积变化率的差异,分析ADC变化率的受试者工作特性曲线(ROC),预测获得MHR的ADC变化率临界值(cut-off value)。结果在化疗2个疗程后,两组ADC值,有显著性差异,P值=0.009;肿瘤最大径、肿瘤体积变化率,两组无显著性差异,P值分别为0.244和0.313。以ADC值升高12.5%为ADC值变化率诊断分界点,预测获得MHR的敏感性和特异性分别为73.7%和81.2%。结论化疗中监测ADC值变化,有可能是早期预测NAC是否能获得MHR的指标。

Objective To evaluate the inchoate predictive value of diffusion-weighted MR imaging（DWI） in neoadjuvant chemotherapy effect of breast cancer.Methods DWI and dynamic contrast enhanced magnetic resonance imaging（DCE MRI） were carried out in 35 patients with pathologically confirmed breast cancer at three time points;before NAC,after two cycles of NAC and after NAC.The patients were divided into achieved major histological response（MHR） group and non MHR group based on postoperative pathological diagnosis.ADC value,the change of tumor size and volume between the two groups were compared.The cut off values of ADC for MHR prediction were evaluated by drawing the ROC curve of the change rate of ADC.Results After two cycles of NAC,ADC was significant different in the MHR and non MHR groups（P=0.009）.The change rate of tumor size and tumor volume between the two groups had no difference（P=0.244 and P=0.313）.Using 12.5% of ACD ascending as the cut off value,prediction of MHR with sensitivity and specificity was 73.7% and 81.2%,respectively.Conclusion Monitoring the change rate of ADC early after NAC may probably be the index of predicting whether MHR is achieved or not.