多模态磁共振成像在Luminal型与非Luminal型乳腺癌鉴别诊断中的价值

Value of multiparametric MRI in the differential diagnosis of Luminal and non-Luminal breast cancer

目的:探讨多模态磁共振成像在Luminal型与非Luminal型乳腺癌鉴别诊断中的应用价值。方法:回顾性分析经病理证实为浸润性乳腺癌患者109例,其中Luminal型62例,非Luminal型47例。所有患者行乳腺DCE-MRI、DKI及IVIM扫描,采用独立样本t检验、Wilcoxon符号秩检验及卡方检验比较Luminal型与非Luminal型患者磁共振参数容量转移常数(K_(trans))、速率常数(K_(ep))、血管外细胞间隙容积比(V_(e))、标准ADC(ADC_(standard))、单纯扩散系数(ADC_(slow))、灌注相关扩散系数(ADC_(fast))、灌注分数(f)、扩散峰度值(MK)及平均扩散率(MD)及预后因素间的差异,采用Logistic回归分析筛选鉴别诊断的独立因素,绘制受试者工作特征曲线评估模型的诊断效能,定量参数与预后因素的相关性分析采用Spearman和Pearson分析方法评价。结果:Luminal组与非Luminal组的K_(trans)、K_(ep)、ADC_(slow)、ADC_(fast)及MD、MK值有统计学差异(P=0.001~0.04)。DCE-MRI模型中的K_(trans)、K_(ep)值,IVIM模型中的ADC_(slow)、ADC_(fast)及DKI模型中的MK值为鉴别Luminal与非Luminal型的独立影响因素。DCE-MRI的准确度为76.1%,IVIM的准确度为64.2%,DKI的准确度为60.6%,DCE-MRI+IVIM+DKI模型诊断效能高于单一模型(Z=3.174~4.122,P=0.001~0.015),AUC为0.876,准确度为78.0%。ADC_(slow)、ADC_(standard)及MK与病理分级呈负相关;K_(ep)与Nottingham指数呈正相关,ADC_(slow)、ADC_(standard)及MK与Nottingham指数呈负相关。结论:DCE-MRI、IVIM和DKI可用于Luminal与非Luminal型乳腺癌的鉴别诊断以及预后评估,三者联合的鉴别诊断能力优于单一模型。

Objective:To investigate the value of multiparametric magnetic resonance imaging(DCE-MRI+DKI+IVIM)in the differential diagnosis of Luminal type and non-Luminal type breast cancer.Methods:A total of 109 cases of breast cancer patients confirmed by pathology were collected,including 62 cases of Luminal type and 47 cases of non-Luminal type.IVIM,DKI and DCE-MRI were performed in all patients.The independent sample t test,Wilcoxon signed rank test and Chi-square test were used to compare K^(trans),K_(ep),V_(e),ADC_(standard),ADC_(fast),f and MD,MK between Luminal and non-Luminal type.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficiency.The correlation between quantitative parameters and prognostic factors was evaluated by Spearman and Pearson analysis.Results:The values of K^(trans),K_(ep),ADC_(slow),ADC_(fast),MD and MK were significantly different between the Luminal and the non-Luminal group(P=0.001~0.04).K^(trans)and K_(ep)values in the DCE-MRI model,ADC_(slow)and ADC_(fast)values in the IVIM model and MK values in the DKI model were independent influencing factors for the differentiation of Luminal and non-Luminal types.The accuracy of DCE-MRI,IVIM and DKI was 76.1%,64.2%and 60.6%respectively.The diagnostic efficiency of DCE-MRI+IVIM+DKI model was higher than that of the single model(Z=3.174~4.122,P=0.001~0.015).The AUC was 0.876 and the accuracy was 78.0%.ADC_(slow),ADC_(standard)and MK were negatively correlated with pathological grade.K_(ep)was positively correlated with Nottingham index,while ADC_(slow),AD-Cstandardand MK were negatively correlated with Nottingham index.Conclusion:DCE-MRI,IVIM and DKI can be used for the differential diagnosis and prognosis assessment of Luminal and non-Luminal breast cancer.The differential diagnostic ability of the combined use of DCE-MRI,IVIM and DKI model is better than that of the single model.