IVIM-DWI参数在乳腺癌诊断中的应用及其与免疫组织化学指标表达的关系

Application of IVIM-DWI parameters in the diagnosis of breast cancer and its relationship with the expression of immunohistochemical indexes

目的:研究体素内不相干运动扩散加权成像(intravoxel incoherent motion diffusion-weighted imaging,IVIM-DWI)参数在乳腺癌诊断中的应用及其与免疫组织化学指标表达的关系。方法:回顾性分析2019年12月至2020年12月徐州医科大学附属连云港医院收治的70例疑似乳腺癌患者,采用Philips Ingenia 3.0 T超导型磁共振扫描仪和乳腺专用相控线圈进行检测,通过影像学序列设定,分别测定表观扩散系数(apparent diffusion coefficient,ADC)值、慢扩散系数(slow diffusion coefficient,D)值、快扩散系数(fast diffusion coefficient,D^(*))值、灌注分数(perfusion fraction,f)值,同时进行免疫生化指标雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)及细胞增殖抗原标志物Ki-67的测定。结果:病理检查诊断良性肿瘤2 2例,恶性肿瘤4 8例;E R阳性5 4例,阴性1 6例;P R阳性5 0例,阴性2 0例;K i-6 7高表达5 5例,低表达1 5例;H E R-2阳性2 7例,阴性4 3例。恶性肿瘤患者ADC值、D值、D^(*)值低于良性肿瘤患者,f值高于恶性肿瘤患者,差异有统计学意义(P<0.0 5)。E R阴性与阳性患者、P R阴性与阳性患者、H E R-2阴性与阳性患者的A D C值、D值、D^(*)值、f值差异均无统计学意义(P>0.05),Ki-67高表达与低表达患者的D^(*)值、f值差异无统计学意义(P>0.05)。Ki-67高表达患者的ADC值与D值均低于低表达者,差异有统计学意义(P<0.05)。ER、PR、H ER-2分别与A D C值、D值、D^(*)值、f值无相关性(P>0.05),Ki-67与D^(*)值、f值无相关性(P>0.05),与ADC值和D值呈正相关性(P<0.05)。结论:IVIM-DWI定量参数ADC值、D值、D^(*)值、f值可以为乳腺癌定性诊断提供有价值的依据,其中参数ADC值与D值在乳腺癌Ki-67高表达与低表达患者中存在统计学差异,可以为预测Ki-67表达提供参考。

Objective:To study the application of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)parameters in the diagnosis of breast cancer and its relationship with the expression of immunohistochemical indicators.Methods:A retrospective analysis of 70 cases of suspected breast cancer admitted in our hospital from December 2019 to December 2020 was conducted.The Philips Ingenia 3 T superconducting MRI scanner and the mammary phased coils were used to detect the apparent diffusion coefficient(ADC) value,slow diffusion coefficient value(D value),fast diffusion coefficient value(D^(*)value) and perfusion fraction value(f value) by imaging sequence setting.Meanwhile,the indexes of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER-2),and Ki-67 were detected.Results:Pathological examinations diagnosed 22 cases of benign tumors and 48 cases of malignant tumors;54 cases were ER positive and 16 cases were negative;50 cases were PR positive and 20 cases were negative;55 cases had high expression of Ki-67 and 15 cases had low expression;27 cases were positive for HER-2,43 cases were negative.The ADC value,D value and D^(*)value of malignant tumor patients were lower than those of benign tumor patients,and the f value was higher than that of malignant tumor patients,and the difference was statistically significant(P<0.05).There was no significant difference in ADC value, D value, D;value and fvalue between ER-negative and positive patients,PR-negative and positive patients,and HER-2-negative and positive patients(P>0.05).There was no significant difference in the D^(*)value and f value of the expressing patients(P>0.05).The ADC and D values of patients with high Ki-67 expression were lower than those with low expression,and the difference was statistically significant(P<0.05).ER,PR,HER-2 had no correlation with AD C,D,D^(*),f values respectively(P>0.05),and Ki-67 had no correlation with D;,f values(P>0.05),but was positively correlated with ADC and D values(P<0.05).Conclusion:IVIM-DWI quantitative parameters ADC, D,D;and F values can provide a valuable basis for the qualitative diagnosis of breast cancer.There are statistical differences between the parameters ADC and D in the patients with high and low expression of Ki-67 in breast cancer,which can provide a reference for predicting the expression of Ki-67.