动态增强磁共振成像参考区域模型结合表观扩散系数直方图对Luminal型乳腺癌的诊断效能

Diagnostic efficiency of Dynamic enhanced magnetic resonance imaging reference region model combined with apparent diffusion coefficient histogram for Luminal breast cancer

目的研究动态增强磁共振成像(DCE-MRI)参考区域模型结合表观扩散系数(ADC)直方图对Luminal型乳腺癌的诊断效能。方法选取我院于2019年1月至2021年12月收治的96例Luminal型乳腺癌患者,均行3.0 T DCE-MRI检测、MR常规扫描以及扩散加权成像(DWI)扫描。利用GEAW 4.6后处理工作站分析b值为200、500、1000 s/mm^(2)时的ADC直方图,记录ADC相关参数(ADCmin、ADCmean、偏度、峰度)、灌注参数[速率常数(Kep)、容量转移常数(Ktrans)]。根据乳腺癌分型分为A型、B型,比较各组间参数差异,采用Pearson分析参数间的相关性,并采用受试者工作特征(ROC)曲线分析灌注参数联合ADC值对Luminal型乳腺癌分型的诊断价值。结果Luminal A型乳腺癌34例,Luminal B型乳腺癌62例。A型患者的Ktrans明显低于B型(P<0.05),而Kep值差异无统计学意义(P>0.05)。b值为200、500、1000 s/mm^(2)时,患者的ADCmean、峰度差异无统计意义(P>0.05),其中b值为1000 s/mm^(2)时,A型患者的ADCmin、偏度均明显高于B型患者(P<0.05)。Pearson相关性分析显示,Ktrans与ADCmin、偏度呈负相关性(b=1000 s/mm^(2)),r分别为-0.545、-0.528,均P<0.05。Ktrans、ADCmin、偏度鉴别Luminal乳腺癌分型的AUC分别为0.799(95%CI:0.706~0.892)、0.832(95%CI:0.753~0.911)、0.721(95%CI:0.614~0.827)。三指标联合诊断的AUC为0.887(95%CI:0.813~0.960),明显高于单独检测(P<0.001)。结论b值为1000 s/mm^(2)时的ADC值(ADCmin、偏度)与DCE-MRI的定量参数(Ktrans)具有负相关性,两者联合检测对Luminal型乳腺癌的分型较高的诊断价值。

Objective To study the diagnostic efficiency of Dynamic enhanced magnetic resonance imaging(DCE-MRI)reference region model combined with apparent diffusion coefficient(ADC)histogram in the diagnosis of Luminal breast cancer.Methods 96 patients with Luminal breast cancer in our hospital from January 2019 to December 2021 were selected.All patients underwent 3.0 T DCE-MRI,conventional MR scan and DWI scan.The ADC histogram with b value of 200,500 and 1000 s/mm^(2)were analyzed by GEAW 4.6 post-processing workstation.ADC related parameters(adcmin,adcmean,skewness,kurtosis)and perfusion parameters(kep,Ktrans)were recorded.According to the classification of breast cancer,they were divided into type A and type B,and the differences of parameters among the groups were compared.The correlation between parameters was analyzed by Pearson,and ROC curve was used to analyze the diagnostic value of perfusion parameters combined with ADC value in the classification of Luminal breast cancer.Results There were 34 cases of Luminal a breast cancer and 62 cases Luminal B breast cancer.Ktrans of type A was significantly lower than that of type B(P<0.05),but there was no significant difference in kep(P>0.05).When the b value were 200,500 and 1000 s/mm^(2),the difference in ADCmean and kurtosis of patients is not statistically significant(P>0.05).When the b value was 1000 s/mm^(2),the ADCmin and skewness of type A patients are significantly higher In type B patients(P<0.05).Pearson correlation analysis showed that Ktrans was negatively correlated with adcmin and skewness(b=1000 s/mm^(2)),r=-0.545,-0.528,P<0.05.The AUC of Ktrans,adcmin and skewness were 0.799(95%CI:0.706-0.892),0.832(95%CI:0.753-0.911),0.721(95%CI:0.614-0.827),respectively.The AUC of combined diagnosis was 0.887(95%CI:0.813-0.960),which was significantly higher than that of single detection(P<0.001).Conclusion The ADC values(ADCmin,skewness)at the b value of 1000 s/mm^(2)were negatively correlated with the quantitative parameters(Ktrans)of DCE-MRI.The combined detection of the two has high diagnostic value for the classification of Luminal breast cancer.