不同b值的MRI-DWI对乳腺癌术前新辅助化疗效果的评估价值

Evaluation Value of MRI-DWI with Different b Values in Preoperative Neoadjuvant Chemotherapy for Breast Cancer

目的探讨不同扩散敏感系数(b值)的磁共振扩散加权成像(MRI-DWI)对乳腺癌术前新辅助化疗效果的评估价值。方法本研究为一项回顾性研究,采集2020年01月-2023年11月河南中医药大学第三附属医院75例完成4个周期新辅助化疗的乳腺癌患者资料。纳入的患者临床资料保存完整,查阅患者资料,记录研究所需资料数据。所有患者于化疗前完成不同b值(由低到高依次取600、1000、1500 s/mm^(2))的MRI-DWI检查,获取DWI相关参数:图像质量参数[图像信噪比(SNR)、对比信噪比(CNR)]、病变处表观扩散系数(ADC)。依据患者新辅助化疗前后穿刺活检病理Miller-Payne标准,将患者分为化疗敏感组和化疗耐药组。比较不同b值MRI-DWI检查获取的图像质量参数;比较两组不同b值MRI-DWI检查所测的ADC,并绘制受试者工作特征(ROC)曲线,分析不同b值MRI-DWI对乳腺癌患者新辅助化疗效果的预测评估价值。结果新辅助化疗4个周期后检查发现,75例患者化疗敏感53例,占70.67%;化疗耐药22例,占29.33%。b值取600、1000 s/mm^(2)时对应的SNR、CNR均高于b值取1500 s/mm^(2)时对应的SNR、CNR(P<0.05);b值取600、1000 s/mm^(2)时对应的SNR、CNR比较无显著差异(P>0.05)。化疗敏感组化疗前b值取600、1000、1500 s/mm^(2)时所测的ADC值均高于化疗耐药组(P<0.05)。绘制ROC曲线图结果显示,不同b值的MRI-DWI所测的ADC值用于预测评估化疗耐药风险的AUC均≥0.70,具有一定预测价值;其中b值取1000、1500 s/mm^(2)时对应的AUC均高于b值取600 s/mm^(2)时对应的AUC,差异有统计学意义(Z=2.142、2.512,P=0.032、0.012),b值取1000、1500 s/mm^(2)时对应的AUC比较,差异无统计学意义(Z=0.406,P=0.342)。结论使用MRI-DWI检查乳腺癌患者获取的ADC值可用于预测术前新辅助化疗效果,与b值取600、1500 s/mm^(2)比较,b值取1000 s/mm^(2)时,可兼顾DWI图像质量以及预测价值。

Objective To investigate the value of diffusion-weighted magnetic resonance imaging(MRI-DWI)with different diffusion sensitivity coefficients(b values)in evaluating the effect of preoperative neoadjuvant chemotherapy for breast cancer.Methods This study was a retrospective study.The data of 75 breast cancer patients who completed four cycles of neoadjuvant chemotherapy in the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2020 to November 2023 were collected.The clinical data of the included patients was kept intact,patient information was consulted,and the required research data was recorded.All patients completed MRI-DWI examinations with different b-values(600,1000,and 1500 s/mm^(2),in descending order)before chemotherapy,and obtained DWI related parameters:image quality parameters[Image signal-to-noise ratio(SNR),contrastive signal-to-noise ratio(CNR)],and apparent diffusion coefficient(ADC)at the lesion site.According to the Miller Payne criteria for biopsy pathology before and after neoadjuvant chemotherapy,patients were divided into chemotherapy sensitive group and chemotherapy resistant group.The image quality parameters obtained from different b-value MRI-DWI examinations were compared.The ADC measured by MRI-DWI with different b values was compared between the two groups,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive evaluation value of MRI-DWI with different b values for neoadjuvant chemotherapy in breast cancer patients.Results After 4 cycles of neoadjuvant chemotherapy,it was found that 53 out of 75 patients were chemotherapy sensitive,accounting for 70.67%.There were 22 cases of chemotherapy resistance,accounting for 29.33%.The SNR and CNR corresponding to b values of 600 and 1000 s/mm^(2) were higher than those corresponding to b values of 1500 s/mm^(2)(P<0.05).There was no significant difference in SNR and CNR corresponding to b values of 600 and 1000 s/mm^(2)(P>0.05).The ADC values measured at 600,1000,and 1500 s/mm^(2) before chemotherapy in the chemotherapy sensitive group were higher than those in the chemotherapy resistant group(P<0.05).The ROC curve plot showed that the ADC values measured by MRI-DWI with different b-values were used to predict and evaluate the AUC of chemotherapy resistance risk,which was≥0.70 and had certain predictive value.The AUC corresponding to b values of 1000 and 1500 s/mm^(2) were higher than those corresponding to b values of 600 s/mm^(2),with statistical significant differences(Z=2.142,2.512,P=0.032,0.012).However,there was no statistical significant difference(Z=0.406,P=0.342)when comparing the AUC corresponding to b values of 1000 and 1500 s/mm^(2).Conclusions ADC value obtained by MRI-DWI in breast cancer patients can be used to predict the effect of preoperative neoadjuvant chemotherapy.Compared with b value of 600 s/mm^(2) and 1500 s/mm^(2),when b value is 1000 s/mm^(2),DWI image quality and predictive value can be considered.