动态增强磁共振联合体素内不相干运动成像对三阴性乳腺癌的诊断价值

The Values of Dynamic Contrast Enhancement Magnetic Resonance Imaging and Intravoxel Incoherent Motion to the Diagnosis of Triple Negative Breast Cancer

目的 探讨动态增强磁共振成像(DCE-MRI)联合体素内不相干运动(IVIM)对三阴性(TNBC)及非三阴性乳腺癌的鉴别诊断价值。方法 回顾性分析本院经病理证实的乳腺癌患者180例,TNBC组49例,非TNBC组131例,所有患者均行DCE-MRI及IVIM及检查。分析两组间的临床病理资料、常规MRI征象和IVIM、 DCE-MRI模型诸定量参数。结果 TNBC组的病灶不规则形较非TNBC组少见,强化多不均匀,环形强化占比较大,两组间差异有统计学意义(P=0.001,P=0.007)。TNBC组的Ve值小于非TNBC组(P<0.001),呈低度负相关(r=-0.439,P<0.001);TNBC组的D、f、K_(ep)值高于非TNBC组(P=0.002~0.016),呈低度正相关(r=0.186~0.257,P<0.05)。D^(*)、K^(trans)值在两组间差异不具有统计学差异(P>0.05)。D≥0.86×10^(-3)mm^(2)/s、f≥38.1%、K_(ep)≥0.359/min、V_(e)≤0.589为鉴别TNBC和非TNBC的独立影响因素,其中Ve值的AUC为0.784,大于其他定量参数(Z=2.201~2.752,P=0.006~0.028)。DC E-MRI模型AUC为0.817,大于IVIM模型(AUC=0.657)和常规MRI模型(AUC=0.689),差异具有统计学意义(Z=2.657;P=0.008;Z=2.516,P=0.012)。联合DCE-MRI、IVIM模型,AUC为0.862,诊断效能均高于单一模型(Z=2.194~4.649,P<0.05),敏感度为83.7%,特异度为74.8%,准确度为80.0%。结论 DCE-MRI、IVIM模型可用于TNBC的诊断,其中DCE-MRI模型的Ve值诊断效能最高,IVIM联合DC E-M RI模型对鉴别TN BC及非TN BC的诊断效能优于单一模型。

Objective To investigate predictive value of dynamic contrast-enhanced magnetic resonance imaging(DCEMRI)and intravoxel incoherent motion(IVIM)for the diagnosis of triple negative breast cancer.Methods A total of 180 cases of breast cancer patients confirmed by pathology were collected,including 49 cases in the triple negative(TNBC) group and 131 cases in the non-TNBC group.DCE-MRI and IVIM scanning were performed in all patients.The clinicopathological characteristics and conventional MRI features and the quantitative parameters of IVIM and DCE-MRI models were analyzed.Results The Ve value of the TNBC group was lower than that of the non-TNBC group(P<0.001),showing a low degree of negative correlation(r=-0.439,P<0.001).The D,f,and Kep values of the TNBC group were higher than those of the non-t NBC group(P=0.002~0.016),showing a low degree of positive correlation(r=0.186~0.257,P<0.05).There was no statistical difference in D* and Ktrans values between the two groups(P>0.05).D≥0.86×10^(-3)mm^(2)/s,f≥38.1%,Kep≥0.359/min,Ve≤0.589 are independent influencing factors for the identification of TNBC and non-TNBC.The AUC of Ve value was 0.784,which was higher than other quantitative factors(Z=2.201~2.752,P=0.006~0.028).The AUC of the DCE-MRI model was 0.817,which was greater than that of the IVIM model(AUC=0.657) and conventional MRI model(AUC=0.689),the difference was statistically significant(Z=2.657,P=0.008;Z=2.516,P=0.012).The AUC of the combining IVIM and DCE-MRI models was 0.862,the diagnostic performance was higher than the single model(Z=2.194~4.649,P<0.05),the sensitivity was 83.7%,the specificity was 74.8%,and the accuracy was 80.0%.Conclusion DCE-MRI and IVIM models can be used for the diagnosis of TNBC.Among them,the Ve value of DCE-MRI model has the highest diagnostic efficiency.The diagnostic efficiency of DCE-MRI combined with IVIM model to differentiate tNBC and non-tNBC is better than that of a single model.