乳腺MRI检查DWI、DCE-MRI定量参数与乳腺癌分子亚型及Ki-67表达的关系

Relationship between DWI,DCE-MRI quantitative parameters of breast MRI and molecular subtypes and Ki-67 expression in breast cancer

目的 探讨乳腺核磁共振成像(magnetic resonance imaging, MRI)检查扩散加权成像(diffusion-weighted imaging, DWI)、动态增强磁共振(dynamic contrast enhanced magnetic resonance imaging, DCE-MRI)定量参数与乳腺癌分子亚型及雌激素受体(estrogen receptor, ER)、孕激素受体(progesterone receptor, PR)、人类表皮生长因子(human epidermal-growth-factor receptor 2,HER-2)、Ki-67表达的关系。方法 选取乳腺癌患者116例,所有患者给予DWI、DCE-MRI检查,分析不同乳腺癌分子亚型、以及ER、PR、HER-2、Ki-67表达组织表观扩散系数(apparent diffusion coefficient, ADC)值、容积转移常数(volumetric transfer constants, K^(trans))、反向速率常数(reverse rate constants, Kep)等差异。结果 临床分期Ⅲ-Ⅳ期患者ADC值为(0.92±0.23)×10^(-3) mm^(2)/s,明显低于Ⅰ-Ⅱ期患者(P<0.05),而K^(trans)为(1.47±0.22)min^(-1),明显高于Ⅰ-Ⅱ期患者(P<0.05)。三阴型患者ADC值为(0.87±0.19)×10^(-3) mm^(2)/s,明显低于Luminal A型、Luminal B型和Her-2型(P<0.05);三阴型K^(trans)为(1.94±0.28)min^(-1),明显高于Luminal A型、Luminal B型和Her-2型(P<0.05);三阴型Kep为(1.76±0.21)min^(-1),明显高于Luminal A型和Luminal B型(P<0.05);ER阴性表达组织ADC值为(0.96±0.21)×10^(-3) mm^(2)/s,明显低于ER阳性表达组织(P<0.05);Ki-67高表达组织ADC值为(0.99±0.19)×10^(-3) mm^(2)/s,明显低于Ki-67低表达组织(P<0.05);ER阴性表达组织K^(trans)和Kep分别为(1.41±0.26)min^(-1)和(1.63±0.26)min^(-1),明显高于ER阳性表达组织(P<0.05);PR阴性表达组织K^(trans)和Kep分别为(1.53±0.27)min^(-1)和(1.68±0.25)min^(-1),明显高于PR阳性表达组织(P<0.05);Ki-67高表达组织K^(trans)为(1.30±0.22)min^(-1),明显高于Ki-67低表达组织(P<0.05);不同HER-2表达组织ADC值及DEC-MRI定量参数比较差异无统计学意义(P>0.05)。结论 DWI及DCE-MRI定量参数与乳腺癌分子亚型、ER、PR及Ki-67表达存在相关性,而与Her-2表达无明显相关性,值得进一步研究。

Objective To explore the relationship of diffusion weighted imaging(DWI)and dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)quantitative parameters with molecular subtypes of breast cancer,estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER-2),and Ki-67 expression.Methods In total,116 patients with breast cancer were selected,and all patients received DWI DCE-MRI examination.Different molecular subtypes of breast cancer were analyzed,and differences in ER,PR,HER-2,Ki-67 expression tissue apparent diffusion coefficient(ADC)values,volumetric transfer constants(K^(trans)),and reverse rate constants(Kep)were analyzed.Results The ADC value of patients with clinical stageⅢ-Ⅳwas(0.92±0.23)×10^(-3) mm^(2)/s,which was significantly lower than that of patients with stageⅠ-Ⅱbreast cancer(P<0.05),while K^(trans) was(1.47±0.22)min^(-1),which was significantly higher than that of patients with stageⅠ-Ⅱbreast cancer(P<0.05).The ADC value of patients with triple negative type was(0.87±0.19)×10^(-3) mm^(2)/s,which was significantly lower than that of Luminal A type,Luminal B type and Her-2 type(P<0.05).The K^(trans) of the triple negative type was(1.94±0.28)min^(-1),which was significantly higher than that of the Luminal A type,Luminal B type and Her-2 type(P<0.05).The Kep of triple negative type was(1.76±0.21)min^(-1),which was significantly higher than Luminal A type and Luminal B type(P<0.05).The ADC value of ER negative expression tissue was(0.96±0.21)×10^(-3) mm^(2)/s,which was significantly lower than that of ER positive expression tissue(P<0.05).The ADC value of Ki-67 high expression tissue was(0.99±0.19)×10^(-3) mm^(2)/s,which was significantly lower than that of Ki-67 low expression tissue(P<0.05).The K^(trans) and Kep values of ER negative expression tissues were(1.41±0.26)min^(-1) and(1.63±0.26)min^(-1),respectively,which were significantly higher than those of ER positive expression tissues(P<0.05).The K^(trans) and Kep values of PR negative expression tissues were(1.53±0.27)min^(-1) and(1.68±0.25)min^(-1),respectively,which were significantly higher than those of PR positive expression tissues(P<0.05).The K^(trans) of Ki-67 high expression tissue was(1.30±0.22)min^(-1),which was significantly higher than that of Ki-67 low expression tissue(P<0.05).There was no significant difference in ADC values and DEC-MRI quantitative parameters among different HER-2 expression tissues(P>0.05).Conclusion DWI and DCE-MRI quantitative parameters are correlated with molecular subtypes,ER,PR and Ki-67 expression of breast cancer,but are not significantly correlated with Her-2 expression,which is worthy of further study.