DCE-MRI定量参数联合DWI术前评估乳腺癌前哨淋巴结转移的价值

Value of DCE-MRI quantitative parameters combined with DWI in preoperative evaluation of sentinel lymph node metastasis in patients with breast cancer

目的探讨动态对比增强磁共振成像(DCE-MRI)定量参数联合扩散加权成像(DWI)在乳腺癌术前前哨淋巴结(SLN)转移中的评估价值。方法观察性研究。抽取2021年10月至2022年10月于河南科技大学附属许昌市中心医院拟行手术治疗的乳腺癌患者96例。所有患者均接受乳腺癌改良根治术治疗,术前均行DWI与DCE-MRI检查,术后行病理组织学检查。以手术病理结果为诊断"金标准",比较SLN转移患者与SLN未转移患者的DCE-MRI定量参数[容量转移常数(Ktrans)、血管外细胞外容积分数(Ve)、速率常数(Kep)]与DWI参数[表观扩散系数(ADC)],探究DCE-MRI定量参数、DWI与乳腺癌术前SLN转移的相关性。绘制受试者工作特征曲线,分析DCE-MRI定量参数联合DWI对乳腺癌术前SLN转移的评估价值。结果病理学检查结果显示,96例乳腺癌患者中发生SLN转移43例,占44.79%;SLN未转移53例,占55.21%。SLN转移患者的ADC、Ktrans、Ve值均低于SLN未转移患者,差异有统计学意义(P<0.05);SLN转移患者的Kep与SLN未转移患者比较,差异未见统计学意义(P>0.05)。Pearson相关性分析结果显示,Ktrans、Ve、ADC与乳腺癌患者术前SLN转移均呈负相关(r均<0,P均<0.05)。绘制受试者工作特征曲线结果显示,Ktrans、Ve、ADC单独评估乳腺癌患者术前SLN转移情况均具有一定的价值,但联合评估的价值更高。结论DCE-MRI定量参数联合DWI在乳腺癌患者术前SLN转移情况中具有重要的临床评估价值,能够有效评估SLN转移情况,为临床治疗方案的选择提供依据。

Objective To investigate the value of quantitative parameters of dynamic contrast enhanced-magnetic resonance imaging(DCE-MRI)combined with diffusion-weighted imaging(DWI)in preoperative evaluation of sentinel lymph node(SLN)metastasis in patients with breast cancer.Methods Observational research was adopted in this study.A total of 96 patients with breast cancer who were scheduled to undergo surgery in Xuchang Central Hospital Affiliated to Henan University of Science and Technology from October 2021 to October 2022 were selected.All patients received modified radical mastectomy for breast cancer.DWI and DCE-MRI were performed on both groups before surgery,and histopathology examination was performed after surgery.Based on the surgical and pathological results as the gold standard for diagnosis,the quantitative parameters of DCE-MRI,including volume transfer constant(Ktrans),extravascular extracellular volume fraction(Ve)and rate constant(Kep),and DWI parameter apparent diffusion coefficient(ADC),were compared between patients with SLN metastasis and patients without SLN metastasis.The correlations of quantitative parameters of DCE-MRI and DWI with preoperative SLN metastasis from breast cancer were investigated.The receiver operating characteristic curve was drawn to analyze the value of DCE-MRI quantitative parameters combined with DWI in the evaluation of SLN metastasis before breast cancer surgery.Results Pathological examination revealed that 43(44.79%)of 96 breast cancer patients had SLN metastasis;53 cases did not have SLN metastasis,accounting for 55.21%.The ADC,Ktrans and Ve values of patients with SLN metastasis were lower than those of patients without SLN metastasis(P<0.05).There was no statistical significant difference in Kep between patients with SLN metastasis and patients without SLN metastasis(P>0.05).Pearson correlation analysis revealed that the Ktrans,Ve and ADC were negatively correlated with preoperative SLN metastasis in breast cancer(all r<0,P<0.05).The receiver operating characteristic curve showed that the three single parameters,including Ktrans,Ve and ADC,had certain value in evaluation of preoperative SLN metastasis in breast cancer,however,the combination of them had higher evaluative value.Conclusions In clinical,DCE-MRI quantitative parameters combined with DWI have great significance in evaluation of preoperative SLN metastasis in breast cancer,which can effectively evaluate SLN metastasis and provide basis for formulation of treatment protocol.