磁共振DCE-TIC联合DWI-ADC在乳腺癌新辅助化疗后病理反应性评估中的作用

The Role of Magnetic Resonance DCE-TIC Combined with DWI-ADC in the Evaluation of Pathological Reactivity after Neoadjuvant Chemotherapy in Breast Cancer

目的探讨磁共振动态增强成像中时间-信号强度曲线(DCE-TIC)联合弥散加权成像表观扩散系数(DWI-ADC)在乳腺癌新辅助化疗后病理反应性评估中的作用。方法筛选女性乳腺癌患者147例,根据新辅助化疗(NAC)后是否发生显著病理反应性将患者分为病理组织学显著反应(MHR)组(n=51)和非显著反应(NMHR)(n=96)。比较2组TIC曲线类型和ADC值,并通过多因素Logistic回归模型分析NAC后发生MHR的影响因素,用受试者工作特征曲线(ROC)及曲线下面积(AUC)分析时间-信号强度曲线(TIC)曲线与ADC对乳腺癌NAC后发生MHR的评估效能。结果NAC后,MHR组TIC曲线类型降低的患者占比及△ADC%值均大于NMHR组(P<0.05)。MHR组ER阴性、PR阴性及分子亚型三阴型的患者占比大于NMHR组,分子亚型LuminalB型占比则小于NMHR组(P<0.05)。多因素Logistic回归分析模型结果显示,ER与PR阴性、三阴型分子亚型、TIC类型降低和高△ADC%是NAC后发生MHR的影响因素(P<0.05)。ROC曲线显示,TIC类型降低、△ADC%及二者联合诊断NAC后发生M H R的AUC分别为0.735、0.885、0.951,联合诊断效能高于单一指标(P<0.05)。结论TIC类型降低及高△ADC%是乳腺癌NAC后发生MHR的影响因素,并且二者均对NAC后发生MHR有一定的评估效能,二者联合效能更高。

Objective To investigate the role of time-signal intensity curve(DCE-TIC)combined with diffusionweighted imaging apparent diffusion coefficient(DWI-ADC)in evaluating pathological reactivity of breast cancer after neoadjuvant chemotherapy in dynamic enhanced magnetic resonance imaging.Methods 147 female breast cancer patients treated in our hospital were selected as the study objects.Patients were divided into histopathologically significant response(MHR)group(n=51)and nonsignificant response(NMHR)group(n=96)according to whether there was significant pathological response after neoadjuvant chemotherapy(NAC).TIC curve types and ADC values of the two groups were compared,and the influencing factors of MHR after NAC were analyzed by multivariate Logistic regression model.The effectiveness of time-signal strength curve(TIC)curve and ADC in evaluating MHR after NAC was analyzed by receiver operating characteristic curve(ROC)and area under curve(AUC).Results After NAC,the proportion of patients with decreased TIC curve type and△ADC%value in MHR group were higher than those in NMHR group(P<0.05).The proportion of ER negative,PR negative and molecular subtype triple negative patients in MHR group was higher than that in NMHR group,while the proportion of molecular subtype LuminalB was lower than that in NMHR group(P<0.05).Multivariate Logistic regression analysis model showed that negative ER and PR,triplenegative molecular subtype,decreased TIC type and high△ADC%were the influencing factors for MHR after NAC(P<0.05).ROC curve showed that the AUC of TIC type reduction,△ADC%and the AUC of MHR after the combined diagnosis of NAC were 0.735,0.885 and 0.951,respectively,and the combined diagnosis efficiency was higher than that of single index(P<0.05).Conclusion Decreased TIC type reductionand high△ADC%are the influencing factors for the occurrence of MHR after NAC in breast cancer,and both of them have certain efficacy in evaluating the occurrence of MHR after NAC,and the combined efficacy is higher.