IVIM在乳腺癌新辅助化疗后早期反应评估的应用价值

The application value of IVIM in the assessment of early reaction after neoadjuvant chemotherapy for breast cancer

目的:本研究拟探讨基于体素内不相干扩散运动(IVIM)成像对乳腺癌新辅助化疗后早期反应的监测能力。方法:回顾性分析经过乳腺癌新辅助化疗女性患者30例,患者行多b值双指数信号衰减模型的IVIM检查,采用15个b值,分别为0、25、50、75、100、150、200、500、700、800、900、950、1 000、1 200、1 400 s/mm^2。首先将病例分为化疗前组和化疗后组,又以病理诊断为金标准,将化疗后组分为有效组和无效组。结果:新辅助化疗前组与化疗后组比较,化疗后组ADC_(slow)值明显增高,f值减小,两组具有统计学差异(P=0.001;P=0.021),经2周期化疗后有效组与无效组相比,有效组ADCslow高于无效组,f值低于无效组,具有统计学差异(P=0.000;P=0.000),ADC_(fast)不具有统计学意义(P=0.408),ADC_(slow)预测性能高于f值,曲线下面积AUC 88.9%,f的AUC为74.3%,ADC_(fast)的AUC为64.9%。通过比较化疗前后两组差值,ΔADC_(slow)与Δf有统计学意义(P<0.05),曲线下面积分别为92.4%、88.9%,ΔADC_(fast)无统计学意义(P=0.211),AUC为70.8%。结论:IVIM在乳腺癌化疗疗效的评估中有价值,其中ADC_(slow)和f值具有潜在对化疗早期反应的评估价值,而ΔADC_(slow)对化疗反应的评估价值最大。

Objective: To investigate the monitoring ability of early response to neoadjuvant chemotherapy in breast cancer based on intravoxel incoherent motion(IVIM). Methods: A retrospective analysis was performed on 30 cases of female patients with breast cancer neoadjuvant chemotherapy, who underwent IVIM examination of multiple b-value dual exponential signal attenuation model. Fifteen b-values were used, including 0, 25, 50, 75, 100, 150, 200, 500, 700, 800, 900, 950, 1 000, 1 200,1 400 s/mm2 respectively. We divided all cases into pre-chemotherapy group and post-chemotherapy group. And pathologic diagnosis as golden standard, divided post-chemotherapy group into valid group and invalid group. Results: Compared with prechemotherapy, ADCslow value increased and f value decreased significantly in post-chemotherapy group(P=0.001;P=0.021). After two cycles of chemotherapy ADCslow was higher in the valid group and f value was lower in the invalid group(P=0.000;P=0.000). ADCfast showed no statistical significance(P=0.408). The prediction performance of ADCslow was higher than f value with AUC of 88.9%. The AUC of f value and ADCfast were 74.3% and 64.9% respectively. After comparing the difference before and after chemotherapy, ΔADCslow and Δf value were statistically significant(P<0.05) with AUC of 92.4% and 88.9% respectively.ΔADCfast showed no statistical significance(P=0.211) and the AUC is 70.8%. Conclusion: IVIM has value in evaluating the efficacy of breast cancer chemotherapy. ADCslow and f value have such potential ability while ΔADCslow value most.