Dual-input two-compartment pharmacokinetic model of dynamic contrast-enhanced magnetic resonance imaging in hepatocellular carcinoma

AIM: To investigate the feasibility of a dual-input two-compartment tracer kinetic model for evaluating tumorous microvascular properties in advanced hepatocellular carcinoma(HCC). METHODS: From January 2014 to April 2015, we prospectively measured and analyzed pharmacokinetic parameters [transfer constant(K_(trans)), plasma flow(F_p), permeability surface area product(PS), efflux rate constant(k_(ep)), extravascular extracellular space volume ratio(V_e), blood plasma volume ratio(V_p), and hepatic perfusion index(HPI)] using dual-input two-compartment tracer kinetic models [a dual-input extended Tofts model and a dual-input 2-compartment exchange model(2CXM)] in 28 consecutive HCC patients. A well-known consensus that HCC is a hypervascular tumor supplied by the hepatic artery and the portal vein was used as a reference standard. A paired Student's t-test and a nonparametric paired Wilcoxon rank sum test were used to compare the equivalent pharmacokinetic parameters derived from the two models, and Pearson correlation analysis was also applied to observe the correlations among all equivalent parameters. The tumor size and pharmacokinetic parameters were tested by Pearson correlation analysis, while correlations among stage, tumor size and all pharmacokinetic parameters were assessed by Spearman correlation analysis. RESULTS: The F_p value was greater than the PS value(F_P = 1.07 m L/m L per minute, PS = 0.19 m L/m L per minute) in the dual-input 2CXM; HPI was 0.66 and 0.63 in the dual-input extended Tofts model and the dualinput 2CXM, respectively. There were no significant differences in the K_(ep), V_p, or HPI between the dual-input extended Tofts model and the dual-input 2CXM(P = 0.524, 0.569, and 0.622, respectively). All equivalent pharmacokinetic parameters, except for V_e, were correlated in the two dual-input two-compartment pharmacokinetic models; both Fp and PS in the dualinput 2CXM were correlated with K_(trans) derived from the dual-input extended Tofts model(P = 0.002, r = 0.566; P = 0.002, r = 0.570); K_(ep), V_p, and HPI between the two kinetic models were positively correlated(P = 0.001, r = 0.594; P = 0.0001, r = 0.686; P = 0.04, r = 0.391, respectively). In the dual input extended Tofts model, V_e was significantly less than that in the dual input 2CXM(P = 0.004), and no significant correlation was seen between the two tracer kinetic models(P = 0.156, r = 0.276). Neither tumor size nor tumor stage was significantly correlated with any of the pharmacokinetic parameters obtained from the two models(P > 0.05).CONCLUSION: A dual-input two-compartment pharmacokinetic model(a dual-input extended Tofts model and a dual-input 2CXM) can be used in assessing the microvascular physiopathological properties before the treatment of advanced HCC. The dual-input extended Tofts model may be more stable in measuring the V_e; however, the dual-input 2CXM may be more detailed and accurate in measuring microvascular permeability.

Discrimination of Metastatic from Non-metastatic Mesorectal Lymph Nodes in Rectal Cancer Using Quantitative Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Preoperative detection of lymph nodes（LNs） metastasis is always highly challenging for radiologists nowadays. The utility of quantitative dynamic contrast-enhanced magnetic resonance imaging（QDCE-MRI） in identifying LNs metastasis is not well understood. In the present study, 59 patients with histologically proven rectal carcinoma underwent preoperative QDCE-MRI. The short axis diameter ratio, long axis diameter ratio, short-to-long axis diameter ratio and QDEC-MRI parameters（Ktrans, Kep, fPV and Ve） values were compared between the non-metastatic（n=44） and metastatic（n=35） LNs groups based on pathological examination. Compared with the non-metastatic group, the metastatic group exhibited significantly higher short axis diameter（7.558±0.668 mm vs. 5.427±0.285 mm）, Ktrans（0.483±0.198 min-1 vs. 0.218±0.116 min^-1） and Ve（0.399±0.118 vs. 0.203±0.096） values（all P〈0.05）. The short-to-long axis diameter ratio, long axis diameter ratio, Kep and fPV values did not show significant differences between the two groups. In conclusion, our results showed that for LNs larger than 5 mm in rectal cancer, there are distinctive differences in the Ktrans and Ve values between the metastatic and non-metastatic LNs, suggesting that QDCE-MRI may be potentially helpful in identifying LNs status.

Texture analysis on parametric maps derived from dynamic contrast-enhanced magnetic resonance imaging in head and neck cancer

AIM: To investigate the merits of texture analysis on parametric maps derived from pharmacokinetic modeling with dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) as imaging biomarkers for the prediction of treatment response in patients with head and neck squamous cell carcinoma(HNSCC). METHODS: In this retrospective study,19 HNSCC patients underwent pre- and intra-treatment DCEMRI scans at a 1.5T MRI scanner. All patients had chemo-radiation treatment. Pharmacokinetic modeling was performed on the acquired DCE-MRI images,generating maps of volume transfer rate(Ktrans) and volume fraction of the extravascular extracellular space(ve). Image texture analysis was then employed on maps of Ktrans and ve,generating two texture measures: Energy(E) and homogeneity.RESULTS: No significant changes were found for the mean and standard deviation for Ktrans and ve between pre- and intra-treatment(P > 0.09). Texture analysis revealed that the imaging biomarker E of ve was significantly higher in intra-treatment scans,relative to pretreatment scans(P < 0.04). CONCLUSION: Chemo-radiation treatment in HNSCC significantly reduces the heterogeneity of tumors.

Dynamic contrast-enhanced magnetic resonance imaging of prostate cancer: A review of current methods and applications

In many areas of oncology, dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) has proven to be a clinically useful, non-invasive functional imaging technique to quantify tumor vasculature and tumor perfusion characteristics. Tumor angiogenesis is an essential process for tumor growth, proliferation, and metastasis. Malignant lesions demonstrate rapid extravasation of contrast from the intravascular space to the capillary bed due to leaky capillaries associated with tumor neovascularity. DCE-MRI has the potential to provide information regarding blood flow, areas of hypoperfusion, and variations in endothelial permeability and microvessel density to aid treatment selection, enable frequent monitoring during treatment and assess response to targeted therapy following treatment. This review will discuss the current status of DCE-MRI in cancer imaging, with a focus on its use in imaging prostate malignancies as well as weaknesses that limit its widespread clinical use. The latest techniques for quantification of DCE-MRI parameters will be reviewed and compared.

Prediction of radiosensitivity in primary central nervous system germ cell tumors using dynamic contrast-enhanced magnetic resonance imaging

Objective： To evaluate the feasibility of dynamic contrast-enhanced magnetic resonance imaging（DCEMRI） for predicting tumor response to radiotherapy in patients with suspected primary central nervous system（CNS） germ cell tumors（GCTs）.Methods： DCE-MRI parameters of 35 patients with suspected primary CNS GCTs were obtained prior to diagnostic radiation, using the Tofts and Kermode model. Radiosensitivity was determined in tumors diagnosed 2 weeks after radiation by observing changes in tumor size and markers as a response to MRI. Taking radiosensitivity as the gold standard, the cut-off value of DCE-MRI parameters was measured by receiver operating characteristic（ROC） curve. Diagnostic accuracy of DCE-MRI parameters for predicting radiosensitivity was evaluated by ROC curve.Results： A significant elevation in transfer constant（K^trans） and extravascular extracellular space（Ve）（P=0.000）, as well as a significant reduction in rate constant（Kep）（P=0.000） was observed in tumors. K^trans, relative K^trans, and relative Kep of the responsive group were significantly higher than non-responsive groups. No significant difference was found in Kep, Ve, and relative Ve between the two groups. Relative K^trans showed the best diagnostic value in predicting radiosensitivity with a sensitivity of 100%, specificity of 91.7%, positive predictive value（PPV） of 95.8%, and negative predictive value（NPV） of 100%.Conclusions： Relative K^trans appeared promising in predicting tumor response to radiation therapy（RT）. It is implied that DCE-MRI pre-treatment is a requisite step in diagnostic procedures and a novel and reliable approach to guide clinical choice of RT.

Evaluation of tumor response to antiangiogenic therapy in patients with recurrent gliomas using contrast-enhanced perfusion-weighted magnetic resonance imaging techniques:A meta-analysis

BACKGROUND It is of vital importance to find radiologic biomarkers that can accurately predict treatment response. Usually, the initiation of antiangiogenic therapy causes a rapid decrease in the contrast enhancing tumor. However, the treatment response is observed only in a fraction of patients due to the partial radiological response secondary to stabilization of abnormal vessels which does not essentially indicate a true antitumor effect. Perfusion-weighted magnetic resonance imaging(PWMRI) techniques have shown implicitness as a strong imaging biomarker for gliomas since they give hemodynamic information of blood vessels. Hence, there is a rapid expansion of PW-MRI related studies and clinical applications.AIM To determine the diagnostic performance of PW-MRI techniques including:(A)dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI); and(B)dynamic susceptibility contrast magnetic resonance imaging(DSC-MRI) for evaluating response to antiangiogenic therapy in patients with recurrent gliomas.METHODS Databases such as PubMed(MEDLINE included), EMBASE, and Google Scholar were searched for relevant original articles. The included studies were assessed for methodological quality with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Medical imaging follow-up or histopathological analysis was used as the reference standard. The data were extracted by two reviewers independently, and then the sensitivity, specificity, summary receiver operating characteristic curve, area under the curve(AUC), and heterogeneity were calculated using Meta-Disc 1.4 software.RESULTS This study analyzed a total of six articles. The overall sensitivity for DCE-MRI and DSC-MRI was 0.69 [95% confidence interval(CI): 0.53-0.82], and the specificity was 0.99(95%CI: 0.93-1) by a random effects model(DerSimonianeeLaird model). The likelihood ratio(LR) +, LR-, and diagnostic odds ratio(DOR)were 12.84(4.54-36.28), 0.35(0.22-0.53), and 24.44(7.19-83.06), respectively. The AUC(± SE) was 0.9921(± 0.0120), and the Q* index(± SE) was 0.9640(± 0.0323).For DSC-MRI, the sensitivity was 0.73, the specificity was 0.98, the LR+ was 7.82,the LR-was 0.32, the DOR was 31.65, the AUC(± SE) was 0.9925(± 0.0132), and the Q* index was 0.9649(± 0.0363). For DCE-MRI, the sensitivity was 0.41, the specificity was 0.97, the LR+ was 5.34, the LR-was 0.71, the DOR was 8.76, the AUC(± SE) was 0.9922(± 0.2218), and the Q* index was 0.8935(± 0.3037).CONCLUSION This meta-analysis demonstrated a beneficial value of PW-MRI(DSC-MRI and DCE-MRI) in monitoring the response of recurrent gliomas to antiangiogenic therapy, with reasonable sensitivity, specificity, +LR, and-LR.

Role of pulmonary perfusion magnetic resonance imaging for the diagnosis of pulmonary hypertension:A review

Among five types of pulmonary hypertension,chronic thromboembolic pulmonary hypertension(CTEPH)is the only curable form,but prompt and accurate diagnosis can be challenging.Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH,however these are limited by radiation exposure,subjective qualitative bias,and lack of cardiac functional assessment.This review aims to assess the methodology,diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages,limitations and future research scope.

Dynamic contrast-enhanced MRI versus ^(18)F-FDG PET/CT: Which is better in differentiation between malignant and benign solitary pulmonary nodules?

Objective： To prospectively compare the discriminative capacity of dynamic contrast enhanced-magnetic resonance imaging（DCE-MRI） with that of^18F-fluorodeoxyglucose（^18F-FDG） positron emission tomography/computed tomography（PET/CT） in the differentiation of malignant and benign solitary pulmonary nodules（SPNs）.Methods： Forty-nine patients with SPNs were included in this prospective study. Thirty-two of the patients had malignant SPNs, while the other 17 had benign SPNs. All these patients underwent DCE-MRI and ^18F-FDG PET/CT examinations. The quantitative MRI pharmacokinetic parameters, including the trans-endothelial transfer constant（K^trans）, redistribution rate constant（Kep）, and fractional volume（Ve）, were calculated using the Extended-Tofts Linear two-compartment model. The ^18F-FDG PET/CT parameter, maximum standardized uptake value（SUV（max））, was also measured. Spearman＇s correlations were calculated between the MRI pharmacokinetic parameters and the SUV（max） of each SPN. These parameters were statistically compared between the malignant and benign nodules. Receiver operating characteristic（ROC） analyses were used to compare the diagnostic capability between the DCE-MRI and ^18F-FDG PET/CT indexes.Results： Positive correlations were found between K^trans and SUV（max）, and between K（ep） and SUV（max）（P〈0.05）.There were significant differences between the malignant and benign nodules in terms of the K^trans, K（ep） and SUV（max） values（P〈0.05）. The areas under the ROC curve（AUC） of K^trans） K（ep） and SUV（max） between the malignant and benign nodules were 0.909, 0.838 and 0.759, respectively. The sensitivity and specificity in differentiating malignant from benign SPNs were 90.6% and 82.4% for K^trans; 87.5% and 76.5% for K（ep）; and 75.0% and 70.6%for SUV（max）, respectively. The sensitivity and specificity of K^trans and K（ep） were higher than those of SUV（max）, but there was no significant difference between them（P〉0.05）.Conclusions： DCE-MRI can be used to differentiate between benign and malignant SPNs and has the advantage of being radiation free.

Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures

The goal in brain tumor surgery is to remove the maxi-mum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been in-troduced, including an operating microscope in the late 1950 s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging(DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging(DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resec-tion cavity and thus overcome this remaining uncer-tainty of intraoperative MRI in high grade brain tumor resection.

Clinical applications of advanced magnetic resonance imaging techniques for arthritis evaluation

Magnetic resonance imaging(MRI) has allowed a comprehensive evaluation of articular disease, increasing the detection of early cartilage involvement, bone erosions, and edema in soft tissue and bone marrow compared to other imaging techniques. In the era of functional imaging, new advanced MRI sequences are being successfully applied for articular evaluation in cases of inflammatory, infectious, and degenerative arthropathies. Diffusion weighted imaging, new fat suppression techniques such as DIXON, dynamic contrast enhanced-MRI, and specific T2 mapping cartilage sequences allow a better understanding of the physiopathological processes that underlie these different arthropathies. They provide valuable quantitative information that aids in their differentiation and can be used as potential biomarkers of articular disease course and treatment response.

Magnetic resonance imaging of the liver:New imaging strategies for evaluating focal liver lesions

The early detection of focal liver lesions,particularly those which are malignant,is of utmost importance.The resection of liver metastases of some malignancies(including colorectal cancer)has been shown to improve the survival of patients.Exact knowledge of the number,size,and regional distribution of liver metastases is essential to determine their resectability.Almost all focal liver lesions larger than 10 mm are demonstrated with current imaging techniques but the detection of smaller focal liver lesions is still relatively poor.One of the advantages of magnetic resonance imaging(MRI)of the liver is better soft tissue contrast(compared to other radiologic modalities),which allows better detection and characterization of the focal liver lesions in question.Developments in MRI hardware and software and the availability of novel MRI contrast agents have further improved the diagnostic yield of MRI in lesion detection and characterization.Although the primary modalities for liver imaging are ultrasound and computed tomography,recent studies have suggested that MRI is the most sensitive method for detecting small liver metastatic lesions,and MRI is now considered the pre-operative standard method for diagnosis.Two recent developments in MRI sequences for the upper abdomen comprise unenhanced diffusion-weighted imaging(DWI),and keyhole-based dynamic contrast-enhanced(DCE)MRI(4D THRIVE).DWI allows improved detection(b=10 s/mm2)of small(<10 mm)focal liver lesions in particular,and is useful as a road map sequence.Also,using higher b-values,the calculation of the apparent diffusion coefficient value,true diffusion coefficient,D,and the perfusion fraction,f,has been used for the characterization of focal liver lesions.DCE 4D THRIVE enables MRI of the liver with high temporal and spatial resolution and full liver coverage.4D THRIVE improves evaluation of focal liver lesions,providing multiple arterial and venous phases,and allows the calculation of perfusion parameters using pharmacokinetic models.4D THRIVE has potential benefits in terms of detection,characterization and staging of focal liver lesions and in monitoring therapy.

Perfusion magnetic resonance imaging of the liver

Perfusion magnetic resonance imaging (MRI) studies quantify the microcirculatory status of liver parenchyma and liver lesions, and can be used for the detection of liver metastases, assessing the effectiveness of antiangiogenic therapy, evaluating tumor viability after anticancer therapy or ablation, and diagnosis of liver cirrhosis and its severity. In this review, we discuss the basic concepts of perfusion MRI using tracer kinetic modeling, the common kinetic models applied for analyses, the MR scanning techniques, methods of data processing, and evidence that supports its use from published clinical and research studies. Technical standardization and further studies will help to establish and validate perfusion MRI as a clinical imaging modality.

动态增强MRI定量参数及肿瘤标记物对乳腺癌新辅助化疗疗效的评估价值分析

目的:探索动态增强磁共振成像(DCE-MRI)定量参数及肿瘤标记物对乳腺癌新辅助化疗疗效的评估价值。方法:选取2019年5月至2022年5月在济宁市第一人民医院接受新辅助化疗联合手术干预的75例乳腺癌患者,根据实体瘤疗效评价标准(RECIST)将其分为有效组(54例)和无效组(21例),比较化疗前和化疗后两组患者DCE-MRI定量参数血管外细胞外间隙容积比(V_(e))、速率常数(K_(ep))及容积转换常数(K^(trans))指标与肿瘤标志物癌胚抗原(CEA)、糖类抗原(CA125)及糖类抗原15-3(CA15-3)水平,采用受试者工作特征(ROC)曲线分析各项诊断方式预测效能。结果:化疗后,有效组患者DCEMRI定量参数Ve、K_(ep)及K^(trans)与无效组比较,差异有统计学意义(t=7.237、51.695、16.879,P<0.05)。有效组患者肿瘤标志物CEA、CA125及CA15-3与无效组比较,差异有统计学意义(t=44.201、6.736、6.885,P<0.05)。V_(e)、K_(ep)、K^(trans)、CEA、CA125及CA15-3的6项指标联合预测乳腺癌新辅助化疗疗效ROC曲线下面积(AUC)值为0.979,显著高于各项指标单独检测的AUC值,差异有统计学意义(Z=2.993、2.679、2.510、2.731、3.215、3.071,P<0.05)。结论:肿瘤标记物联合DCE-MRI定量参数可更好预测乳腺癌新辅助化疗疗效情况,间接评估预后。

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

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。

扩散峰度联合动态增强磁共振成像对乳腺癌不同中医证型的诊断价值

目的探讨扩散峰度成像(DKI)联合动态增强磁共振成像(DCE-MRI)对乳腺癌不同中医证型的诊断价值。方法选取本院经病理证实的乳腺癌患者170例,其中肝郁痰凝证88例,冲任失调证45例,正虚毒炽证37例,所有病例均行DKI及DCE-MRI检查。分析两组间的临床病例资料、常规MRI征象和DKI模型的平均扩散率(MD)、平均扩散峰度值(MK)及DCE-MRI模型的血管外细胞外间隙容积比(Ve)、速率常数(Kep)和容量转移常数(Ktrans)值;并运用受试者工作特征曲线(ROC)分析诸定量参数的诊断效能。结果肝郁痰凝证、冲任失调证及正虚毒炽证病灶形态及强化方式差异有统计学意义(P=0.003;P=0.027)。肝郁痰凝证组的MD值小于冲任失调证组及正虚毒炽证组,差异有统计学意义(P<0.01);肝郁痰凝证、冲任失调证及正虚毒炽证组的MK值逐渐减小(P<0.001),且两两之间比较差异有统计学意义(P<0.05);正虚毒炽证组的Ktrans及Kep值最大,其次是冲任失调证组,肝郁痰凝证组最小(P<0.001),两两之间比较差异有统计学意义(P<0.05)。常规MRI模型中病变形态特征及强化方式对鉴别正虚毒炽证与非正虚毒炽证乳腺癌有意义,ROC曲线下面积为0.772。DCE-MRI模型的Ktrans值对正虚毒炽证的诊断效能最高,AUC均大于其他定量参数(Z=2.729~3.852,P<0.05)。DKI模型(MD+MK)的AUC为0.745;DCE-MRI模型(Ktrans+Kep)的AUC为0.902,大于DKI及常规MRI模型,差异具有统计学意义(Z=3.002,P=0.003;Z=2.113,P=0.035)。DCE-MRI+DKI模型AUC为0.917,诊断效能高于DKI及常规MRI模型(Z=3.834,P<0.001;Z=2.556,P=0.011);DCE-MRI+DKI模型的准确度91.8%,均高于DCE-MRI、DKI及常规MRI单一模型。结论DKI和DCE-MRI模型可用于中医证型乳腺癌的鉴别诊断,其中DCE-MRI模型的Ktrans值诊断效能最高,DKI联合DCE-MRI模型对乳腺癌中医证型的鉴别能力优于单一模型。

超声造影与DCE-MRI对乳腺癌患者新辅助化疗的评估价值

目的探究超声造影(CEUS)与动态增强磁共振成像(DCE-MRI)对乳腺癌患者新辅助化疗(NAC)的评估价值。方法选取2020年1月~2023年1月于我院接受NAC的乳腺癌患者68例,对所有入选患者NAC治疗后行CEUS、DCE-MRI检查,以手术病理结果为金标准,将治疗后患者分为有效组与无效组,比较CEUS、DCE-MRI以及两者联合对乳腺癌患者NAC疗效的评估价值,对比有效组与无效组CEUS、DCEMRI检查的参数水平。结果68例乳腺癌患者NAC后,经手术病理诊断发现49例有效,19例无效。采用CEUS检查评估NAC疗效的敏感性、特异性及准确性分别为81.63%、68.42%、67.65%,经手术病理评估为有效患者的峰值强度(PI)、曲线下面积(AUC)水平低于无效患者(P<0.05);采用DCE-MRI检查时的敏感性、特异性及准确性分别为83.67%、73.68%、67.65%,经手术病理评估为有效患者的容量转移常数(K^(trans))、速率常数(K_(ep))均低于无效患者(P<0.05)。CEUS联合DCE-MRI评估NAC疗效的敏感性及准确性分别为97.96%、94.83%,均显著高于单一检查方法(P<0.05)。结论CEUS联合DCE-MRI能提高对乳腺癌患者NAC疗效的评估价值,其敏感性及准确性较高,值得推广。

磁共振动态增强定量参数诊断乳腺癌的价值及其与恶性转化中血管生成的相关性

目的探究磁共振动态增强(DCE-MRI)定量参数对乳腺癌的诊断价值,并分析定量参数与恶性转化中血管生成的相关性。方法前瞻性选取2020年3月至2022年1月南阳市第二人民医院收治的160例乳腺病变患者,其中浸润性导管癌、导管内原位癌、非典型增生、单纯增生乳腺病变患者各40例。采用磁共振动态增强(DCE-MRI)扫描获取定量参数[细胞外血管外空间的体积分数(Ve)、转运常数(Ktrans)、速率常数(Kep)],比较各组患者DCE-MRI定量参数及血管生成相关因子[血管内生长因子(VEGF)、血管内皮细胞生长因子受体1(Flk-1/KDR)表达、微血管密度],并比较不同病变性质乳腺病变患者DCE-MRI定量参数,采用受试者工作特征曲线(ROC)分析DCE-MRI定量参数联合诊断乳腺癌的价值,采用Pearson相关性分析DCE-MRI定量参数与血管生成相关因子的关系。结果浸润性导管癌组患者的Ve、Ktrans、Kep分别为0.17±0.05、(0.18±0.06)min、(1.37±0.32)min,明显高于导管内原位癌组的0.14±0.04、(0.15±0.04)min、(1.22±0.27)min,非典型增生组的0.12±0.04、(0.05±0.02)min、(0.74±0.07)min和单纯增生组的0.10±0.03、(0.04±0.01)min、(0.53±0.02)min,差异均有统计学意义(P<0.05);浸润性导管癌组患者的Flk-1/KDR半定量积分、VEGF半定量评分及微血管密度分别为(7.44±2.18)分、(7.85±2.46)分、(51.88±3.07)个/100倍镜,明显高于导管内原位癌组的(5.33±1.30)分、(5.72±1.44)分、(31.53±6.51)个/100倍镜,非典型增生组的(3.26±1.65)分、(3.36±1.73)分、(28.74±4.05)个/100倍镜和单纯增生组的(1.06±0.71)分、(1.26±0.74)分、(19.03±4.02)个/100倍镜,差异均有统计学意义(P<0.05);恶性组患者的Ve、Ktrans、Kep分别为0.16±0.05、(0.17±0.05)min、(1.30±0.38)min,明显高于良性组的0.11±0.03、(0.05±0.02)min、(0.64±0.11)min,差异均有统计学意义(P<0.05);经Pearson相关性分析结果显示,Ve、Ktrans、Kep与Flk-1/KDR、VEGF表达及微血管密度均呈正相关(P<0.05);经ROC分析结果显示,Ve、Ktrans、Kep诊断乳腺癌的AUC值均高于0.7,但各项参数联合预测恶性转化中血管生成的AUC值最大,为0.947(P<0.05)。结论DCE-MRI定量参数可显著提高乳腺癌患者阳性检出率,在一定程度上可反映癌前病变阶段组织血管生成趋势,临床应用价值较高。

基于多模态MRI定量分析诊断宫颈癌宫旁浸润的研究

目的探讨多模态MRI定量分析诊断宫颈癌宫旁浸润的价值。方法回顾性分析2019年1月~2021年12月新疆维吾尔自治区人民医院收治的86例宫颈癌患者临床资料,根据病理结果分为宫旁浸润组31例与非宫旁浸润组55例。所有患者均接受MRI常规平扫及扩散加权成像(DWI)扫描、动态对比增强磁共振成像(DCE-MRI)扫描,获得感兴趣区表观弥散系数(ADC)值和对比剂容积转换常量(K^(trans))、速率常数(K_(ep))、血管外细胞间隙容积分数(V_(e))值等多模态MRI定量参数。比较宫旁浸润组和非宫旁浸润组临床特征、ADC值和DCE-MRI定量参数;Pearson相关性分析宫颈癌宫旁浸润患者ADC值和K^(trans)、K_(ep)、V_(e)的关系;受试者工作特征曲线(ROC)分析ADC值和K^(trans)、K_(ep)、V_(e)对宫颈癌宫旁浸润的诊断效能。结果宫旁浸润组与非宫旁浸润组肿瘤直径和病理分级的分布差异比较,差异有统计学意义(P<0.05);宫旁浸润组K^(trans)、K_(ep)和V_(e)均明显高于非宫旁浸润组(P<0.05);Pearson相关性显示,宫颈癌宫旁浸润患者ADC值与V_(e)值呈明显的正相关(P<0.05);ROC显示,K^(trans)、K_(ep)、V_(e)值诊断宫颈癌宫旁浸润的曲线下面积(AUC)分别为0.876、0.821和0.864(P<0.05)。结论多模态MRI定量参数对宫颈癌宫旁浸润具有较好的诊断价值,可为宫颈癌宫旁浸润的影像诊断提供量化参考。

DCE-MRI和IVIM-DWI评估直肠癌微血管含量的比较研究

目的:探讨动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)和体素内不相干运动弥散加权成像(intravoxel incoherent motion diffusion-weighted imaging,IVIM-DWI)在评估直肠癌微血管含量中的差异。方法:研究2019年12月—2022年12月上海中医药大学附属曙光医院经病理学检查诊断为直肠腺癌并行IVIMDWI和DCE-MRI扫描的患者23例。Tofts模型计算DCE-MRI参数为容积分数(volume fraction,V_(e))、容量转移常数(space transport coefficient,K^(trans))和速率常数(rate constant,K_(ep))。IVIM-DWI参数:单纯弥散系数(simple diffusion coefficient,D),灌注相关弥散系数(perfusion related diffusion coefficient,D^(*)),灌注分数(perfusion fraction,f),通过计算双指数模型得到。对与直肠癌微血管含量相关的DCE-MRI和IVIM-DWI定量参数进行分析比较。结果:不同病理学分级的直肠癌K^(trans)和D差异有统计学意义(F=9.159,P=0.002;F=5.106,P=0.016)。在评估直肠癌病理学分级时,K^(trans)优于D。灌注参数K^(trans),K_(ep)和D^(*)与直肠癌微血管含量呈显著正相关(r=0.734,P<0.001;r=0.617,P=0.002;r=0.456,P=0.029)。其中DCE-MRI定量参数评估直肠癌微血管含量优于IVIM-DWI定量参数。结论:与IVIM-DWI相比,DCE-MRI评价直肠癌分化程度和微循状态方面效能更佳。但是考虑到IVIM-DWI不需要注射对比剂,IVIM-DWI仍然可以被推荐用于直肠癌分化程度和微循环状态。

动态增强磁共振成像定量参数联合表观扩散系数值对外周带前列腺癌的诊断价值研究

目的探究动态增强磁共振成像(DCE-MRI)定量参数联合表观扩散系数(ADC)值诊断外周带早期前列腺癌的价值。方法选取2019年2月至2021年12月经穿刺病理学检查确诊为外周带早期前列腺癌31例和前列腺炎27例为研究对象。患者均进行DCE-MRI定量参数检查,以病理学检查结果为金标准,分析不同患者的DCE-MRI特征。并采用受试者工作特征曲线下面积(AUC)分析基于DCE-MRI定量参数与扩散加权成像(DWI)序列对外周带早期前列腺癌与前列腺炎的诊断价值。结果31例前列腺癌患者中,T2加权成像(T2WI)以外周带结节状低信号为主,占58.06%;DWI以结节状、弥漫性高信号,ADC值下降为主,占51.61%;DCE-MRI可见病灶早期强化,以延迟后病灶造影剂退出,强化曲线呈流出型为主,占64.52%。27例前列腺炎患者中,T2WI以外周带单侧或双侧弥漫性不均匀低信号为主,占51.85%;DWI可见外周带单侧或双侧不规则高信号,ADC值降低为主,占59.26%;DCE-MRI可见病灶早期强化,以延迟后造影剂退出不明显,强化曲线呈流入型为主,占81.48%。外周带早期前列腺癌患者ADC值低于前列腺炎,速率常数(Kep)值、转移常数(K^(trans))高于前列腺炎(P<0.05)。DCE-MRI定量参数联合ADC值诊断外周带早期前列腺癌的AUC为0.862(95%CI:0.659,0.865)、敏感度为87.10%,特异度为81.48%,准确度为84.48%,阳性预测值为84.38%,阴性预测值为84.62%。结论DCE-MRI定量参数联合ADC值对外周带早期前列腺癌的诊断效能良好,能显著提高临床检出率,为疾病的诊断与治疗提供依据。