摘要
目的探讨乳腺癌新辅助化疗后动态增强 MRI(DCE-MRI)表现的形态学和时间信号强度曲线(TIC)类型与病理学反应性的关系。方法 45例乳腺癌患者经新辅助化疗结束后行乳腺 DCE-MR 检查及手术治疗。应用 AW 4.2图像工作站观察残余肿瘤强化的形态和 TIC 类型(共3型)。由病理科医师对乳腺癌化疗后手术标本的病理反应性进行评估,分为1～5级,5级为病理完全缓解,4级和5级为组织学显著反应。分析病理反应性级别与 DCE-MRI 残余强化的 TIC 类型、形态的关系,统计方法采用精确概率法。结果 45例中病理反应性5级7例,4级16例,3级16例,1和2级共6例。20例Ⅰ型曲线中组织学显著反应者占70.0%(14/20),而6例Ⅲ型曲线均为组织学反应不显著者。TIC 类型在不同的病理反应级别分布差异有统计学意义(P=0.001)。组织学显著反应且有残余强化者共18例,其中非肿块性强化11例。残余强化的肿块(非肿块)形态表现在不同病理反应性分级中分布差异有统计学意义(P=0.012)。结论乳腺癌新辅助化疗后 DCE-MRI 的形态及血液动力学表现特点与化疗后病理反应性相关。非肿块性强化和Ⅰ型 TIC 与组织学显著反应有关。
Objective To investigate the relationship of pathological response of breast cancer after neoadjuvant chemotherapy with the imaging findings in dynamic contrast-enhanced MRI. Methods Forty- five patients with pathologically confirmed breast carcinoma who finished courses of neoadjuvant chemotherapy had breast MRI prior to operation. Dynamic contrast-enhanced MRI scans were performed on a 1.5 T scanner using 3D SPGR sequence before and repeated 6 times after administration of Gd-DTPA. Pathological response was assessed by a pathologist according to Miller ＆ Payne five points classification blinded to breast MRI results. Grade 5 was defined as pCR （pathological complete response）. Grade 4 and 5 were defined as major histopathological response （MHR）. The type of time signal intensity curve （TIC） （three types） , pattern of residual enhancement of each breast cancer were recorded and correlated with pathological findings. Fisher exact test was used for statistical analysis. Results Grade 5 responses were achieved in seven patients; grade 4 in sixteen patients; grade 3 in sixteen patients and grade 1--2 in six patients. 70. 0% （ 14/20 ） of type I time signal intensity curve correlated with MHR, while all 6 type III curves showed non-MHR response. The type of time signal intensity curve and pathological response grades had statistically significant correlation （P =0. 001 ）. 18 of the 23 cases with MHR exhibited residual enhancement,while the remaining 5 cases showed no enhancement. Of the 18 MHR cases with residual enhancement, 11 showed non-mass-like enhancement and 7 showed mass-like enhancement. The mass （nonmass） morphological pattern in dynamic contrast enhanced-MRI had statistically significant differences in pathological response （ P = 0. 012 ） . Conclusions Pathological response of breast carcinoma after neoadjuvant chemotherapy could be characterized using dynamic contrast-enhanced MRI by identifying patterns of residual contrast enhancement and kinetic curve. Favorable pathological responses correlated with Type I TIC, non-enhancement, and non-mass-like residual enhancement.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2007年第11期1200-1204,共5页
Chinese Journal of Radiology
基金
北京肿瘤防治研究所科研启动基金(04-11)
关键词
乳腺肿瘤
药物疗法
联合
图像增强
磁共振成像
病理状态
体征和症状
Breast neoplasms
Drug therapy, combination
Image enhancement
Magneticresonance imaging
Pathological conditions, signs and symptoms
