摘要
目的:探讨扩散加权成像(DWI)、体素内不相干运动扩散加权成像(IVIM)、扩散峰度成像(DKI)对三阴性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164例,三阴性组46例,非三阴性组118例,所有患者均行DWI、IVIM及DKI检查。分析两组间的表观扩散系数(ADC)及真实扩散系数(D)、灌注相关扩散系数(D*)和灌注分数(f)和平均扩散峰度值(MK)、平均扩散率(MD);采用两独立样本t检验及Mann-Whitney U检验比较两组间DWI、IVIM和DKI诸参数的差异,绘制ROC比较其诊断效能。结果:三阴性组的MK值小于非三阴性组(P=0.02),呈低度负相关(r=-0.212,P=0.006);而三阴性组的ADC、D、f值及MD值高于非三阴性组(P<0.05),呈低度正相关(r=0.178~0.449,P<0.05)。当ADC≥1.11×10^(-3)mm^(2)/s、D≥0.72×10^(-3)mm^(2)/s、f≥33.3%、MD≥2.13×10^(-3)mm^(2)/s及MK≤0.714时,倾向于三阴性乳腺癌,其中D值的AUC为0.789,大于其他定量参数(Z=1.897~2.806,P=0.013~0.049)。IVIM模型的AUC为0.808,大于DWI(AUC=0.623)及DKI(AUC=0.684)模型,差异具有统计学意义(Z=3.184,P=0.002;Z=2.407,P=0.016)。而将DWI、IVIM及DKI模型联合,AUC为0.826,诊断效能高于DWI及DKI模型(Z=3.998,P=0.001;Z=3.543,P=0.004),联合模型的敏感度为89.1%,特异度为75.4%,准确度为72.3%,均高于单一模型。结论:基于DWI的MRI模型中IVIM对三阴性乳腺癌诊断效能较高,DWI+IVIM+DKI可提升三阴性乳腺癌的诊断准确性,有利于患者的个体化治疗。
Objective:To investigate the predictive value of diffusion weighted imaging(DWI),intravoxel incoherent motion(IVIM)and diffusion kurtosis imaging(DKI)for the diagnosis of triple and non-triple negative breast cancer.Methods:A total of 164 cases of breast cancer patients confirmed by pathology were collected,including 46 cases in the triple negative group and 118 cases in the non-triple negative group.DWI,IVIM and DKI scanning were performed in all patients.The apparent diffusion coefficient(ADC),true diffusion coefficient(D),perfusion-related diffusion coefficient(D*),perfusion fraction(f),mean diffusion rate(MD),and mean kurtosis value(MK)were analyzed.The t test of two independent samples and Mann-Whitney U test were used to compare the differences of the parameters,and the ROC was plotted to compare the diagnostic efficiency.Results:The MK values of the triple negative group were lower than that of the non-triple negative group(P=0.02),showing a low degree of negative correlation(r=-0.212,P=0.006).The ADC,D,f and MD values of the triple negative group were higher than those of the non-triple negative group(P<0.05),showing a low degree of positive correlation(r=0.178~0.449,P<0.05).When ADC≥1.11×10^(-3) mm^(2)/s,D≥0.72×10^(-3) mm^(2)/s,f≥33.3%,MD≥2.13×10^(-3) mm^(2)/s and MK≤0.714,tending to be the triple negative breast cancer.The AUC of the D value was 0.789,which was greater than the other quantitative parameters(Z=1.897~2.806,P=0.013~0.049).The AUC of the IVIM model was 0.808,which was greater than that of the DWI(AUC=0.623)and DKI model(AUC=0.684),and the difference was statistically significant(Z=3.184,P=0.002;Z=2.407,P=0.016).Combined with DWI,IVIM and DKI models,the AUC was 0.826,and the diagnostic efficiency was higher than that of DWI and DKI models(Z=3.998,P=0.001;Z=3.543,P=0.004).The sensitivity,specificity and accuracy of the combined model were 89.1%,75.4%and 72.3%,which were all higher than those of the single model.Conclusion:Multiparametric diffusion-weighted imaging(DWI+IVIM+DKI)can be used to the diagnosis of triple negative breast cancer,which is beneficial to individualized treatment of patients.
作者
马姝
杨自力
周哲
王唯伟
MA Shu;YANG Zi-li;ZHOU Zhe;WANG Wei-wei(Affiliated Hospital of Jining Medical University,Jining Shandong 272029,China)
出处
《中国临床医学影像杂志》
CAS
CSCD
2023年第7期481-485,共5页
Journal of China Clinic Medical Imaging
基金
山东省中医药科技项目(Q-2022132)
济宁市重点研发计划项目(2021YXNS035)
济宁医学院附属医院“苗圃”科研计划立项项目(MP-MS-2021-008)。
关键词
乳腺肿瘤
磁共振成像
Breast Neoplasms
Magnetic Resonance Imaging
