多模态磁共振技术对乳腺癌腋窝淋巴结转移的预测价值
The value of predicting axillary lymph node metastasis in patients with breast cancer based on multi-modal magnetic resonance imaging
党燕 1韦艳艳 1朱来敏 1邵凯 1胡喜斌 1王唯伟1
作者信息
- 1. 济宁医学院附属医院影像科 山东 济宁 272029
- 折叠
摘要
目的 探讨动态增强MRI(DCE-MRI)联合体素内不相干运动(IVIM)及扩散峰度成像(DKI)技术预测乳腺癌腋窝淋巴结转移的价值.方法 选取本院经病理证实的 165 例乳腺癌患者,77 例有腋窝淋巴结转移(axillary lymph node,ALN),88 例无腋窝淋巴结转移,术前乳腺病灶均行DCE-MRI及IVIM、DKI检查.分析临床资料、常规MRI征象和两组间的容量转移常数(Ktrans),血管外细胞外间隙容积比(Ve),速率常数(Kep)及真实扩散系数(D),灌注相关扩散系数(D*),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DCE-MRI和IVIM、DKI诸参数的差异,绘制 ROC 比较其诊断效能.结果 ALN转移组边缘多较无转移组模糊(P=0.032);ALN转移组瘤内强化多不均匀,环形强化占比较大(P=0.012).ALN转移组患者D、MD值低于无ALN转移组(P<0.01),且呈低度负相关(r=-0.441,r=-0.259);ALN转移组Ktrans、Kep、D*及MK值高于无ALN转移组(P<0.01),其中Ktrans值与ALN转移呈中度正相关(r=0.621),Kep、D*及MK值与ALN转移呈低度正相关(r=0.337;r=0.255,r=0.398).DCE-MRI模型的Ktrans值的诊断效能最高,ROC曲线下面积(AUC)为 0.859,诊断效能高于其他定量参数(Z=2.275～4.028,P<0.05).DCE-MRI模型为Ktrans+Kep,AUC为 0.868;IVIM模型为D+D*,AUC为 0.781;DKI模型为MD+MK,AUC为 0.730,其中DCE-MRI模型(AUC=0.868)的诊断效能高于IVIM(AUC=0.781)及DKI(AUC=0.730)模型,AUC差异有统计学意义(Z=2.001,P=0.046;Z=3.156,P=0.002).而将DCE-MRI、IVIM、DKI模型联合,AUC为 0.913,诊断效能均高于单一模型(Z=2.483～4.838,P<0.05),敏感度为 90.9%,特异度为 81.8%,准确率 86.1%,亦高于单一模型.结论 DCE-MRI和IVIM、DKI模型可用于预测乳腺癌腋窝淋巴结转移,其中DCE-MRI模型及其Ktrans值诊断效能较高,且将DCE-MRI联合IVIM、DKI模型在乳腺癌腋窝淋巴结性质的鉴别能力优于单一模型.
Abstract
Objective To assess the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and Intra-voxel incoherent motion(IVIM),diffusion kurtosis imaging(DKI)for predicting the risk of axillary lymph node(ALN)metasta-sis in patients with breast cancer.Methods A total of 165 cases of breast cancer confirmed by pathology were collected.Seventy-seven patients had an axillary lymph node metastasis(axillary lymph node,ALN),and 88 patients had no axillary lymph node metastasis.DCE-MRI,IVIM and DKI scanning were performed in all patients.The clinicopathological characteris-tics and conventional MRI features and volume transfer constant(Ktrans),extravascular extracellular space distribute volume per unit tissue volume(Ve)and rate constant(Kep)and true diffusion coefficient(D),perfusion-related diffusion coefficient(D*),perfusion fraction(f)and mean diffusion rate(MD),mean kurtosis value(MK)were analyzed.The diagnostic performance of these models was evaluated by Receiver Operating Characteristic Curve(ROC)analysis.Results The edge of the ALN metas-tasis group was more blurry than that of the non-ALN metastasis group(P=0.032).The ALN metastasis group had higher propor-tion of patients with heterogeneous enhancement and rim enhancement(P=0.012).The D and MD values of the ALN metastasis group were lower than those of the non-ALN metastasis group(P<0.01),showing a low degree of negative correlation(r=-0.441,-0.259).The D*,Ktrans,Kep and MK values of the ALN metastasis group were higher than those of the non-ALN metastasis group(P<0.01).The Ktrans value was moderately positively correlated with ALN metastasis(r=0.621),and the Kep,D * and MK val-ues were low-degree positively correlated with ALN metastasis(r=0.337;r=0.255,r=0.398).The Ktrans value of the DCE-MRI model had the highest diagnostic efficacy,with the area under the ROC curve(AUC)of 0.859.The DCE-MRI model was Ktrans+Kep,with an AUC of 0.868.The IVIM model was D+D *,with an AUC of 0.781.The DKI model was MD+MK,with an AUC of 0.730.The diagnostic efficiency of the DCE-MRI model(AUC=0.868)was higher than that of the IVIM(AUC=0.781)and DKI(AUC=0.730)models,and the differences were statistically significant(Z=2.001,P=0.046;Z=3.156,P=0.002).When DCE-MRI,IVIM and DKI models were combined,the AUC was 0.913,the diagnostic efficacy was higher than that of the single model(Z=2.483～4.838,P<0.05),the sensitivity was 90.9%,the specificity was 81.8%,and the accuracy was 86.1%,which was also higher than that of the single model.Conclusion DCE-MRI,IVIM and DKI models can be used to predict the axillary lymph node metastasis of breast cancer.Among them,DCE-MRI model and its Ktrans value have higher diagnostic efficiencies,and DCE-MRI+IVIM+DKI model is superior to a single model in the differentiation of axillary lymph node properties of breast cancer.
关键词
乳腺癌/腋窝淋巴结/动态增强磁共振成像/体素内不相干运动/扩散峰度成像Key words
Breast cancer/Axillary lymph nodes/Dynamic contrast enhancement imaging/Intravoxel incoherent motion/Diffusion Kurtosis imaging引用本文复制引用
基金项目
山东省中医药科技项目(Q-2022132)
山东省医药卫生科技发展计划项目(202109010447)
济宁医学院附属医院医学英才培养计划项目(2022-yxyc-010)
出版年
2024
NETL
NSTL
万方数据