目的 探讨扩散峰度成像(DKI)联合动态对比增强磁共振成像(DCE-MRI)对乳腺癌预后因子的鉴别诊断价值.方法 回顾性分析本院经病理证实的乳腺癌患者150 例,所有病例均行DKI、DCE-MRI检查.分析两组间的平均扩散峰度值(MK)、平均扩散率(MD)、容积转运常数(Ktrans)、血管外细胞外间隙容积分数(Ve)、速率常数(Kep).运用受试者工作特征曲线(ROC)分析诊断效能.结果 雌激素受体(ER)阴性组的MD、Ktrans值高于阳性组(P<0.05);人表皮生长因子受体-2(HER-2)阳性组的Ktrans值大于阴性组,而Ve 值小于阴性组(P<0.05);MD、MK及Ktrans、Kep值在腋窝淋巴结转移方面差异有统计学意义(P<0.05);病理高级别组的MK及Ktrans、Kep值大于低级别组,而MD值小于低级别组(P<0.05);TNM高分期的MK、Kep值较低分期组大(P<0.05);增殖细胞核抗原(Ki-67)高表达组的MK及Ktrans、Kep值大于低表达组,而MD小于低表达组(P<0.05);预后不良组[Nottingham指数(NPI)≥3.4]的MK及Ktrans、Kep值高于预后良好组(NPI<3.4),而MD小于预后良好组(P<0.05).MD、MK和Ktrans、Kep的联合模型与NPI呈中度正相关(r =0.612,P<0.01),曲线下面积(AUC)为0.887,诊断效能高于单一参数(Z =3.403,P =0.001;Z =2.716,P =0.007;Z =1.986,P =0.047;Z =2.420,P =0.016),敏感度为 75.0%,特异度为89.5%,准确率85.3%.结论 DKI联合DCE-MRI可用于乳腺癌预后因子的预测,为临床治疗及预后评估提供参考.
Objective To investigate the predictive value of diffusion kurtosis imaging(DKI)and dynamic contrast-en-hanced magnetic resonance imaging(DCE-MRI)for the prognostic factors in breast cancer.Methods A total of 150 cases of breast cancer patients confirmed by pathology were collected.DKI and DCE-MRI scanning were performed in all patients.The mean diffusion rate(MD),mean kurtosis value(MK),volume transfer constant(Ktrans),extravascular extracellular space distribute volume per unit tissue volume(Ve)and rate constant(Kep)were analyzed.The diagnostic the diagnostic ef-ficacy was analyzed by receiver operating characteristic curve.Results MD and Ktrans values in the ER negative group were higher than that of positive group(P<0.05).The HER-2 positive group had higher Ktrans value and lower Ve value than that of the negative group(P<0.05).MD,MK,Ktrans,Kep values were significantly different between the axillary lymph node metastasis and non-metastasis groups(P<0.05).MK and Ktrans and Kep in high-grade group were higher than that of the low-grade group,while MD was lower than low-grade group(P<0.05).The MK and Kep values of high-stage TNM group were higher than those of the low-stage group(P<0.05).MK and Ktrans and Kep values were higher in the Ki-67 high expression group than those of the lower expression group,while MD was smaller than that of the low expression group(P<0.05).MK and Ktrans and Kep values in high-grade Nottingham group(NPI≥3.4)were higher than those of the low-grade Nottingham group(NPI<3.4)and MD was less than the low-grade Nottingham group(P<0.05).The combination of MD +MK +Ktrans +Kep showed moderate positive correlation with Nottingham index(r =0.612,P<0.01).The AUC was 0.887,which was higher than a single parameter(Z =1.986-3.403;P<0.05),the sensitivity is 75.0%,the specificity is 89.5%,and the accuracy is85.3%.Conclusion DKI combined with DCE-MRI can be used to predict prognostic factors in breast cancer and provide a reference for clinical treatment and prognostic evaluation.