目的:确定最有效的DCE-MRI组合(Ktrans,Kep)和IVIM(D,f),并分析这些参数与预后指标(ER,PR,和HER2,Ki-67指数,腋窝淋巴结(ALN)和肿瘤大小),以提高乳腺癌的诊断和预后效率。
方法:这是一项前瞻性研究。我们表演了T1WI,T2WI,IVIM,符合纳入标准的良性和恶性乳腺病变在3TMRI检查时的DCE-MRI。我们还收集了相应病变的病理结果,包括ER,PR,和HER2,Ki-67指数,腋窝淋巴结(ALN)和肿瘤大小。DCE-MRI的诊断效能,IVIM成像,并评估了它们的良性和恶性乳腺病变的组合。评估DCE-MRI与IVIM参数和预后指标之间的相关性。
结果:总体而言,本研究包括59例女性患者,其中62个病变(22个良性病变和40个恶性病变)。恶性组D值显著降低(p<0.05),Ktrans显著升高,Kep,和f值(p<0.05)。DCE的AUC值,IVIM,DCE+IVIM分别为0.828、0.882、0.901。Ktrans,Kep,D、f值与病理分级相关(p<0.05);Ktrans与ER表达呈负相关(r=-0.519,p<0.05);Kep与PR表达及Ki-67指数相关(r=-0.489,0.330,p<0.05);DCE、IVIM参数与HER2、ALN无显著相关性(p>0.05)。肿瘤直径与Kep相关,D和f值(r=0.246,-0.278,0.293;p<0.05)。
结论:IVIM和DCE-MRI可以鉴别乳腺良恶性病变,它们的组合显示出明显更好的诊断效率。DCE和IVIM衍生的参数显示与乳腺癌的一些预后因素相关。
OBJECTIVE: To identify the most effective combination of DCE-MRI (Ktrans,Kep) and IVIM (D,f) and analyze the correlations of these parameters with prognostic indicators (ER, PR, and HER2, Ki-67 index, axillary lymph node (ALN) and tumor size) to improve the diagnostic and prognostic efficiency in breast cancer.
METHODS: This is a prospective study. We performed T1WI, T2WI, IVIM, DCE-MRI at 3 T MRI examinations on benign and malignant breast lesions that met the inclusion criteria. We also collected pathological results of corresponding lesions, including ER, PR, and HER2, Ki-67 index, axillary lymph node (ALN) and tumor size. The diagnostic efficacy of DCE-MRI, IVIM imaging, and their combination for benign and malignant breast lesions was assessed. Correlations between the DCE-MRI and IVIM parameters and prognostic indicators were assessed.
RESULTS: Overall,59 female patients with 62 lesions (22 benign lesions and 40 malignant lesions) were included in this study. The malignant group showed significantly lower D values (p < 0.05) and significantly higher Ktrans, Kep, and f values (p < 0.05). The AUC values of DCE, IVIM, DCE + IVIM were 0.828, 0.882, 0.901. Ktrans, Kep, D and f values were correlated with the pathological grade (p < 0.05); Ktrans was negatively correlated with ER expression (r = -0.519, p < 0.05); Kep was correlated with PR expression and the Ki-67 index (r = -0.489, 0.330, p < 0.05); the DCE and IVIM parameters showed no significant correlations with the HER2 and ALN (p > 0.05). Tumor diameter was correlated with the Kep, D and f values (r = 0.246, -0.278, 0.293; p < 0.05).
CONCLUSIONS: IVIM and DCE-MRI allowed differential diagnosis of benign and malignant breast lesions, and their combination showed significantly better diagnostic efficiency. DCE- and IVIM-derived parameters showed correlations with some prognostic factors for breast cancer.