DCE-MRI测定药代动力学定量参数、ADC值、病灶血流TIC与乳腺癌患者病理分型及疗效评估的关系分析

目的:探讨分析动态增强磁共振成像(DCE-MRI)测定药代动力学定量参数、表观弥散系数(ADC)值、病灶血流时间-信号强度曲线(TIC)与乳腺癌患者病理分型及治疗效果评估的关系。方法:选取2017年5月—2019年12月我院收治的56例经病理学检查证实的乳腺癌患者作为研究对象,所有患者均给予新辅助化疗(NAC),收集患者的病理学和MRI检查资料,MRI测量并比较患者NAC前后药代动力学定量参数、肿瘤直径、ADC值和病灶TIC变化。应用诊断试验法检测MRI与病理学评价NAC疗效的一致性,以病理学Miller-Payne(M-P)分级作为评价的金标准。结果:56例乳腺癌患者中导管内癌的药代动力学定量参数转移常数(Ktrans)、速率常数(Kep)相比特殊类型癌者均明显降低,非特殊类型浸润癌患者的Ktrans、Kep相比特殊类型癌者也明显降低(P<0.05);高组织学分级(Ⅲ级)者的Ktrans、Kep相比低组织学分级(Ⅰ、Ⅱ级)者均明显升高(P<0.05),Luminal型患者的Ktrans、Kep相比三阴型患者、表皮生长因子受体(HER-2)过表达型患者均明显降低,三阴型患者的血管外细胞间隙容积比(Ve)相比Luminal型、HER-2型患者均明显降低(P<0.05)。4个周期NAC治疗后病理反应性5级(pCR)11例(19.64%),DCEMRI诊断完全缓解(CR)共计10例,其中9例均达到病理反应性5级,1例为病理反应性4级。DCE-MRI诊断乳腺癌NAC后肿瘤残余情况的敏感度为100.0%(9/9),特异度为97.87%(46/47),阳性预测值为90.0%(9/10),阴性预测值为100.0%(46/46),准确度为98.21%(55/56)。NAC治疗前后患者的Ktrans、Kep、Ve、ADC值和病灶血流TIC类型比较比较差异均有统计学意义(P<0.05)。结论:乳腺癌不同病理类型患者之间的DCE-MRI技术及特定药物动力学模型相关的部分量化参数之间存在明显差异,此外NAC前后病灶的定量参数、TIC类型和ADC值变化情况有助于准确判定患者的化疗疗效,MRI在乳腺癌筛查、诊断、治疗和疗效监测等方面具有较高的应用价值。

Analysis of the relationship between the quantitative parameters of pharmacokinetics,ADC value,TIC of focus blood flow measured by DCE-MRI and pathological classification and curative effect evaluation of breast cancer patients

Objective:To analyze the relationship between the quantitative parameters of pharmacokinetics,apparent diffusion coefficient(ADC)value,time-signal intensity curve(TIC)of focus blood flow measured by dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and pathological classification and therapeutic effect evaluation of breast cancer patients.Methods:From May 2017 to December 2019,56 patients with breast cancer confirmed by pathological examination were selected as the study objects.All patients were given neoadjuvant chemotherapy(NAC).The pathological and MRI data of patients were collected.The quantitative parameters of pharmacokinetics,tumor diameter,ADC value and TIC of lesions before and after NAC were measured and compared.The consistency of MRI and pathology in evaluating the curative effect of NAC was detected by diagnostic test,and the Miller Payne(M-P)grading of pathology was used as the gold standard.Results:Compared with the patients with special types of cancer,the quantitative parameters of pharmacokinetics(Ktrans)and rate constants(Kep)of patients with intraductal cancer were significantly lower,the Ktrans and Kep in patients with nonspecific invasive carcinoma were also significantly lower than those in patients with special type carcinoma(P<0.05).Ktrans and Kep of high histological grade(gradeⅢ)were significantly higher than those of low histological grade(gradeⅠandⅡ)(P<0.05),Ktrans and Kep of patients with luminal type were significantly lower than those of patients with triple negative type and patients with over expression of epidermal growth factor receptor(HER-2).The volume ratio of extracellular space(Ve)of patients with triple negative type was significantly lower than that of patients with luminal type and HER-2 type(P<0.05).After 4 cycles of NAC treatment,11 cases(19.64%)had pathological response level 5(PCR),DCE-MRI diagnosed 10 cases of CR,of which 9 cases had pathological response level 5 and 1 case had pathological response level 4.The sensitivity of DCE-MRI was 100.0%(9/9),the specificity was 97.87%(46/47),the positive predictive value was 90.0%(9/10),the negative predictive value was 100.0%(46/46),and the accuracy was 98.21%(55/56).There were significant differences in the values of Ktrans,Kep,Ve,ADC and TIC types before and after NAC treatment(P<0.05).Conclusion:DCE-MRI technology and some quantitative parameters related to the specific pharmacokinetic model of breast cancer patients with different pathological types are significantly different.In addition,the changes of quantitative parameters,TIC type and ADC value before and after NAC are helpful to accurately determine the chemotherapy effect of patients.MRI has a high application value in breast cancer screening,diagnosis,treatment and efficacy monitoring.