MR扩散峰度成像在浸润性乳腺癌分级及与预后因素的相关性应用研究

目的评价MR扩散峰度成像(diffusion kurtosis imaging,DKI)在浸润性乳腺癌分级中的应用及与ER、PR、HER-2、Ki-67的相关性。材料与方法搜集2014年8月至2016年9月在我院经病理及临床确诊为乳腺癌的患者53例,其中男1例,女52例,病理组织学分级:5例(9.4%)为1级,26例(49.1%)为2级,22例(41.5%)为3级。所有患者进行包括DKI序列的乳腺磁共振扫描。通过Matlab2011b软件计算表观弥散系数(apparent diffusion coefficient,ADC)、平均扩散率(mean diffusivity,MD)和扩散峰度平均值(mean kurtosis,MK)值,对照病理结果,应用Mann-Whitney U检验评价上述参数值与浸润性乳腺癌病理分级及与ER、PR、HER-2、Ki-67的相关性。结果 ADC、MD和MK值在不同级别浸润性乳腺癌之间差异没有统计学意义(P0.05),在不同表达水平的ER、PR、HER-2及Ki-67统计学中发现,仅仅ADC和MD值对ER有统计学意义(P0.05),而MK值对不同乳腺癌Ki-67高、低表达分组间的统计差异P=0.055,相较ADC、MD值已非常接近于0.05。ADC、MD和MK值在PR、HER-2等其余乳腺癌相关预后因素分组中均无统计学意义(P0.05)。结论 DKI在术前评估浸润性乳腺癌的病理分级的价值有限,但在评估肿瘤增殖活性方面有一定帮助,为肿瘤的化疗方案的制定提供了更多的信息,它的价值仍有待进一步探究。

The study on the application value of DKI in the classification of invasive breast carcinoma and its correlation with prognostic factors

Objective:To evaluate the application value of diffusion kurtosis imaging (DKI) based MD, MK parameters in grading invasive breast carcinoma and compare their diagnostic potential.Materials and Methods:Collecting 53 patients with invasive breast carcinoma diagnosed by pathological examination in this study. One male patient and 52 female patients were included. All patients underwent breast magnetic resonance imaging, including traditional magnetic resonance imaging and diffusion kurtosis imaging. ADC, MK and MD were calculated by using post-processing software, Matlab 2011b. Compared with histological grade, the classification of invasive breast carcinoma and its correlation with prognostic factors were statistically analyzed.Results:ADC, MD and MK values have no significant difference in well, moderately and poorly differentiated invasive breast carcinoma (P>0.05). Only ADC and MD were significantly different in ER expression (P<0.05). ADC, MD and MK values showed no significant difference in PR, HER-2 and Ki-67 expression (P>0.05,P=0.055 with MK in Ki-67).Conclusions:DKI has limited value in the evaluation on the classification of invasive breast carcinoma. However it provides useful information in the assessment of tumor proliferation activity.