动态对比增强磁共振成像及弥散加权成像参数与乳腺癌肿瘤突变负荷的相关性

目的 探讨动态对比增强磁共振成像（DCE-MRI）及弥散加权成像（DWI）参数与乳腺癌肿瘤突变负荷(TMB)的相关性，评价DCE-MRI及DWI在乳腺癌免疫治疗中的潜在价值。 方法 回顾性分析山西医科大学附属运城医院暨第八临床医学院2019~ 2021年共100例乳腺癌患者的临床资料和术前MRI检查结果。根据TMB值的中位数(5.4/Mb)，将100例患者分为TMB高表达组（TMB≥5.4/Mb，n=28）和TMB低表达组(TMB＜5.4/Mb，n=72)。提取DCE-MRI及DWI的影像特征，计算表观扩散系数(ADC)和动态增强曲线类型等参数。采用高通量测序技术检测肿瘤组织中的基因突变情况，计算TMB值。分析DCE-MRI及DWI参数与TMB值之间的相关性，以及与乳腺癌病理指标[雌激素受体、孕激素受体、人表皮生长因子受体2、Ki67]之间的关系。采用单因素和多因素Logistic回归分析筛选影响TMB值的独立危险因素。 结果 DCE-MRI及DWI参数中，ADC值、动态增强曲线类型、峰值信号强度、时间-信号强度曲线斜率等与TMB值呈负相关关系(P＜0.05)，而峰时、时间-信号强度曲线下面积等与TMB值呈正相关关系(P＜0.05)。乳腺癌病理指标中，雌激素受体、孕激素受体、人表皮生长因子受体2、Ki67的表达与TMB值均无相关性(P>0.05)。多因素Logistic回归分析显示，ADC值、动态增强曲线类型和峰时是影响TMB值的独立危险因素。 结论 DCEMRI及DWI参数与乳腺癌TMB值存在显著相关性，可作为评估乳腺癌免疫治疗效果的辅助手段。

Correlation between dynamic contrast-enhanced magnetic resonance imaging and diffusion weighted imaging parameters and tumor mutation burdenin breast cancer

Objective To explore the correlation between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion weighted imaging (DWI) parameters and tumor mutation burden (TMB) in breast cancer, and to evaluate the potential value of DCE- MRI and DWI in breast cancer immunotherapy. Methods The clinical data and preoperative MRI examination results of 100 patients with breast cancer from 2019 to 2021 were retrospectively analyzed, and the imaging features of DCE-MRI and DWI were extracted. According to the median TMB value (5.4/Mb), 100 patients were divided into high TMB expression group (TMB ≥5.4/Mb, n=28) and low TMB expression group (TMB < 5.4/Mb, n=72). The image features from DCE-MRI and DWI were collected, and the apparent diffusion coefficient (ADC) and dynamic enhancement curve type were calculated. High-throughput sequencing technology was used to detect gene mutations in tumor tissues, and TMB values were calculated. The correlation between DCE-MRI and DWI parameters and TMB values, as well as the relationship with breast cancer pathological indicators (ER, PR, HER- 2, Ki67) were analyzed. Univariate and multivariate Logistic regression analyses were used to screen the independent risk factors affecting TMB values. Results Among the DCE- MRI and DWI parameters, ADC value, dynamic enhancement curve type, peak signal intensity, time- signal intensity curve slope were significantly negatively correlated with TMB value (P < 0.05), while peak time, time-signal intensity curve area were significantly positively correlated with TMB value (P < 0.05). Among the breast cancer pathological indicators, ER, PR, HER-2 and Ki67 expression were not significantly correlated with TMB value (P>0.05). Multivariate Logistic regression analysis showed that ADC value, dynamic enhancement curve type and peak time were independent risk factors affecting TMB value. Conclusion DCE-MRI and DWI parameters are significantly correlated with TMB value in breast cancer, they can be used as an auxiliary means to evaluate the effect of breast cancer immunotherapy.