张锲;陈雪;顾晓雯;张继斌;秦明明;许建铭;

• 1:南京医科大学附属苏州医院

摘要(Abstract)：

目的评估3.0 T MR功能成像的体素内不相干运动(intravoxel incoherent motion,IVIM)及扩散峰度成像(diffusionkurtosisimaging,DKI)独立及联合应用对于乳腺良恶性病变的诊断效能。材料与方法前瞻性收集术前行多参数MR功能成像并获得明确病理结果的50例女性乳腺病变患者(共54个病灶),利用MITK及DKE软件获得扩散系数(diffusion coefficient,D)、伪扩散系数(pseudo-diffusivity coefficient,D*)、灌注分数(perfusion fraction,f)以及平均扩散峰度系数(mean kurtosis,MK)、平均扩散系数(mean diffusivity,MD)。分析各个参数在乳腺良恶性病变中的统计学差异并利用ROC曲线评估有显著差异参数的诊断效能。结果 D、MD、f及MK值在乳腺良恶性病变组间差异均有统计学意义(P<0.05),D*值的差异无统计学意义(P>0.05)。以病理结果为金标准获得D、f、MK及MD值的AUC分别为0.927、0.664、0.944及0.876,以0.91×10-3 mm2/s、14.58%、0.75及1.47×10-3mm2/s作为最佳诊断阈值,鉴别乳腺良恶性病变的敏感度和特异度依次为(90.91%,95.24%)、(57.58%,76.19%)、(87.88%,85.71%)及(81.82%,80.95%)。结论 IVIM及DKI参数中的MK值具有较大的AUC,D值具有较高的敏感度和特异度,联合诊断中的D+MK值的AUC及敏感度最大。IVIM及DKI对于乳腺良恶性病的鉴别诊断具有临床价值,联合应用可以提高诊断效能。

关键词(KeyWords)： 乳腺肿瘤;体素内不相干运动;扩散峰度成像;磁共振成像

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张锲;陈雪;顾晓雯;张继斌;秦明明;许建铭;

Email:

DOI:

参考文献(References)：

• [1]Bray F,Ferlay J,Soerjomataram I,et al.Global cancer statistics 2018:Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin,2018,68(6):394-424.DOI:10.3322/caac.21492.
• [2]Feng RM,Zong YN,Cao SM,et al.Current cancer situation in China:good or bad news from the 2018 global cancer statistics?.Cancer Commun (Lond),2019,39(1):22.DOI:10.1186/s40880-019-0368-6.
• [3]Partridge SC,Nissan N,Rahbar H,et al.Diffusion-weighted breast MRI:Clinical applications and emerging techniques.J Magn Reson Imaging,2017,45(2):337-355.DOI:10.1002/jmri.25479.
• [4]Lima M,Kataoka M,Kanao S,et al.Intravoxel incoherent motion and quantitative non-Gaussian diffusion MR Imaging:evaluation of the diagnostic and prognostic value of several markers of malignant and benign breast lesions.Radiology,2018,287(2):432-441.DOI:10.1148/radiol.2017162853.
• [5]Che SN,Cui XL,Li J,et al.The value of intravoxel incoherent motion model of diffusion weighted imaging in differentiating benign from malignant breast lesions.Chin J Magn Reson Imaging,2015,6(7):506-512.DOI:10.3969/j.issn.1674-8034.2015.07.006.车树楠,崔晓琳,李静,等.MR扩散加权成像体素内不相干运动模型对于乳腺良恶性病变诊断价值的研究.磁共振成像,2015,6(7):506-512.DOI:10.3969/j.issn.1674-8034.2015.07.006.
• [6]Hou YW,Shao ZZ,Hou ML,et al.Comparison between the value of the IVIM imaging and DWI in differential diagnosis of benign and malignant breast lesions.J Pract Radiol,2017,33(3):396-400.DOI:10.3969/j.issn.1002-1671.2017.03.019.侯玉薇,邵真真,侯明丽,等.IVIM成像与DWI在乳腺良恶性病变鉴别诊断中的比较.实用放射学杂志,2017,33(3):396-400.DOI:10.3969/j.issn.1002-1671.2017.03.019.
• [7]Li ZS,Zhang JB,Wang H,et al.A study of quantitative intravoxel incoherent motion diffusion weighted imaging in the diagnosis and clinical staging of cervical cancer at 3.0 T MR scanner.Radiol Pract,2019,34(8):896-900.DOI:10.13609/j.cnki.1000-0313.2019.08.013.李志森,张继斌,王宏,等.3.0 T MR IVIM-DWI在宫颈癌诊断及临床分期中的价值.放射学实践,2019,34(8):896-900.DOI:10.13609/j.cnki.1000-0313.2019.08.013.
• [8]Qiu L,Cai XR,Liu SR,et al.3.0 T MR intravoxel incoherent motion diffusion weighed imaging in preoperative diagnosis of rectal carcinoma.Chin J Med Imaging Technol,2015,31(9):1349-1353.DOI:10.13929/j.1003-3289.2015.09.016.邱麟,蔡香然,刘斯润,等.3.0 T磁共振体素内不相干运动扩散加权成像术前检查直肠癌.中国医学影像技术,2015,31(9):1349-1353.DOI:10.13929/j.1003-3289.2015.09.016.
• [9]Hao JG,Lei YY,Tan YH,et al.Quantitative parameters of DWI and IVIM in the qualitative diagnosis of pancreatic cancer and mass-forming chronic pancreatitis.J Pract Radiol,2020,36(3):406-409.DOI:10.3969/j.issn.1002-1671.2020.03.017.郝金钢,雷玉英,谭艳华,等.扩散加权成像和IVIM定量参数在胰腺癌和肿块型慢性胰腺炎定性诊断的价值.实用放射学杂志,2020,36(3):406-409.DOI:10.3969/j.issn.1002-1671.2020.03.017.
• [10]Pang Y,Turkbey B,Bernardo M,et al.Intravoxel incoherent motion MR imaging for prostate cancer:An evaluation of perfusion fraction and diffusion coefficient derived from different b-value combinations.Magn Reson in Med,2013,69(2):553-562.DOI:10.1002/mrm.24277.
• [11]Lima M,Yano K,Kataoka M,et al.Quantitative non-Gaussian diffusion and intravoxel incoherent motion magnetic resonance imaging:differentiation of malignant and benign breast lesions.Invest Radiol,2015,50(4):205.DOI:10.1097/RLI.0000000000000094.
• [12]Chen Q,Shen YY,Qian WL,et al.The value of the diffusion kurtosis imaging in differential diagnosis of benign and malignant breast lesions.J Pract Radiol,2019,35(2):220-223.DOI:10.3969/j.issn.1002-1671.2019.02.012.陈倩,沈玉英,钱伟亮,等.MR扩散峰度成像对乳腺良恶性病变鉴别诊断的价值.实用放射学杂志,2019,35(2):220-223.DOI:10.3969/j.issn.1002-1671.2019.02.012.
• [13]Durando M,Gennaro L,Cho GY,et al.Quantitative apparent diffusion coefficient measurement obtained by 3.0 Tesla MRI as a potential noninvasive marker of tumor aggressiveness in breast cancer.Eur JRadiol,2016,85(9):1651-1658.DOI:10.1016/j.ejrad.2016.06.019.
• [14]Yu ZX,Liu JK,Zhou H,et al.Prediction of immunohistochemical markers of breast cancer based on intravoxel incoherent motion diffusion weighted imaging and dynamic contrast enhancement.Chin J of Med Imaging,2019,27(7):522-526.DOI:10.3969/j.issn.1005-5185.2019.07.010.余哲歆,刘进康,周晖,等.体素内不相干运动与动态增强对乳腺癌免疫组化指标的预测价值.中国医学影像学杂志,2019,27(7):522-526.DOI:10.3969/j.issn.1005-5185.2019.07.010.
• [15]Sun K,Chen X,Chai W,et al.Breast cancer:diffusion kurtosis MRimaging-diagnostic accuracy and correlation with clinical-pathologic factors.Radiology,2015,277(1):46-55.DOI:10.1148/radiol.15141625.