定量DCE-MRI在乳腺良恶性病变诊断中的临床价值与病理对照研究Evaluations of quantitative DCE-MRI parameters in breast lesions and correlations with histology
窦瑞雪;杨丽;黄宁;时高峰;
摘要(Abstract):
目的探讨动态增强磁共振成像(dynamic contrast-enhanced MRI,DCEMRI)定量参数对乳腺良恶性病变鉴别诊断价值及其与微血管密度(microvessel density,MVD)和血管内皮生长因子(vascular endothelial growth factors,VEGF)的相关性。材料与方法收集河北医科大学第四医院2014年11月至2015年2月67例乳腺病变患者行T1-DCE-MRI扫描,总扫描时相70次,第1时相17.3 s,以后单时相扫描时间4.58 s,总时间约5 min 33 s。测量如下参数:容量转移常数(volume transfer constant,Ktrans)、速率常数(rate constant,Kep)、血管外细胞外间隙容积比(extravascular extracellular volume fraction,Ve)。检查后1周内均经手术取得病理,采用单因素方差分析和LSD法两两比较正常组、良性组及恶性组间定量参数的差异,并绘制ROC曲线分析良、恶性组间的差异。用Pearson相关分析,分析恶性组MVD、VEGF表达与定量参数的相关性。结果正常组Ktrans、Kep、Ve值分别为(0.012±0.003)min-1、(0.439±0.083)min-1、(0.045±0.013);良性组Ktrans、Kep、Ve值分别为(0.049±0.007)min-1、(0.588±0.073)min-1、(0.107±0.022);恶性组Ktrans、Kep、Ve值分别为(0.187±0.045)min-1、(1.205±0.517)min-1、(0.133±0.049)。Kep、Ktrans在良、恶性组间差异有统计学意义(P=0,P=0.041);Kep、Ktrans在正常、恶性组间差异有统计学意义(P=0,P=0.008)。以最大约登指数为最佳诊断切入点,Ktrans、Kep的敏感性分别为86.8%、67.9%。Ktrans、Kep特异性分别为89.5%、94.7%,曲线下面积分别为0.931、0.819。30例乳腺癌患者的Ktrans、Kep、Ve值分别为(0.183±0.031)min-1、(1.192±0.063)min-1、(0.127±0.031),MVD计数为(34.96±9.86),VEGF积分为(5±1)分,均与Ktrans、Kep、Ve呈正相关(P<0.05)。Kep、Ktrans与VEGF相关性最强(r=0.759,r=0.771),与MVD相关性较强(r=0.613,r=0.607)。结论定量参数Ktrans、Kep对乳腺良恶性病变鉴别诊断有临床价值,且有较高的诊断效能。乳腺癌Kt r a ns、Ke p与VEGF、MVD相关性较强,有望成为无创性评价乳腺肿瘤微循环的新方法。
关键词(KeyWords): 乳腺肿瘤;磁共振成像;动态增强;微血管密度;血管内皮生长因子
基金项目(Foundation):
作者(Authors): 窦瑞雪;杨丽;黄宁;时高峰;
参考文献(References):
- [1]Zhou CW,Li EN.Development history and prospect of the breast imaging.Zhonghua Fang She Xue Za Zhi,2013,47(zl):27-29.周纯武,李二妮.乳腺影像学发展历程及展望.中华放射学杂志,2013,47(zl):27-29.
- [2]Akarolo-Anthony SN,Ogundiran TO,Adebamowo CA.Emerging breast cancer epidemic:evidence from Africa.Breast Cancer Res,2010,12(Suppl 4):8.
- [3]Zhou CW,Zhang RZ.Status and mission of the breast imaging.Chin J Magn Reson Imaging,2014,5(4):241-245.周纯武,张仁知.乳腺影像学的现状与使命.磁共振成像,2014,5(4):241-245.
- [4]Peters NH,Borel Rinkes IH,Zuithoff NP,et al.Meta-analysis of MR imaging in the diagnosis of breast lesions.Radiology,2008,246(1):116-124.
- [5]Uzzan B,Nicolas P,cucherat M,et a1.Microvessel density as a prognostic factor in women with breast cancer:a systematic review of the literature and Meta-analysis.Canccr Res,2004,64(9):2941-2955.
- [6]Liu CF,Li W,Xu J,et al.Role and Significance of Vascular Endothelial Growth Factor Expression in breast carcinoma.China Pharmaceuticals,2014,23(11):76-77.刘春富,李卫,许军,等.血管内皮生长因子在乳腺癌表达的作用及意义.中国药业,2014,23(11):76-77.
- [7]Bisacchi D,Benelli R,Vanzetto C,et al.Anti-angiogenesis and angioprevention:mechanisms,problems and perspectives.Cancer Detect Prev,2003,27(3):229-238.
- [8]Weidner N.Current Pathologic methods for measuring intratumoral microvessel density within breast carcinoma and other solid tumor.Breast Cancer Res Treat,1996,36(2):169-180.
- [9]Mattern J,Koomagi R,Volm M.Vascular endothelial growth-factor expression and angiogenesis in nonsmall cell lung carcinomas.Int J Oncol,1995,6(5):1059-1062.
- [10]Yu Y,Jiang Q,Miao Y,et al.Quantitative analysis of clinical dynamic contrast-enhanced MR imaging for evaluating treatment response in human breast cancer.Radiology,2010,257(1):47-55.
- [11]Folkman J.Tumor angiogenesis:therapeutic implications.N Engl J Med,1971,285(21):1182-1186.
- [12]Rykala J,Przybylowska K,Majsterek I,et al.Angiogenesis markers quantification in breast cancer and their correlation with clinicopathological prognostic variables.Pathol Oncol Res,2011,17(4):809-817.
- [13]Sourbron S.Technical aspects of MR perfusion.Eur J Radiol,2010,76(3):304-313.
- [14]Medeiros LR,Duarte CS,Rosa DD,et a1.Accuracy of magnetic resonance in suspicious breast lesions:a systematic quantitative review and meta-analysis.Breast Cancer Res Treat,2011,1(26):273-285.
- [15]Li RM,Gu YJ,Mao J,et al.Evaluation of quantitative dynamic contrast enhanced MRI in differential diagnosis of breast lesions.Zhonghua Fang She Xue Za Zhi,2011,45(2):164-169.李瑞敏,顾雅佳,毛健,等.定量动态增强MRI鉴别乳腺良恶性病变的研究.中华放射学杂志,2011,45(2):164-169.
- [16]Baek HM,Chen JH,Nie K,et al.Predicting pathologic response to neoadjuvant chemotherapy in breast cancer by using MR imaging and quantitative 1H MR spectroscopy.Radiology,2009,251(3):653-662.
- [17]A m a m a t h J,S a n g e e t a T,M e h t a S B.R o l e o f q u a n t i t a t i v e pharmacokinetic parameter(transfer constant:Ktrans)in the characterization of breast lesions on MRI.Indian Journal of Radiology and Imaging,2013,23(1):19-25.
- [18]Tudorica LA,Oh KY,Roy N,et al.A feasible high spatio temporal resolution breast DCE-MRI protocol for clinical settings.Magnetic resonance imaging,2012,30(9):1257-1267.
- [19]Lim RP,Shapiro M,Wang EY,et al.3D time-resolved MR angiography(MRA)of the carotid arteries with time-resolved imaging with stochastic trajectories:comparison with 3D contrast enhanced bolus-chase MRA and 3D time-of-fl ight MRA.AJNR,2008,29(10):1847-1854.
- [20]Tofts PS.Modeling tracer kinetics in dynamic Gd-DTPA MR imaging.J Magn Reson Imaging,1997,7(l):91-101.
- [21]Wang Y,Huang W,panieek DM.Feasibility of using limitedPopulation-based arterial input function for Pharmacokinetic modeling of osteo-sarcoma dynamic contrast-enhanced MRI data.Magn Reson Med,2008,59(5):1183-1189.
- [22]Cheng HL.Investigation and optimization of Parameter acuracy in dynamic contrast-enhanced MRI.J Magn Reson Imaging,2008,28(3):736-743.
- [23]Boram Y,Doo KK,Dukyong Y,et al.Is there any correlation between model-based perfusion parameters and model-free parameters of timesignal intensity curve on dynamic contrast enhanced MRI in breast cancer patients?.Eur Radiology,2014,24(6):1089-1096.
- [24]Song Q,Ma J,Rro SX,et al.Study of microcirculation function status of HCC using 3D-DCE-MRI perfusion Tofts model.Radio Practice,2013,28(6):662-665.宋琼,马静,饶圣祥,等.MR全肝增强灌注Tofts模型分析对肝癌微循环功能状态的影像生物学标记物的评价研究.放射学实践,2013,28(6):662-665.
- [25]Li KA,Zhang RM,Zhang F,et al.Studies of pathology and VEGF expression in rabbit cerebrospinal fluid metastasis:application of dynamic contrast-enhanced MRI.Magn Reson Imaging,2011,29(2):1101.
- [26]Liu KF,Xie P,Peng WJ,et al.Dynamic contrast-enhanced Magnetic Resonance Imaging for pancreatic ductal adenocarcinoma at 3.0 T Magnetic Resonance:correlation with histopathology.Journal of Computer Assisted Tomography,2015,39(1):13-18.