联合DCE-MRI定量参数和DWI对乳腺癌新辅助化疗疗效的预测价值

发布时间：2018-04-18 07:13

  本文选题：乳腺癌 + 新辅助化疗　； 参考：《山西医科大学》2017年硕士论文

【摘要】：目的:探讨乳腺癌新辅助化疗2周期后联合动态增强MRI(DCE-MRI)和扩散加权成像(DWI)对预测病理反应性的价值。方法:收集山西省肿瘤医院2014年1月至2016年12月术前需行新辅助化疗(NAC)的乳腺癌患者共48例,于新辅助化疗(NAC)前、NAC第2周期后分别行两次磁共振检查并获得DWI和DCE-MRI各参数数据。所有患者在治疗前均经穿刺活检证实,术后按病理结果分为组织学显著反应(MHR)组和非组织学显著反应(NMHR)组。对化疗前两组参数采用两独立样本t检验,然后计算并评估表观扩散系数(ADC)、容量转移常数(K~（trans）)、速率常数(K_(ep))的变化率,并通过Mann-Whitney U检验评估MHR组和NMHR组间各参数变化率的差异。选择ADC变化率和最佳DCE-MRI定量参数变化率建立Logistic回归模型并构建新参数,以术后病理结果为金标准,通过绘制受试者工作特征曲线(ROC)探究新构建参数对预测乳腺癌新辅助化疗疗效的价值。结果:MHR组有11例,NMHR组37例。NAC前MHR组ADC、K~（trans）和K_(ep)值分别为774±104*10~(-6) mm~2/s、0.345±0.121 min~(-1)、0.925±0.30 min~(-1);NMHR组参数值分别为786±126 mm~2/s、0.347±0.157 min~(-1)、0.936±0.349 min~(-1),两组间各参数均无统计学差异(t=-0.291,P=0.772;t=-0.055,P=0.956;t=-0.09,=0.928)。NAC 2周期后MHR组ADC、K~（trans）和K_(ep)变化率分别51.2%、-65.1%、-64.7%,NMHR组ADC、K~（trans）和K_(ep)变化率分别为31.2%、-11.8%、-24.9%,两组间ADC、K~（trans）、K_(ep)变化率均有统计学差异。ADC、K~（trans）、K_(ep)变化率和新构建联合预测参数曲线下面积(area under curve,AUC)分别为0.774、0.850、0.823和0.894,曲线下面积最大者为新构建联合预测参数。结论:1、乳腺癌NAC 2周期后ADC、K~（trans）和K_(ep)变化率可以预测乳腺癌NAC的最终疗效。2、联合ADC和K~（trans）可以更准确的预测乳腺癌NAC的疗效。
[Abstract]:Objective: to evaluate the value of dynamic enhanced MRICE-MRI and diffusion weighted imaging (DWI) in predicting pathological reactivity after 2 cycles of neoadjuvant chemotherapy in breast cancer.Methods: from January 2014 to December 2016, 48 patients with breast cancer underwent neoadjuvant chemotherapy (NAC) before neoadjuvant chemotherapy. After the second cycle of neoadjuvant chemotherapy, two magnetic resonance examinations were performed and the parameters of DWI and DCE-MRI were obtained.All the patients were confirmed by biopsy before treatment. According to the pathological results, they were divided into two groups: histologically significant response group (MHRs) and non-histologically significant response group (NMHRs).Before chemotherapy, two independent samples t test were used to calculate and evaluate the change rate of apparent diffusion coefficient (ADCC), capacity transfer constant (K), rate constant (K), and to evaluate the difference between MHR group and NMHR group by Mann-Whitney U test.The Logistic regression model was established by selecting the rate of change of ADC and the rate of change of optimal quantitative parameters of DCE-MRI, and the new parameters were constructed. The results of postoperative pathology were taken as the golden standard.To explore the value of new construction parameters in predicting the therapeutic effect of neoadjuvant chemotherapy in breast cancer by drawing the operating characteristic curve of subjects.缁撴灉:MHR缁勬湁11渚，

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