河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (10): 1210-1215.doi: 10.3969/j.issn.1007-3205.2023.10.016

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DCE-MRI与DWI在乳腺癌诊断中的应用及预后评估价值

  

  1. 空军军医大学第一附属医院放射诊断科，陕西 西安 710032

  • 出版日期:2023-10-25 发布日期:2023-11-03
  • 作者简介:崔博(1980-)，男，陕西武功人，空军军医大学第一附属医院主治医师，医学学士，从事骨骼肌系统及乳腺影像诊断研究。
  • 基金资助:
    陕西省重点研发一般项目(2019SF-182)

Application of DCE-MRI and DWI in the diagnosis of breast cancer and their prognostic evaluation

  1. Department of Radiological Diagnosis, the First Affiliated Hospital of the Air Force Military Medical University, Shaanxi Province, Xi′an 710032, China

  • Online:2023-10-25 Published:2023-11-03

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摘要： 目的 探索动态增强成像（dynamic contrast enhanced-magnetic resonance imaging，DCE-MRI）与弥散加权成像（diffusion weighted imaging，DWI）在乳腺癌诊断中的应用及预后评估价值。
方法 回顾性分析乳腺肿块患者80例的临床资料。所有患者均进行DCE-MRI、DWI检查，以病理活组织检查为金标准，分析DCE-MRI、DWI的诊断效能，对于确诊的乳腺癌患者需进行相关治疗，并根据患者预后情况（以患者是否存活为最终研究终点）分为预后良好组（生存/无进展，n=58）和预后不良组（死亡/病情进展，n=6），经受试者工作特征曲线（receiver operating characteristic curve，ROC）分析DCE-MRI、DWI对预后的预测效能。
结果 DCE-MRI诊断准确率为70.00%，DWI诊断准确率为81.25%，两项联合诊断准确率为96.25%，恶性肿块早期强化率高于良性肿块，表观弥散系数(apparent diffusion coefficient，ADC)值低于良性肿块（P＜0.05），且恶性肿块绘制时间-信号强度曲线（time-signal intensity curve，TIC）类型以Ⅱ型、Ⅲ型为主；良性肿块TIC类型以Ⅰ型、Ⅱ型为主；经ROC曲线分析，DCE-MRI、DWI、两项联合诊断乳腺恶性肿块的AUC分别为0.625、0.766、0.953。同时，预后良好组早期强化率低于预后不良组，ADC值高于预后不良组，经ROC曲线分析，早期强化率、ADC值及两项联合预测患者预后的AUC分别为0.816、0.763、0.945。
结论 DCE-MRI联合DWI在分辨乳腺良恶性肿块中具有一定价值，且可预判乳腺癌患者预后情况，具有较高效能。


关键词: 乳腺肿瘤, 动态增强成像, 弥散磁共振成像

Abstract: Objective To explore the application of dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) and diffusion weighted imaging (DWI) in the diagnosis of breast cancer and their prognostic value. 
Methods We performed a retrospective analysis of clinical data from 80 patients with breast masses. All patients were examined with DCE-MRI and DWI, and the diagnostic efficacy of DCE-MRI and DWI was analyzed based on pathological biopsy as the gold standard. The patients diagnosed with breast cancer needed relevant treatment, and were divided into a good prognosis group (survival/no progression, n=58) and a poor prognosis group (death/progression, n=6) according to the prognosis of the patients (with or without survival as the final study endpoint). Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of DCE-MRI and DWI for prognosis. 
Results The diagnostic accuracy of DCE-MRI and DWI was 70.00% and 81.25% respectively, and the combined diagnostic accuracy of the two was 96.25%. The early enhancement rate of malignant masses was higher than that of benign masses, and the apparent diffusion coefficient (ADC) value was lower than that of benign masses (P＜0.05). Moreover, the time-signal intensity curve (TIC) of malignant masses was mainly type II and type III when plotted, and the TIC types of benign masses are mainly type Ⅰ and type Ⅱ. According to ROC curve analysis, the are under the ROC curve (AUC) of DCE-MRI, DWI, and their combination in the diagnosis of malignant breast tumors were 0.625, 0.766, and 0.953, respectively. In the meantime, the early enhancement rate of patients with good prognosis was lower than that of patients with poor prognosis, and the ADC value was higher than that of patients with poor prognosis. According to the ROC analysis, the AUC of the early enhancement rate, ADC value, and their combination in predicting patient prognosis were 0.816, 0.763, and 0.945, respectively. 
Conclusion DCE-MRI DCE-MRI combined with DWI has certain value in distinguishing benign and malignant breast masses, and can predict the prognosis of breast cancer patients, with high efficiency.


Key words: breast neoplasms, dynamic contrast enhanced-magnetic resonance imaging, diffusion magnetic resonance imaging

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