摘要
目的评估磁共振动态对比增强成像(dynamic contrast enhancement,DCE-MRI)及扩散加权成像(diffusion-weighted imaging,DWI)在诊断和预估乳腺癌的早期和晚期复发的价值。材料与方法选取2011年1月至2014年6月,在河北省人民医院接受手术且经病理证实的78名乳腺癌患者。比较了早期复发(手术后≤2年)和晚期复发(手术后>2年)患者的MRI特征[包括:背景实质增强(background parenchymal enhancement,BPE)]、肿块的增强特征,全乳的血管分布情况,动态增强曲线类型和病变区域的表观扩散系数(apparent diffusion coefficient,ADC)和临床病理的相关指标。对早期和晚期复发的独立危险因素进行了Cox比例风险回归分析。结果通过MR动态对比增强检查发现,乳腺癌患者的患侧的全乳血管分布增多与早期复发具有显著的相关性。乳腺中度或明显的BPE和边缘增强与晚期复发有关。在扩散加权成像中,ADC值<1.20×10^(-3) mm^2/s的病变在早期复发病例中的比例明显高于晚期复发(P<0.05)。在临床病理指标中,雌激素受体阴性与早期复发有显著相关性(HR为0.45,95%可信区间为0.26~0.93)。结论患侧的全乳血管分布增多,乳腺中度或显著的实质背景增强和肿块边缘增强可以预估乳腺癌的复发。磁共振动态对比增强检查结合动态增强曲线类型和DWI序列的ADC值可以有效地诊断和预估乳腺癌患者的复发。
Objective Assess the value of MRI dynamic contrast enhancement （DCE-MRI） and diffusion-weighted imaging （DWI） in diagnosing and predicting early and late breast cancer recurrence. Materials and methods： There were 78 breastcancer patients in Hebei general hospital were examed by DCE-MRI and DWI scan,between January 2011 and June 2014. All of these patients were examed by breast mammography or ultrasound before our exam and had been confirmed by pathology. We compared the early recurrence after surgery （2 years） or less and late recurrence [（〉2 years） after the surgery] in patients with MRI characteristics [including： background parenchymal enhancement （BPE）, mass of substantial enhancement patterns, the vascular distribution of the whole breast, dynamic enhancement curve type, apparent diffusion coefficient （ADC） value] and clinical pathological variables. In this paper, Cox proportional hazard regression analysis was performed to evaluate independent risk factors for early and late recurrence. Results： In the MRI examination of breast cancer, the distribution of total breast blood vessels was significantly correlated with the early recurrence. Moderate or obvious BPE and rim enhancement, which is associated with late recurrence.In the diffusion weighted imaging, the proportion of ADC values 〈1.20×10^（-3） mm2/s were significantly higher in the early recurrence cases than in the later recurrence （P〈0.05）. The clinical pathological variables associated with early recurrence were estrogen receptor （ER） negative （HR was 0.45, 95% confidence interval was 0.26-0.93）. Conclusions： In DCE-MRI, prominent ipsilateral whole-breast vascularity, moderate or marked BPE, and rim enhancement could be useful for predicting recurrence timing in patients with breast cancer. MRI dynamic contrast enhancement examination and dynamic enhancement curve type and the value of ADC can effectively diagnose and predict the recurrence of breast cancer patients.
作者
张晖
单春辉
王勇
ZHANG Hui;SHAN Chun-hui;WANG Yong(Department of Radiology, Hebei General Hospital, Shijiazhuang 050051, China;Department of Radiology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China)
出处
《磁共振成像》
CAS
CSCD
2017年第11期827-833,共7页
Chinese Journal of Magnetic Resonance Imaging
基金
河北省医学科学研究重点课题计划项目(编号:20110229)~~
关键词
乳腺癌
动态对比增强
肿瘤复发
扩散加权成像
Breast cancer
Dynamic contrast enhancement
Tumor recurrence
Diffusion-weighted imaging
