目的：探讨体素内不相干运动（IVIM）成像在乳腺癌新辅助化疗疗效评估中的价值。方法：前瞻性搜集进行新辅助化疗并随后行手术治疗且取得手术病理的乳腺癌患者60位（共61个病灶）。所有患者均于新辅助化疗前（简称T1）、化疗第1疗程后（简称T2）及化疗结束后（简称T3）各进行1次MRI检查（含IVIM成像），测量肿瘤的表观扩散系数（ADC）、纯扩散系数（D）、假扩散系数（D*）及灌注分数（f）值。按照Miller-Payne分级，将患者分为良好病理反应组（简称R组，Miller-Payne分级3~5）及轻微病理反应组（简称NR组，Miller-Payne分级1、2）。采用两独立样本t检验或Mann-Whitney U检验，比较两组之间在3个时间点上各参数值是否有显著差异，比较两组之间T2与T1各参数的差值（△ADC、△D、△D*、△f）是否有显著差异；采用配对样本t检验或Wilcoxon秩和检验比较每组内T2与T1、T3与T1之间各参数值是否有显著差异。对组间比较有显著差异的参数进行ROC分析。结果：分组后，R组21个，NR组40个。T2时间点上，R组的f值明显低于NR组（P=0.027），但两组间ADC及D值不具有统计学差异。T3时间点上，R组的ADC及D值明显高于NR组（P分别为0.002、0.000），R组的f值明显低于NR组（P=0.000）。两组间D*值在T2及T3时间点上均无统计学差异。两组间△D、△f有显著性差异（P分别为0.001、0.000），而△ADC及△D*值无显著差异。组内比较，T2及T3时间点分别与T1时间点的参数相比，R组的f、D及ADC值均具有显著变化（P均<0.05），而NR组仅T3与T1相比D值有显著变化（P=0.010）。ROC分析示f、△f及△D预测新辅助化疗疗效的曲线下面积分别为0.673、0.788、0.753，三者之间曲线下面积无显著差异。结论：IVIM成像在评价新辅助化疗疗效方面是有潜力的技术方法，f、D尤其是f对新辅助化疗第1疗程后预测疗效及化疗结束后评价疗效均有价值，ADC对化疗结束后评价疗效有价值，D*值对评价疗效无价值。
Abstract
Objective: To assess the value of intravoxel incoherent motion(IVIM) in evaluating the response of breast cancers to the neoadjuvant chemotherapy(NAC). Methods: Sixty patients with 61 lesions, who underwent neoadjuvant chemotherapy and subsequent surgery, were prospectively recruited. All patients underwent MRI(including IVIM imaging) for three times: before NAC(T1), after the first course of NAC(T2) and after NAC(T3). The values of apparent diffusion coefficient(ADC), pure diffusion coefficient(D), pseudo-diffusion coefficient(D*) and perfusion fraction(f) were measured. According to Miller-Payne grading of pathology from surgery, patients were divided into good(R group) and mild response group(NR group). The t test of two independent samples and Mann-Whitney U test were used to compare the parameters at the three time points between groups and to compare the T2~T1 parameter difference(△ADC, △D*, △D, △f) between groups. The paired sample t test and Wilcoxon rank sum test were used to compare the parameters from T2 or T3 with those from T1, respectively. For parameters with statistically significant inter-group difference, ROC analysis was used. Results: There were 21 cases in the R group and 40 cases in NR group. At T2, the f value of R group was significantly lower than that of NR group(P=0.027); however, ADC and D values had no significant difference between groups. At T3, ADC and D values of R group were significantly higher than those of NR(P=0.002, 0.000, respectively); the f value of R group was significantly lower than that of NR(P=0.000). D* values showed no inter-group difference at both T2 and T3. The difference of △D, △f values between groups were statistically significant(P=0.001, 0.000, respectively), however, △ADC and △D* were not statistically different between groups. Further intra-group comparison showed that f, D and ADC value of the R group were significantly changed, no matter at T2 or T3, compared with T1; However, in NR group, only the D value at T3 significantly changed when compared with T1(P=0.010). The areas under the ROC curve of f, △f and △D value were 0.673, 0.788, 0.753, with no significant difference among them. Conclusions: IVIM may be a useful adjunctive tool in evaluating the response of tumors to NAC. The f and D, especially f, have the potential of both early prediction and end-NAC evaluation, while ADC is helpful only in end-NAC evaluation. However, D* has no value.
关键词
乳腺肿瘤 /
治疗结果 /
磁共振成像
Key words
Breast neoplasms /
Treatment outcome /
Magnetic resonance imaging
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参考文献
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基金
北京市科技计划项目（Z151100004015154）、北京医院院内博士启动基金（BJ-2009-4）。
