摘要
目的:探讨酰胺质子转移(APT)加权成像联合扩散峰度成像(DKI)对乳腺癌新辅助化疗(NAC)早期病理完全反应的预测效能。方法:本研究中纳入2022年7月-2023年8月在本院确诊为乳腺癌后接受新辅助化疗且在治疗前行DKI和APT加权成像检查的72例患者。搜集并记录每例患者的临床和病理信息。测量病灶的平均峰度系数(MK)、平均扩散系数(MD)和非对称磁化转移率(MTR_(asym))。根据Miller Payne分级系统评估患者对NAC的反应,定义Miller Payne 5级为病理完全反应(pCR),Miller Payne 1~4级为非pCR(non-pCR)。采用独立样本t检验及卡方检验比较pCR组与non-pCR组之间临床病理资料(包括一般临床资料及免疫组化结果)及影像学定量参数间的差异,随后对P值小于0.05的变量采用二元多因素Logistic回归分析构建联合模型,并使用受试者工作特性曲线(ROC)分析各参数单独或联合的诊断效能。结果:pCR组肿瘤最大径(MRI图像测量)明显小于non-pCR组(P=0.006)MD值高于non-pCR组(P=0.008),MTR_(asym)(3.5 ppm)值低于non-pCR组(P=0.006);联合模型的AUC为0.799,与各项单一参数AUC的差异均有统计学意义(Z=2.059~2.168,P=0.0302~0.0395)。结论:DKI和APT衍生参数及肿瘤最大径对早期预测乳腺癌NAC病理完全反应具有重要价值,且三者联合的预测效能优于单一因素。
Objective:To investigate the predictive efficacy of amide proton transfer(APT)-weighted imaging combined with diffusion kurtosis imaging(DKI)for early pathological complete response(pCR)to neoadjuvant chemotherapy in breast cancer.Methods:Seventy-two patients who received neoadjuvant chemotherapy after diagnosis of breast cancer at our hospital from July 2022 to August 2023 and underwent DKI and APT-weighted imaging before treatment were included in this stu-dy.Clinical and pathological information was collected and recorded for each patient.Mean kurtosis coefficient(MK),mean diffusion coefficient(MD)and asymmetric magnetisation transfer rate(MTR_(asym))of the lesions were measured.Patient response to NAC was assessed according to the Mil-ler Payne grading system,defining Miller Payne grade 5 as pCR and Miller Payne grades 1~4 as non-pCR(non-pCR).Independent samples t-test and Chi-square test were used to compare the differences in clinicopathological data(including general clinical information and immunohistochemical results)and quantitative imaging parameters between the pCR and non-pCR groups,and a joint model was constructed by binary logistic multifactorial analysis of factors with a P-value less than 0.05,and the parameters were analyzed using the receiver operating characteristic(ROC)to determine the diagnostic efficacy of the parameters,individually or in combination diagnostic efficacy.Results:The maximum diameter of the tumor(measured in MRI images)in the pCR group was significantly smaller than that in the non-pCR group(P=0.006),the MD value was higher than that in the non-pCR group(P=0.008),and the value of MTR_(asym)(3.5ppm)was lower than that in the non-pCR group(P=0.006);the AUC of the combined model was 0.799,which was significantly different from that of single parameter(Z=2.059~2.168,P=0.0302~0.0395).Conclusion:DKI-and APT-derived parameters and maximum tumour diameter are valuable for early prediction of pathological complete response to NAC in breast cancer,and the predictive efficacy of the combination of the three is better than that of a single factor.
作者
陈科威
潘君龙
余成新
罗雨晴
徐亚卡
杨婷
CHEN Ke-wei;PAN Jun-long;YU Chen-xin(The First College of Clinical Medical Science,Three Gorges University,Hubei 443000,China)
出处
《放射学实践》
CSCD
北大核心
2024年第8期1059-1066,共8页
Radiologic Practice
基金
中华国际医学交流基金会SKY影像科研基金(Z-2014-07-2101)。
关键词
乳腺癌
新辅助化疗
病理完全反应
酰胺质子转移加权成像
扩散峰度成像
Breast cancer
Neoadjuvant chemotherapy
Pathologic complete response
Amide proton transfer weighted imaging
Diffusion kurtosis imaging
