中华乳腺病杂志（电子版）
中華乳腺病雜誌（電子版）
중화유선병잡지（전자판）
CHINESE JOURNAL OF BREAST DISEASE(ELECTRONIC VERSION)
2011年
3期
272-282
,共11页
姜蕾%周意明%陈敏%周诚%李波
薑蕾%週意明%陳敏%週誠%李波
강뢰%주의명%진민%주성%리파
磁共振波谱学%药代动力学%扩散加权成像%乳腺肿瘤%化学疗法
磁共振波譜學%藥代動力學%擴散加權成像%乳腺腫瘤%化學療法
자공진파보학%약대동역학%확산가권성상%유선종류%화학요법
magnetic resonance spectroscopy%pharmacokinetics%diffusion-weighted imaging%breast neoplasms%chemotherapy
目的 评价功能磁共振成像,包括磁共振波谱(MRS)、动态对比增强(DCE)、扩散加权成像(DWI)在早期评估乳腺癌新辅助化疗(NCT)疗效方面的价值.方法 收集已确诊为乳腺癌(T分期在T1c以上)并将进行NCT者21例.患者在全部化疗疗程结束后均进行手术治疗.根据手术后病理组织检查结果,将患者分为化疗有效组(R组)和无效组(NR组).所有患者均进行2次MRI检查,分别在化疗前1周内(化疗前)和化疗第1疗程结束后3周内(第2疗程开始前)进行,包括MRS、DCE和DWI.观察4项指标:MRS的复合胆碱浓度(tCho)、DCE的时间一信号强度曲线(DCE曲线类型)、DWI 的表观扩散系数(ADC)和DCE的病灶最大径.采用配对样本均数t检验或Wilcoxon非参数检验比较化疗前、后病灶4项指标的变化,绘制ROC曲线并分析4项指标的灵敏度、特异度、阳性预测值和阴性预测值等.结果 21例中R组18例,NR组3例.化疗后与化疗前相比,R组tCho浓度、DCE曲线类型、ADC及病灶最大径的变化均有统计学意义(P<0.050),但tCho浓度出现变化的时间最早,其次为DCE曲线类型、ADC和病灶最大径.NR组4项指标均无显著变化.这4项指标的受试者工作特征曲线(ROC)下面积分别为0.98、0.83、0.72、0.63;应用tCho浓度降低35.84%、DCE曲线类型变化、ADC升高1.17%及病灶缩小3.71%预测化疗有效的灵敏度、特异度及阳性预测值分别为94.4%/100.0%/100.0%、66.7%/100.0%/100.0%,44.4%/100.0%/100.0%、55.6%/66.7%/90.9%.结论 功能磁共振成像可用于早期评估NCT疗效;MRS tCho浓度、DCE时间-信号强度曲线类型、ADC及病灶最大径的变化均有较好的阳性预测值,但是tCho浓度预测化疗有效性的敏感性最高.
目的 評價功能磁共振成像,包括磁共振波譜(MRS)、動態對比增彊(DCE)、擴散加權成像(DWI)在早期評估乳腺癌新輔助化療(NCT)療效方麵的價值.方法 收集已確診為乳腺癌(T分期在T1c以上)併將進行NCT者21例.患者在全部化療療程結束後均進行手術治療.根據手術後病理組織檢查結果,將患者分為化療有效組(R組)和無效組(NR組).所有患者均進行2次MRI檢查,分彆在化療前1週內(化療前)和化療第1療程結束後3週內(第2療程開始前)進行,包括MRS、DCE和DWI.觀察4項指標:MRS的複閤膽堿濃度(tCho)、DCE的時間一信號彊度麯線(DCE麯線類型)、DWI 的錶觀擴散繫數(ADC)和DCE的病竈最大徑.採用配對樣本均數t檢驗或Wilcoxon非參數檢驗比較化療前、後病竈4項指標的變化,繪製ROC麯線併分析4項指標的靈敏度、特異度、暘性預測值和陰性預測值等.結果 21例中R組18例,NR組3例.化療後與化療前相比,R組tCho濃度、DCE麯線類型、ADC及病竈最大徑的變化均有統計學意義(P<0.050),但tCho濃度齣現變化的時間最早,其次為DCE麯線類型、ADC和病竈最大徑.NR組4項指標均無顯著變化.這4項指標的受試者工作特徵麯線(ROC)下麵積分彆為0.98、0.83、0.72、0.63;應用tCho濃度降低35.84%、DCE麯線類型變化、ADC升高1.17%及病竈縮小3.71%預測化療有效的靈敏度、特異度及暘性預測值分彆為94.4%/100.0%/100.0%、66.7%/100.0%/100.0%,44.4%/100.0%/100.0%、55.6%/66.7%/90.9%.結論 功能磁共振成像可用于早期評估NCT療效;MRS tCho濃度、DCE時間-信號彊度麯線類型、ADC及病竈最大徑的變化均有較好的暘性預測值,但是tCho濃度預測化療有效性的敏感性最高.
목적 평개공능자공진성상,포괄자공진파보(MRS)、동태대비증강(DCE)、확산가권성상(DWI)재조기평고유선암신보조화료(NCT)료효방면적개치.방법 수집이학진위유선암(T분기재T1c이상)병장진행NCT자21례.환자재전부화료료정결속후균진행수술치료.근거수술후병리조직검사결과,장환자분위화료유효조(R조)화무효조(NR조).소유환자균진행2차MRI검사,분별재화료전1주내(화료전)화화료제1료정결속후3주내(제2료정개시전)진행,포괄MRS、DCE화DWI.관찰4항지표:MRS적복합담감농도(tCho)、DCE적시간일신호강도곡선(DCE곡선류형)、DWI 적표관확산계수(ADC)화DCE적병조최대경.채용배대양본균수t검험혹Wilcoxon비삼수검험비교화료전、후병조4항지표적변화,회제ROC곡선병분석4항지표적령민도、특이도、양성예측치화음성예측치등.결과 21례중R조18례,NR조3례.화료후여화료전상비,R조tCho농도、DCE곡선류형、ADC급병조최대경적변화균유통계학의의(P<0.050),단tCho농도출현변화적시간최조,기차위DCE곡선류형、ADC화병조최대경.NR조4항지표균무현저변화.저4항지표적수시자공작특정곡선(ROC)하면적분별위0.98、0.83、0.72、0.63;응용tCho농도강저35.84%、DCE곡선류형변화、ADC승고1.17%급병조축소3.71%예측화료유효적령민도、특이도급양성예측치분별위94.4%/100.0%/100.0%、66.7%/100.0%/100.0%,44.4%/100.0%/100.0%、55.6%/66.7%/90.9%.결론 공능자공진성상가용우조기평고NCT료효;MRS tCho농도、DCE시간-신호강도곡선류형、ADC급병조최대경적변화균유교호적양성예측치,단시tCho농도예측화료유효성적민감성최고.
Objective To analyze the values of functional MRI, including magnetic resonance spectroscopy ( MRS), dynamic contrast enhancement ( DCE) and diffusion weighted image ( DWI) in monitoring the early response of breast cancer to neoadjuvant chemotherapy (NCT). Methods Twenty-one patients with breast cancer were recruited. All the patients underwent both NCT and surgery. By evaluating histopathology from surgery, patients were divided into a significant responder group (R group) and a nonsignificant responder group (NR group). All the patients underwent MRI twice, including MRS, DCE and DWI, (within one week before and within three weeks after the first cycle of NCT, respectively). Four parameters, including total choline (tCho) concentration on MRS, time-signal intensity curve and lesion size on DCE, apparent diffusion coefficient (ADC) on DWI and lesion size on DCE, before and after the first cycle of NCT were compared using paired sample t test or Wilcoson nonparametric test. ROC curves were drawn and their sensitivity, specificity, positive predictive value and negative predictive value were analyzed. Results Among the 21 cases, 18 were grouped into the R group and 3 into the NR group. In the R group, tCho concentration, DCE time-signal curve, ADC and lesion size after the 1st cycle of NCT changed significantly, compared with those before NCT(P<0. 050), but the tCho concentration changed the earliest, followed by DCE time-signal curve and ADC and lesion size. In the NR group, the four parameters had no significant change. The areas under the ROC curves of the four parameters were 0. 98, 0. 83, 0. 72 and 0. 63, respectively. The values of tCho concentration decrease (threshold of 35. 84%), DCE time-signal curve change, ADC increase (threshold of 1.17%) and lesion size decrease (threshold of 3. 71%) in predicting the sensitivity, specificity and positive predictive value for the early response of breast cancer to NCT were 94. 4%/100. 0%/ 100.0%, 66. 7%/100. 0%/100. 0%, 44. 4%/100. 0%/100. 0% and 55. 6%/66. 7%/90. 9%, respectively. Conclusions Functional MRI can be used in early predicting the response of tumor to NCT. tCho concentration, DCE time-signal curve, ADC and lesion size have good positive predictive value, but tCho concentration has the highest sensitivity.
