中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2013年
8期
704-708
,共5页
赵莉芸%张仁知%周纯武%李静%王琳
趙莉蕓%張仁知%週純武%李靜%王琳
조리예%장인지%주순무%리정%왕림
乳腺肿瘤%磁共振成像%药物疗法,联合
乳腺腫瘤%磁共振成像%藥物療法,聯閤
유선종류%자공진성상%약물요법,연합
Breast neoplasms%Magnetic resonance imaging%Drug therapy,combination
目的 探讨动态增强MR定量分析早期预测乳腺癌新辅助化疗(NAC)疗效的可行性.方法 收集分析47例经核芯针穿刺病理证实的,乳腺浸润性导管癌患者化疗前和NAC 2周期后的动态增强MR量化参数:容量转移常数(Ktrans)、速率常数(Kep)和细胞外血管外间隙容积比(Ve).按病理结果分为组织学非显著反应(NMHR)组和组织学显著反应(MHR)组.采用非参数检验(Mann-Whitney U检验)比较MHR组和NMHR组NAC 2周期后各量化参数的变化值,采用两独立样本t检验比较化疗前两组的基线参数值,并通过绘制受试者工作曲线(ROC)找到最佳预测参数及其诊断阈值.结果 MHR组15例,NMHR组32例.化疗前MHR组的Ktrans、Kep和Ve值分别为(1.51 ±0.33)/min、(2.97±1.06)/min和(0.55 ±0.16),NMHR组各参数值分别为(1.53±0.40)/min、(2.82±0.99)/min和(0.57±0.20),两组间差异无统计学意义(t值分别为-0.123、0.450和-0.380,P值均＞0.05).NAC 2周期后MHR组Ktrans、Kep和Ve的变化值分别为-88.2％(-96.0％～1.5％)、-62.5％(-94.3％～-8.7％)和-57.0％(-82.1％ ～55.5％),NMHR组各参数的变化值分别为-8.1％(-88.5％～32.4％)、-18.2％(-62.1％ ～ 145.9％)和-4.7％(-83.1％ ～95.7％),两组间差异均有统计学意义(Z值分别为4.359、4.359和3.332,P值均＜0.01).通过绘制ROC曲线可得,Ktrans和Kep的变化值及NAC 2周期后Ktrans值的曲线下面积最大,均为0.898,三者预测NMHR的敏感度分别为87.5％、90.6％和78.1％,特异度分别为86.7％、80.0％和93.3％.结论 动态增强MR定量分析可早期(化疗2周期)预测乳腺癌患者NAC的最终疗效.
目的 探討動態增彊MR定量分析早期預測乳腺癌新輔助化療(NAC)療效的可行性.方法 收集分析47例經覈芯針穿刺病理證實的,乳腺浸潤性導管癌患者化療前和NAC 2週期後的動態增彊MR量化參數:容量轉移常數(Ktrans)、速率常數(Kep)和細胞外血管外間隙容積比(Ve).按病理結果分為組織學非顯著反應(NMHR)組和組織學顯著反應(MHR)組.採用非參數檢驗(Mann-Whitney U檢驗)比較MHR組和NMHR組NAC 2週期後各量化參數的變化值,採用兩獨立樣本t檢驗比較化療前兩組的基線參數值,併通過繪製受試者工作麯線(ROC)找到最佳預測參數及其診斷閾值.結果 MHR組15例,NMHR組32例.化療前MHR組的Ktrans、Kep和Ve值分彆為(1.51 ±0.33)/min、(2.97±1.06)/min和(0.55 ±0.16),NMHR組各參數值分彆為(1.53±0.40)/min、(2.82±0.99)/min和(0.57±0.20),兩組間差異無統計學意義(t值分彆為-0.123、0.450和-0.380,P值均＞0.05).NAC 2週期後MHR組Ktrans、Kep和Ve的變化值分彆為-88.2％(-96.0％～1.5％)、-62.5％(-94.3％～-8.7％)和-57.0％(-82.1％ ～55.5％),NMHR組各參數的變化值分彆為-8.1％(-88.5％～32.4％)、-18.2％(-62.1％ ～ 145.9％)和-4.7％(-83.1％ ～95.7％),兩組間差異均有統計學意義(Z值分彆為4.359、4.359和3.332,P值均＜0.01).通過繪製ROC麯線可得,Ktrans和Kep的變化值及NAC 2週期後Ktrans值的麯線下麵積最大,均為0.898,三者預測NMHR的敏感度分彆為87.5％、90.6％和78.1％,特異度分彆為86.7％、80.0％和93.3％.結論 動態增彊MR定量分析可早期(化療2週期)預測乳腺癌患者NAC的最終療效.
목적 탐토동태증강MR정량분석조기예측유선암신보조화료(NAC)료효적가행성.방법 수집분석47례경핵심침천자병리증실적,유선침윤성도관암환자화료전화NAC 2주기후적동태증강MR양화삼수:용량전이상수(Ktrans)、속솔상수(Kep)화세포외혈관외간극용적비(Ve).안병리결과분위조직학비현저반응(NMHR)조화조직학현저반응(MHR)조.채용비삼수검험(Mann-Whitney U검험)비교MHR조화NMHR조NAC 2주기후각양화삼수적변화치,채용량독립양본t검험비교화료전량조적기선삼수치,병통과회제수시자공작곡선(ROC)조도최가예측삼수급기진단역치.결과 MHR조15례,NMHR조32례.화료전MHR조적Ktrans、Kep화Ve치분별위(1.51 ±0.33)/min、(2.97±1.06)/min화(0.55 ±0.16),NMHR조각삼수치분별위(1.53±0.40)/min、(2.82±0.99)/min화(0.57±0.20),량조간차이무통계학의의(t치분별위-0.123、0.450화-0.380,P치균＞0.05).NAC 2주기후MHR조Ktrans、Kep화Ve적변화치분별위-88.2％(-96.0％～1.5％)、-62.5％(-94.3％～-8.7％)화-57.0％(-82.1％ ～55.5％),NMHR조각삼수적변화치분별위-8.1％(-88.5％～32.4％)、-18.2％(-62.1％ ～ 145.9％)화-4.7％(-83.1％ ～95.7％),량조간차이균유통계학의의(Z치분별위4.359、4.359화3.332,P치균＜0.01).통과회제ROC곡선가득,Ktrans화Kep적변화치급NAC 2주기후Ktrans치적곡선하면적최대,균위0.898,삼자예측NMHR적민감도분별위87.5％、90.6％화78.1％,특이도분별위86.7％、80.0％화93.3％.결론 동태증강MR정량분석가조기(화료2주기)예측유선암환자NAC적최종료효.
Objective To investigate whether quantitative dynamic contrast enhanced MR can predict final pathologic response in primary breast cancer patients undergoing neoadjuvant chemotherapy (NAC).Methods Forty seven patients who were pathologically proved infiltrating ductal carcinoma with core needle puncture biopsy were examined before NAC and after 2 cycles of treatment and the quantitative parameters (Ktrans,Kep and Ve) were analyzed prospectively.Histological response is categorized as non-major histological response (NMHR) and major histological response (MHR).Quantitative parameter changes measured after 2 cycles of NAC were compared between MHR and NMHR using non parametric tests (Mann-Whitney U test) and pretreatment parameters were compared using independent samples t tests.Receiver operating characteristic curve (ROC) was used to determine the best predictor and cutoff value.Results Fifteen patients were grouped into MHR and 32 patients were NMHR.Pretreatment parameters(Ktrans,Kep and Ve) were(1.51 ±0.33) /min,(2.97 ± 1.06) /min and (0.55 ±0.16) in MHR and (1.53 ±0.40) /min,(2.82 ± 0.99) /min and (0.57 ± 0.20) in NMHR.There was no significant difference between the two groups (t values were-0.123,0.450 and-0.380,respectively,P ＞ 0.05).Changes inkinetic parameters(K,Kep and Ve) were-88.2％ (-96.0％ to 1.5％),-62.5％ (-94.3％ to -8.7％) and-57.0％(-82.1％ to 55.5％) in MHRand-8.1％(-88.5％ to 32.4％),-18.2％ (-62.1％ to 145.9％) and-4.7％ (-83.1％ to 95.7％) in NMHR.There were significant difference between the two groups (Z values were 4.359,4.359 and 3.332,respectively,P ＜ 0.01).The areas under ROC curve of AKtrans,AKep and Ktrans after 2 cycles of NAC were all 0.898.Sensitivity of the three parameters for predicting NMHR were 87.5％,90.6％ and 78.1％,and specificity were 86.7％,80.0％ and 93.3％,respectively.Conclusion Quantitative dynamic contrast enhanced MRI can predict final pathologic response in primary breast cancers after 2 cycles of NAC.
