磁共振成像
磁共振成像
자공진성상
CHINESE JOURNAL OF MAGNETIC RESONANCE IMAGING
2015年
8期
592-598
,共7页
窦瑞雪%杨丽%黄宁%时高峰
竇瑞雪%楊麗%黃寧%時高峰
두서설%양려%황저%시고봉
乳腺肿瘤%磁共振成像%动态增强%微血管密度%血管内皮生长因子
乳腺腫瘤%磁共振成像%動態增彊%微血管密度%血管內皮生長因子
유선종류%자공진성상%동태증강%미혈관밀도%혈관내피생장인자
Breast neoplasms%Magnetic resonance imaging%Dynamic enhancement%Microvessel density%Vascular endothelial growth factors
目的：探讨动态增强磁共振成像(dynamic contrast-enhanced MRI，DCE-MRI)定量参数对乳腺良恶性病变鉴别诊断价值及其与微血管密度(microvessel density，MVD)和血管内皮生长因子(vascular endothelial growth factors，VEGF)的相关性。材料与方法收集河北医科大学第四医院2014年11月至2015年2月67例乳腺病变患者行T1-DCE- MRI扫描，总扫描时相70次，第1时相17.3 s，以后单时相扫描时间4.58 s，总时间约5 min 33 s。测量如下参数：容量转移常数(volume transfer constant，Ktrans)、速率常数(rate constant，Kep)、血管外细胞外间隙容积比(extravascular extracellular volume fraction，Ve)。检查后1周内均经手术取得病理，采用单因素方差分析和LSD法两两比较正常组、良性组及恶性组间定量参数的差异，并绘制ROC曲线分析良、恶性组间的差异。用Pearson相关分析，分析恶性组MVD、VEGF表达与定量参数的相关性。结果正常组Ktrans、Kep、Ve值分别为(0.012±0.003) min-1、(0.439±0.083) min-1、(0.045±0.013)；良性组Ktrans、Kep、Ve值分别为(0.049±0.007) min-1、(0.588±0.073) min-1、(0.107±0.022)；恶性组Ktrans、Kep、Ve值分别为(0.187±0.045) min-1、(1.205±0.517) min-1、(0.133±0.049)。Kep、Ktrans在良、恶性组间差异有统计学意义(P=0，P=0.041)；Kep、Ktrans在正常、恶性组间差异有统计学意义(P=0，P=0.008)。以最大约登指数为最佳诊断切入点， Ktrans、Kep的敏感性分别为86.8%、67.9%。Ktrans、Kep特异性分别为89.5%、94.7%，曲线下面积分别为0.931、0.819。30例乳腺癌患者的Ktrans、Kep、Ve值分别为(0.183±0.031) min-1、(1.192±0.063) min-1、(0.127±0.031)，MVD计数为(34.96±9.86)，VEGF积分为(5±1)分，均与Ktrans、Kep、Ve呈正相关(P＜0.05)。Kep、Ktrans与VEGF相关性最强(r=0.759, r=0.771)，与MVD相关性较强(r=0.613, r=0.607)。结论定量参数Ktrans、Kep对乳腺良恶性病变鉴别诊断有临床价值，且有较高的诊断效能。乳腺癌Ktrans、Kep与VEGF、MVD相关性较强，有望成为无创性评价乳腺肿瘤微循环的新方法。
目的：探討動態增彊磁共振成像(dynamic contrast-enhanced MRI，DCE-MRI)定量參數對乳腺良噁性病變鑒彆診斷價值及其與微血管密度(microvessel density，MVD)和血管內皮生長因子(vascular endothelial growth factors，VEGF)的相關性。材料與方法收集河北醫科大學第四醫院2014年11月至2015年2月67例乳腺病變患者行T1-DCE- MRI掃描，總掃描時相70次，第1時相17.3 s，以後單時相掃描時間4.58 s，總時間約5 min 33 s。測量如下參數：容量轉移常數(volume transfer constant，Ktrans)、速率常數(rate constant，Kep)、血管外細胞外間隙容積比(extravascular extracellular volume fraction，Ve)。檢查後1週內均經手術取得病理，採用單因素方差分析和LSD法兩兩比較正常組、良性組及噁性組間定量參數的差異，併繪製ROC麯線分析良、噁性組間的差異。用Pearson相關分析，分析噁性組MVD、VEGF錶達與定量參數的相關性。結果正常組Ktrans、Kep、Ve值分彆為(0.012±0.003) min-1、(0.439±0.083) min-1、(0.045±0.013)；良性組Ktrans、Kep、Ve值分彆為(0.049±0.007) min-1、(0.588±0.073) min-1、(0.107±0.022)；噁性組Ktrans、Kep、Ve值分彆為(0.187±0.045) min-1、(1.205±0.517) min-1、(0.133±0.049)。Kep、Ktrans在良、噁性組間差異有統計學意義(P=0，P=0.041)；Kep、Ktrans在正常、噁性組間差異有統計學意義(P=0，P=0.008)。以最大約登指數為最佳診斷切入點， Ktrans、Kep的敏感性分彆為86.8%、67.9%。Ktrans、Kep特異性分彆為89.5%、94.7%，麯線下麵積分彆為0.931、0.819。30例乳腺癌患者的Ktrans、Kep、Ve值分彆為(0.183±0.031) min-1、(1.192±0.063) min-1、(0.127±0.031)，MVD計數為(34.96±9.86)，VEGF積分為(5±1)分，均與Ktrans、Kep、Ve呈正相關(P＜0.05)。Kep、Ktrans與VEGF相關性最彊(r=0.759, r=0.771)，與MVD相關性較彊(r=0.613, r=0.607)。結論定量參數Ktrans、Kep對乳腺良噁性病變鑒彆診斷有臨床價值，且有較高的診斷效能。乳腺癌Ktrans、Kep與VEGF、MVD相關性較彊，有望成為無創性評價乳腺腫瘤微循環的新方法。
목적：탐토동태증강자공진성상(dynamic contrast-enhanced MRI，DCE-MRI)정량삼수대유선량악성병변감별진단개치급기여미혈관밀도(microvessel density，MVD)화혈관내피생장인자(vascular endothelial growth factors，VEGF)적상관성。재료여방법수집하북의과대학제사의원2014년11월지2015년2월67례유선병변환자행T1-DCE- MRI소묘，총소묘시상70차，제1시상17.3 s，이후단시상소묘시간4.58 s，총시간약5 min 33 s。측량여하삼수：용량전이상수(volume transfer constant，Ktrans)、속솔상수(rate constant，Kep)、혈관외세포외간극용적비(extravascular extracellular volume fraction，Ve)。검사후1주내균경수술취득병리，채용단인소방차분석화LSD법량량비교정상조、량성조급악성조간정량삼수적차이，병회제ROC곡선분석량、악성조간적차이。용Pearson상관분석，분석악성조MVD、VEGF표체여정량삼수적상관성。결과정상조Ktrans、Kep、Ve치분별위(0.012±0.003) min-1、(0.439±0.083) min-1、(0.045±0.013)；량성조Ktrans、Kep、Ve치분별위(0.049±0.007) min-1、(0.588±0.073) min-1、(0.107±0.022)；악성조Ktrans、Kep、Ve치분별위(0.187±0.045) min-1、(1.205±0.517) min-1、(0.133±0.049)。Kep、Ktrans재량、악성조간차이유통계학의의(P=0，P=0.041)；Kep、Ktrans재정상、악성조간차이유통계학의의(P=0，P=0.008)。이최대약등지수위최가진단절입점， Ktrans、Kep적민감성분별위86.8%、67.9%。Ktrans、Kep특이성분별위89.5%、94.7%，곡선하면적분별위0.931、0.819。30례유선암환자적Ktrans、Kep、Ve치분별위(0.183±0.031) min-1、(1.192±0.063) min-1、(0.127±0.031)，MVD계수위(34.96±9.86)，VEGF적분위(5±1)분，균여Ktrans、Kep、Ve정정상관(P＜0.05)。Kep、Ktrans여VEGF상관성최강(r=0.759, r=0.771)，여MVD상관성교강(r=0.613, r=0.607)。결론정량삼수Ktrans、Kep대유선량악성병변감별진단유림상개치，차유교고적진단효능。유선암Ktrans、Kep여VEGF、MVD상관성교강，유망성위무창성평개유선종류미순배적신방법。
AbstractObjective:To evaluate the value of T1 quantitative parameters of Dynamic Contrast Enhanced MRI (DCE-MRI) at high temporal resolution in the diagnosis of breast lesions and analyze their correlations with MVD, VEGF for breast carcinoma. Materials and Methods:Sixty-seven patients with breast lesions were enrolled from Nov. 2014 to Feb. 2015 in one hospital, underwent the DCEMRI sequence using TWIST with 70 phases. All were conifrmed with pathology within one week. Temporal resolution was 4.58 s per phase except for the ifrst phase 17.3 s. And total scanning time was 5 min 33 s. The following quantitative parameters were calculated: volume transfer constant (Ktrans), rate constant (Kep) and extravascular extracellular volume fraction (Ve). The Ktrans, Kep and Ve among malignant, benign and normal glandular tissues, and all kinds of ductal carcinoma were calculated and compared by one-way ANOVA and LSD method. Additionally, the areas under the ROC curve of Ktrans, Kep and Ve between malignant and benign lesions were compared. The correlations between quantitative DCEMRI parameters and the microvessel density(MVD), vascular endothelial growth factor(VEGF)of malignant lesions were performed using Pearson correlation analysis.Results:The mean Ktrans, Kep and Ve of normal glandular tissue were (0.012±0.003) min-1, (0.439±0.083) min-1, (0.045±0.013). The mean Ktrans, Kep and Ve of benign lesions were (0.049±0.007) min-1, (0.588±0.073) min-1, (0.107±0.022). The mean Ktrans, Kep and Ve of malignant lesions was (0.187±0.045) min-1, (1.205±0.517) min-1, (0.133±0.049). The difference of Kep, Ktrans between malignant and benign lesions was statistically signiifcant (P=0,P=0.041). The difference of Kep, Ktrans between malignant lesions and normal glandular was statistically signiifcant (P=0,P=0.008). The sensitivity of Ktransand Kep were 86.8% and 67.9%. The speciifcity of Kep and Ktrans were 94.7% and 89.5% using the maximum Youden’ index as the cut-off value. The area under the ROC curve of Ktrans and Kep were 0.931 and 0.819 respectively. The mean Ktrans, Kep and Ve of the 30 patients were (0.183±0.031) min-1, (1.192±0.063) min-1, (0.127±0.031). The amount of MVD was (34.96±9.86) and the score of VEGF was (5±1). The quantitative parameters Ktrans, Kep and Ve were positively correlated with MVD and VEGF (P<0.05). Kep and Ktrans showed signiifcantly statistical correlations with anti-VEGF (r=0.759, r=0.771) and anti-CD34 (r=0.613,r=0.607).Conclusion:The differential diagnosis of benign and malignant breast lesions by Ktrans, Kep were applicable. Ktrans, Kep of breast carcinoma were strongly correlated with MVD and VEGF. They could be used as non-invasive biomarkers to evaluate the microcirculation status of breast carcinoma in vivo.
