实用放射学杂志
實用放射學雜誌
실용방사학잡지
Journal of Practical Radiology
2015年
10期
1608-1612,1616
,共6页
谢瑜%李卓琳%李鹍%丁莹莹
謝瑜%李卓琳%李鹍%丁瑩瑩
사유%리탁림%리곤%정형형
乳腺癌%新辅助化疗%磁共振成像%扩散加权成像%磁共振波谱
乳腺癌%新輔助化療%磁共振成像%擴散加權成像%磁共振波譜
유선암%신보조화료%자공진성상%확산가권성상%자공진파보
breast cancer%neoadjuvant chemotherapy%magnetic resonance imaging%diffusion weighted imaging%magnetic resonance spectroscopy
目的：研究乳腺癌患者新辅助化疗前、1个疗程后、全程化疗后三维氢质子磁共振波谱(3D1 H-MRS)复合胆碱峰下面积值(tChoI)及磁共振扩散加权成像(DWI)表观扩散系数(ADC)值的变化对新辅助化疗病理反应性评估的预测及诊断价值。方法前瞻性分析22例乳腺癌患者3次 MR 检查中 tChoI 及 ADC 值的变化。按照 Miller/Payne 病理反应性分级标准将所有病例分为组织学反应显著组(MHR)与非组织学显著反应组(NMHR)。采用 Mann-Whitney U 检验比较2组病灶 tChoI、ADC 值及变化率的差异。采用受试验者工作特征曲线(ROC)分析2种方法对病理反应性评估的效能,并获得诊断临界点。结果14例为 MHR 组,8例为 NMHR 组。全程化疗后2组病例各组参数及变化率均有统计学意义,且诊断效能较高,全程化疗后最小 ADC(ADCmin )最佳临界预测值为0.913×10-3 mm2/s[曲线下面积(AUC)=0.952,P =0.000],敏感性为85.7%,特异性为100.0%；3D1 H-MRS 的tChoI 变化率最佳临界预测值为81.25%(AUC=0.881,P =0.008),敏感性为71.4%,特异性为100.0%；肿瘤 ADCmin 及 tChoI 变化率较平均 ADC(ADCmean )变化率诊断效能更高。结论应用3D1 H-MRS 联合 DWI 能更好地评估乳腺癌新辅助化疗疗效,并对患者的进一步治疗提供更详细准确的依据。
目的：研究乳腺癌患者新輔助化療前、1箇療程後、全程化療後三維氫質子磁共振波譜(3D1 H-MRS)複閤膽堿峰下麵積值(tChoI)及磁共振擴散加權成像(DWI)錶觀擴散繫數(ADC)值的變化對新輔助化療病理反應性評估的預測及診斷價值。方法前瞻性分析22例乳腺癌患者3次 MR 檢查中 tChoI 及 ADC 值的變化。按照 Miller/Payne 病理反應性分級標準將所有病例分為組織學反應顯著組(MHR)與非組織學顯著反應組(NMHR)。採用 Mann-Whitney U 檢驗比較2組病竈 tChoI、ADC 值及變化率的差異。採用受試驗者工作特徵麯線(ROC)分析2種方法對病理反應性評估的效能,併穫得診斷臨界點。結果14例為 MHR 組,8例為 NMHR 組。全程化療後2組病例各組參數及變化率均有統計學意義,且診斷效能較高,全程化療後最小 ADC(ADCmin )最佳臨界預測值為0.913×10-3 mm2/s[麯線下麵積(AUC)=0.952,P =0.000],敏感性為85.7%,特異性為100.0%；3D1 H-MRS 的tChoI 變化率最佳臨界預測值為81.25%(AUC=0.881,P =0.008),敏感性為71.4%,特異性為100.0%；腫瘤 ADCmin 及 tChoI 變化率較平均 ADC(ADCmean )變化率診斷效能更高。結論應用3D1 H-MRS 聯閤 DWI 能更好地評估乳腺癌新輔助化療療效,併對患者的進一步治療提供更詳細準確的依據。
목적：연구유선암환자신보조화료전、1개료정후、전정화료후삼유경질자자공진파보(3D1 H-MRS)복합담감봉하면적치(tChoI)급자공진확산가권성상(DWI)표관확산계수(ADC)치적변화대신보조화료병리반응성평고적예측급진단개치。방법전첨성분석22례유선암환자3차 MR 검사중 tChoI 급 ADC 치적변화。안조 Miller/Payne 병리반응성분급표준장소유병례분위조직학반응현저조(MHR)여비조직학현저반응조(NMHR)。채용 Mann-Whitney U 검험비교2조병조 tChoI、ADC 치급변화솔적차이。채용수시험자공작특정곡선(ROC)분석2충방법대병리반응성평고적효능,병획득진단림계점。결과14례위 MHR 조,8례위 NMHR 조。전정화료후2조병례각조삼수급변화솔균유통계학의의,차진단효능교고,전정화료후최소 ADC(ADCmin )최가림계예측치위0.913×10-3 mm2/s[곡선하면적(AUC)=0.952,P =0.000],민감성위85.7%,특이성위100.0%；3D1 H-MRS 적tChoI 변화솔최가림계예측치위81.25%(AUC=0.881,P =0.008),민감성위71.4%,특이성위100.0%；종류 ADCmin 급 tChoI 변화솔교평균 ADC(ADCmean )변화솔진단효능경고。결론응용3D1 H-MRS 연합 DWI 능경호지평고유선암신보조화료료효,병대환자적진일보치료제공경상세준학적의거。
Objective To determine whether tChoI and ADC and their changes could be applied to predict pathologic response be-fore,during and after NAC of locally advanced breast.To assess the diagnostic performance of each parameter.Methods The tChoI and ADC and their changes in 22 women who underwent MRI before,during and after the NAC were analyzed prospectively.All pa-tients were divided into major histological response group and non-major histological response group by methods of Miller and Payne system according to the final pathologic response.Pre-and post-treatment measurements and changes in tChoI and ADC values in MHR versus NMHR were analyzed using Mann-Whitney U test.ROC curve analysis was performed to assess the diagnostic per-formance of each parameter and also to identify which parameter could be used to predict the pathologic response to NAC and find the optimal cut off value for MHR prediction.Results After NAC,14 patients showed MHR and 8 showed NMHR.After NAC,all the parameters and their changes were significantly different between the MHR and NMHR groups,the change rate of all parameters af-ter NAC can actively diagnosis the MHR according ROC(AUC>0.5).Using 0.913 ×10 -3 mm2/s of ADCmin after NAC as the cut off value,prediction of MHR with sensitivity and specificity was 85.7% and 100%,respectively.Using 81.25% of the change rate of tCho I after NAC as the cut off value,prediction of MHR with sensitivity and specificity was 71.4% and 100%,respectively(AUC=0.881,P =0.008).The △ADCmin 2% and △tChoI2% are better than △ADCmean 2%.Conclusion Application of 3D 1 H-MRS and DWI can predict pathologic response and may provide more detailed and accurate evidence for subsequent treatment.
