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目的探讨基于动态增强磁共振成像(DCE-MRI)及特定药物动力学模型所获得的量化参数与乳腺癌组织病理相关性。方法搜集61例乳腺癌患者DCE-MRI资料,通过后处理软件生成如下量化参数,定量参数:转移常数(K~(trans))、速率常数(K_(ep))、血浆分数(V_p);半定量参数:(1)增强扫描病灶达峰时间(TTP);(2)增强扫描病灶内对比剂最大浓度值(MAX Conc);(3)增强扫描时间信号曲线下面积(AUC);(4)增强扫描时间信号曲线最大斜率值(MAX Slope)。所有患者MRI检查后1周内经手术或穿刺活检取得病理结果。采用Kruskal-Wallis检验及Mann-Whitney U检验两两比较导管内癌组,非特殊类型浸润性癌组及特殊类型癌组间各量化参数的差异。采用Mann-Whitney U检验分析低组织学分级组(包括Ⅰ级和Ⅱ级)和高组织学分级组(Ⅲ级)、有淋巴结转移组和无淋巴结转移组间各量化参数的差异。结果 61例乳腺癌分为导管内癌组8例,非特殊类型浸润性癌组48例,特殊类型癌组5例。导管内癌组量化参数值K~(trans) Max=0.651(0.209 min~(-1))、K_(ep) Max=0.865(0.198)min~(-1)、K_(ep) Mean=0.270(0.021)min~(-1)明显小于特殊类型癌组量化参数值K~(trans) Max=1.390(0.846)min~(-1)、K_(ep)Max=2.169(1.122)min~(-1)、K_(ep)Mean=0.512(0.449 min~(-1)),P值分别为0.025、0.020、0.038。非特殊类型浸润性癌组量化参数Ktrans Max=0.740(0.078)min~(-1)、K_(ep)Mean=0.235(0.023)min~(-1)及MAX Conc Max=0.188(0.013)小于特殊类型癌组间量化参数K~(trans) Max=1.390(0.846)min~(-1)、K_(ep) Mean=0.512(0.449)min~(~(-1))及MAX Conc Max=0.385(0.238),P值分别为0.043、0.025、0.036。非特殊类型浸润性癌组根据组织学分级,分为低组织学分级组(包括Ⅰ级和Ⅱ级)34例,高组织学分级组(Ⅲ级)12例。根据淋巴结转移状态,分为无淋巴结转移组37例,有淋巴结转移组24例,结果显示较低分化组与高分化组、无淋巴结转移组与有淋巴结转移组间各量化参数间差异无统计学意义。结论基于DCE-MRI技术及特定的药物动力学模型所获得的部分量化参数在乳腺癌不同病理类型间存在差异。
Objective To investigate the relationship between quantitative parameters and histopathology of breast cancer based on dynamic enhanced magnetic resonance imaging (DCE-MRI) and specific pharmacokinetic models. Methods Sixty-one breast cancer patients with DCE-MRI data were collected and the following parameters were quantified by post-processing software. The quantitative parameters were K (trans), K (ep), and plasma fraction Quantitative parameters: (1) enhanced scan time to peak (TTP); (2) enhanced scan contrast maximum concentration (MAX Conc); (3) enhanced scan time signal under the curve area Increase the maximum slope of the sweep time signal curve (MAX Slope). All patients underwent pathological examination by surgery or biopsy within 1 week after MRI examination. Kruskal-Wallis test and Mann-Whitney U test were used to compare the differences of quantification parameters between intraductal carcinoma group, non-special type invasive carcinoma group and special type carcinoma group. The Mann-Whitney U test was used to analyze the differences of the quantitative parameters among the low histological grade group (including Grade I and II) and the high histological grade group (Grade III) with lymph node metastasis and no lymph node metastasis. Results 61 cases of breast cancer were divided into intraductal carcinoma group of 8 cases, non-special type of invasive carcinoma group of 48 cases, special type of cancer group of 5 cases. The intracranial cancer group had the highest values of K (trans) Max = 0.651 (0.209 min -1), K ep ep max = 0.865 (0.198) min -1, K ep ep = 0.270 0.021) min ~ (-1) was significantly lower than that of the special type of cancer group, the maximal value of Max was 1.390 (0.846) min ~ (-1), K ep max was 2.169 (1.122) min ~ ), K ep (ep) Mean = 0.512 (0.449 min -1), P values were 0.025,0.020,0.038 respectively. Ktrans Max = 0.740 (0.078) min -1, K ep (ep) Mean = 0.235 (0.023) min ~ (-1) and MAX Conc Max = 0.188 (0.013) were lower than those of non-specific type of invasive carcinoma The quantitative parameters of the type of cancer group were Kc = 1.390 (0.846) min -1, K ep (ep) Mean = 0.512 (0.449) min ~ (-1) and MAX Conc Max = 0.385 0.238), P values were 0.043,0.025,0.036. According to histological grade, non-special type of invasive cancer group was divided into low histological grade group (including Ⅰ and Ⅱ grade) 34 cases, high histological grade group (Ⅲ grade) 12 cases. According to the status of lymph node metastasis, there were 37 cases without lymph node metastasis and 24 cases with lymph node metastasis. The results showed that there was no statistical difference between the low differentiation group and the well-differentiated group, the non-lymph node metastasis group and the lymph node metastasis group significance. Conclusion The partial quantification parameters obtained on the basis of DCE-MRI technique and specific pharmacokinetic model are different in different pathological types of breast cancer.