磁共振成像在乳腺癌新辅助化疗疗效评估中的应用

目的 探讨磁共振成像(MRI)指标在乳腺癌新辅助化疗(neodjuvant chemotherapy,NCT)疗效评价中的价值.方法 对我院76例女性乳腺癌患者76处病灶进行NCT前第一次MRI检查,NCT后3个月内再做第二次MRI复查,分别对比两次MRI检查中各指标的不同,病灶最大径为10～92 mm.结果 NCT前后病灶表面弥散系数(ADC)值为(0.94±0.18)×10-3 mm2 /s和(1.16±0.30)×10-3 mm2 /s,差异有统计学意义(S=1074.5,P＜0.0001);NCT前后时间-信号强度曲线(TIC)类型有由Ⅲ型向Ⅰ型变化的趋势,且差异有统计学意义(Hc=47.1845,P<0.0001).病灶最大长径的诊断准确率为94.7%;病灶功能指标TIC和ADC值的诊断准确率分别为81.6%和76.3%;综合功能指标诊断准确率为89.5%,与病灶大小的诊断准确率间无统计学差异(2=0.8143,P=0.3669＞0.05),高于ADC值的诊断准确率.结论 乳腺癌NCT后病灶缩小、ADC值升高、TIC有向Ⅰ型的变化趋势;在评价NCT疗效时,病灶最大直径的变化在绝大多数情况下可以代表疗效;病灶MRI综合功能指标优于单项指标,且接近病灶最大直径的评估准确性.

Application of MR imaging to evaluation of neoadjuvant chemotherapy of breast cancer

Objective To investigate the advantage of magnetic resonance imaging（MRI） in evaluating the feasibility of neoadjuvant chemotherapy（NCT） for breast cancer.Methods Seventy-six breast cancer patients were imaged with MRI before and after the neoadjuvant chemotherapy during less than three months.The maximum lesion diameter was about 10-92 mm.The MRI indexes of each lesion were compared respectively.Results After NCT,the lesion′s apparent diffusion coefficients（ADC） value was reduced from（0.94±0.18）×10^-3mm^2/s to（1.16±0.30）×10^-3mm^2/s,and the difference was statistically significant（S=1074.5,P0.0001）.Time-signal intensity curve（TIC） types shifted from type Ⅲ to type Ⅰ,and the difference was statistically significant（Hc=47.1845,P0.0001）.The diagnostic accuracy of the maximum diameter of lesions was 94.7%,and the diagnostic accuracy of the two different function indexes,TIC and ADC,was 81.6% and 76.3%,respectively.The diagnostic accuracy of the integrated function index was 89.5%,which had no significant difference from the diagnostic accuracy of the size（x2=0.8143,P=0.36690.05） and was higher than the value of the diagnostic accuracy of ADC.Conclusion After breast cancer patients receive NCT,lesions shrink.TIC changes from type Ⅲ to type Ⅰ and ADC is increased（P0.05）.In most cases,the change in the maximum diameter of lesions might represent the change in size in the evaluation of effects of NCT.Integrated functional indexes are better than an individual indicator in that they are close to the assessment accuracy of the maximum diameter of lesions.