摘要
目的探究联合应用单指数扩散加权成像(diffusion weighted imaging,DWI)、体素内不相干运动扩散加权成像(intra-voxel incoherent motion-DWI,IVIM-DWI)及扩散峰度成像(diffusion kurtosis imaging,DKI)所获各参数对乳腺动态增强MRIⅡ型平台型时间-信号曲线(time-signal intensity curve,TIC)病变良、恶性的鉴别诊断价值。材料与方法回顾性分析2019年10月至2021年1月经病理证实的乳腺TIC-Ⅱ型病变患者病例103例。根据病理结果分为良性组25例(25个病灶)和恶性组78例(78个病灶),测量其病变的DWI参数[表观扩散系数(apparent diffusion coefficient,ADC)]、IVIM参数[真实扩散系数(true diffusion coefficient,D)、灌注相关扩散系数(perfusion-related diffusion coefficient,D*)和灌注分数(perfusion fraction,f)]及DKI参数[平均扩散率(mean diffusion,MD)、平均扩散峰度(mean kurtosis,MK)]。使用独立样本t检验比较两组各参数的差异,进一步行单因素及多因素logistic回归分析,运用受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)分析各单一参数或不同扩散模型联合应用(DWI+IVIM、DWI+DKI、DWI+IVIM+DKI)对乳腺TIC-Ⅱ型良恶性病变的鉴别诊断效能。结果两组ADC值、D值、f值、MD值、MK值差异具有统计学意义(P<0.05),D*值差异无统计学意义(P>0.05)。多因素logistic回归分析示D值及MK值为两组鉴别诊断的独立影响因素,以MK值优势比最大,对应AUC为0.871,特异度为88.0%,敏感度为80.8%,准确度为78.6%。各联合模型之间的AUC差异均无统计学意义(P>0.05),以三模型联合的诊断效能最大,对应AUC为0.915,敏感度为92.3%,特异度为84.0%,准确度为86.4%。三模型联合的AUC高于DWI序列(AUC为0.816),差异具有统计学意义(P<0.05)。结论DWI联合IVIM及DKI对乳腺TIC-Ⅱ型良、恶性病变具有较好的鉴别诊断价值。
Objective:To explore the value of parameters obtained by mono-exponential diffusion-weighted imaging(DWI),intravoxel incoherent motion-DWI(IVIM-DWI)and diffusion kurtosis imaging(DKI)in the differential diagnosis of benign and malignant breast lesions with plateau time-signal-curve(TIC)type-Ⅱin dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI).Materials and Methods:A total of 103 cases with breast TIC type-Ⅱlesions in the Affiliated Hospital of Jining Medical University from October2019 to January 2021 were reviewed retrospectively.The patients were divided into benign group(25 patients,25 lesions)and malignant group(78 patients,78 lesions)according to the pathological results,the ADC value,true diffusion coefficient(D value),perfusion-related diffusion coefficient(D*value),perfusion fraction(f value),mean diffusion rate(MD value)and mean kurtosis value(MK value)were measured.Independent samples t-test was used to compare the differences of each parameter between the two groups,and univariate/multivariate logistic regression analyses were further performed.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the diagnostic efficacy of each parameter alone or combination diffusion models(DWI+IVIM,DWI+DKI and DWI+IVIM+DKI)in differentiating benign and malignant breast TIC type-Ⅱlesions.Results:The ADC,D,f,MD,and MK values of the two groups were significantly different(P<0.05),but the D*value of the two groups had no significant difference(P>0.05).Multiple logistic regression analysis showed that the D value and MK value were independent influencing factors in the differential diagnosis of the two groups,with the largest odds ratio for MK value(AUC 0.871,specificity 88.0%,sensitivity 80.8%and accuracy78.6%).There was no significant difference in AUC among each combined diffusion model(P>0.05),but three-combination diffusion model achieved the greatest diagnostic efficiency(AUC 0.915,sensitivity 92.3%,specificity 84.0%and accuracy 86.4%),and the AUC of which was statistically higher than that of DWI(AUC 0.816,P<0.05).Conclusions:DWI combined with IVIM and DKI have a good differential diagnostic value for benign and malignant breast TIC type-Ⅱlesions.
作者
王洪杰
王唯伟
吕四强
褚瑶
刘尚宽
朱来敏
陈月芹
孙占国
WANG Hongjie;WANG Weiwei;LÜ Siqiang;CHU Yao;LIU Shangkuan;ZHU Laimin;CHEN Yueqin;SUN Zhanguo(Clinical Medical College of Jining Medical University,Jining 272013,China;Department of Medical Imaging,Affiliated Hospital of Jining Medical University,Jining 272029,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2022年第9期18-24,共7页
Chinese Journal of Magnetic Resonance Imaging
基金
山东省医药卫生科技发展计划项目(编号:202009011151)
山东省中医药科技项目(编号:Q-2022132)。
关键词
乳腺癌
磁共振成像
扩散加权成像
体素内不相干运动
扩散峰度成像
breast neoplasms
magnetic resonance imaging
diffusion-weighted imaging
intravoxel incoherent motion
diffusion kurtosis imaging
