磁共振扩散加权成像在预测乳腺癌肝转移早期疗效中的作用

摘要

目的:探索磁共振扩散加权成像表观扩散系数(ADC)值在预测及早期评估乳腺癌肝转移(BCLM)化疗效果中的作用.方法:选择42例乳腺癌肝转移患者,分别于化疗前3d、化疗后1周、2周及4周进行常规MRI及扩散加权成像(DWI),并测量病灶的ADC值.采用实体肿瘤疗效评价标准(RECIST)作为评价乳腺癌肝转移化疗疗效的评价标准.结果:42例乳腺癌肝转移患者86个病灶中,40个病灶对化疗有效,46个病灶对化疗无效.化疗前有效组ADC值((1.06±0.07)×10-3 mm2/s)明显低于无效组((1.22±0.14)×10-3 mm2/s),且差异具有统计学意义(P＜0.05);化疗后1周,有效组ADC值((1.08±0.13)×10-3 mm2/s,P=0.144)较化疗前有所增加,无效组ADC值((1.20±0.16)×10-3 mm2/s,P=0.179)较化疗前有所降低,两者间差异均无明显统计学意义;化疗后2周及4周,有效组ADC值((1.28±0.11)×10-3 mm2/s,(1.36±0.10) ×10-3 mm2/s)较化疗前明显增高且差异有统计学意义(P＜0.05),而无效组无明显变化.ROC曲线下面积为0.846,以治疗前ADC=1.11×10-3 mm2/s作为判断化疗是否有效的界值,其敏感性与特异性为78.3％和87.5％.结论:治疗前ADC值结合治疗后2周ADC值有助于早期预测及评价BCLMs的化疗疗效.%Objective:To determine whether change of apparent diffusion coefficient (ADC) values could predict early response to chemotherapy in breast cancer liver metastases(BCLM).Methods:We retrospectively studied 42 patients with BCLMs (86 lesions) who had undergone conventional MRI and DWI at 3 days before chemotherapy and 1 week,2 weeks,4 weeks after chemotherapy.Selected patients were divided into responders (R) and non-responders (NR).The grouping reference was based on MRI according to response evaluation criteria in solid tumors(RECIST).Results:Eighty-six metastases were classified as 40 R and 46 NR.The difference in maximum tumor diameter of R group between pre-chemotherapy and 4 weeks after chemotherapy was significant(P＜0.05).Pretreatment mean ADC((1.06±0.07)×10-3 mm2/s) of R group was significantly lower than that of NR group((1.22±0.14)×10-3 mm2/s)(P＜0.05).After 1 week of chemotherapy,the mean ADC of R group increased slightly and the mean ADC of NR group decreased slightly,with no statistical significance.After 2 weeks and 4 weeks of chemothera py,the mean ADC of R group increased significantly but not in NR group.The results of ROC curve showed that areas of under the curve were 0.846,pretreatment ADC of 1.11×10-3 mm2/s concluded BCLMs to chemotherapy ineffective sensitivity and specificity value were 78.3％ and 87.5％,respectively.Conclusion:The pretreatment and 2 weeks after treatment ADC value may be helpful to predict early response to chemotherapy in BCLM.