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目的探讨乳腺癌新辅助化疗后动态增强 MRI(DCE-MRI)表现的形态学和时间信号强度曲线(TIC)类型与病理学反应性的关系。方法 45例乳腺癌患者经新辅助化疗结束后行乳腺 DCE-MR 检查及手术治疗。应用 AW 4.2图像工作站观察残余肿瘤强化的形态和 TIC 类型(共3型)。由病理科医师对乳腺癌化疗后手术标本的病理反应性进行评估,分为1～5级,5级为病理完全缓解,4级和5级为组织学显著反应。分析病理反应性级别与 DCE-MRI 残余强化的 TIC 类型、形态的关系,统计方法采用精确概率法。结果 45例中病理反应性5级7例,4级16例,3级16例,1和2级共6例。20例Ⅰ型曲线中组织学显著反应者占70.0%(14/20),而6例Ⅲ型曲线均为组织学反应不显著者。TIC 类型在不同的病理反应级别分布差异有统计学意义(P=0.001)。组织学显著反应且有残余强化者共18例,其中非肿块性强化11例。残余强化的肿块(非肿块)形态表现在不同病理反应性分级中分布差异有统计学意义(P=0.012)。结论乳腺癌新辅助化疗后 DCE-MRI 的形态及血液动力学表现特点与化疗后病理反应性相关。非肿块性强化和Ⅰ型 TIC 与组织学显著反应有关。
Objective To investigate the relationship between morphological and temporal signal intensity curves (TIC) types and pathological reactivity in dynamic enhanced MRI (DCE-MRI) after neoadjuvant chemotherapy in breast cancer. Methods 45 cases of breast cancer patients underwent neoadjuvant chemotherapy after the end of DCE-MR examination and surgical treatment. The residual tumor enhancement morphology and TIC type (type 3) were observed using an AW 4.2 image workstation. Pathologists evaluated the pathological response of breast cancer after surgical treatment of patients with grade 1 to 5, grade 5 with complete remission and grade 4 and 5 histologically significant responses. The relationship between the pathological reactivity level and TIC type and morphology of residual enhanced DCE-MRI was analyzed. The statistical method used the exact probability method. Results Among the 45 cases, there were 7 cases of grade 5, 16 cases of grade 4, 16 cases of grade 3 and 6 cases of grade 1 and 2. 20 cases of type Ⅰ curve histological significant reaction accounted for 70.0% (14/20), and 6 cases of type Ⅲ curve were histological reactions were not significant. There were significant differences in the distribution of TIC types in different pathological grades (P = 0.001). A significant histological reaction and residual enhancement in a total of 18 cases, of which non-mass enhancement in 11 cases. There was a statistically significant difference (P = 0.012) in the distribution of residual enhanced lumps (non-lumps) in different pathological grades. Conclusion The morphological and hemodynamic characteristics of DCE-MRI after neoadjuvant chemotherapy for breast cancer are related to the pathological reactivity after chemotherapy. Non-lumpy enhancement and type I TIC are associated with significant histological responses.