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[目的]探讨应用MRI在乳腺癌新辅助化疗早期检测肿瘤的变化,对预测疗效的价值。[方法]Ⅱ、Ⅲ期乳腺癌新辅助化疗26例,27个病灶,均为浸润性导管癌。化疗前和两周期化疗后行动态增强MRI和扩散加权成像(DWI)检查,通过时间信号强度曲线(TIC)测量和计算病变信号上升率(SI)、最大信号上升速率(Vmax)、排出率(Ewash)和最大排出速率(Vwash)的变化,并测量表观扩散系数(ADC)值变化。化疗3～6个周期后手术,以Miller&Payne病理疗效评价作为金标准,并将Ⅴ、Ⅳ和Ⅲ级病例为有效组,Ⅰ和Ⅱ级为无效组。分析研究化疗2周期后增强MRI和DWI的变化对预测疗效的价值。[结果]27个病灶临床疗效,CR5例,PR18例,SD4例。病理疗效中有效组为22例(Ⅲ级为15例,Ⅳ级为4例,Ⅴ级为3例);无效组为5例,均为Ⅱ级。SI均值为96.82±27.91,化疗后,有效组SI降低,平均降低21.09±27.57,无效组增高,平均增高3.40±19.80(P=0.076);Vmax的均值为254.85±82.75,化疗后,有效组Vmax明显下降122.00±117.89,无效组则有所上升,平均上升19.78±80.47(P=0.019);Ewash的均值为-13.32±9.54,化疗后,两组均上升,分别为13.94±18.85和11.36±14.71(P=0.780);Vwash均值为19.63±16.71,化疗后,两组均下降,分别为5.99±15.23和12.87±30.58(P=0.472)。27个病灶可进行化疗前ADC的测量。25个病灶可进行化疗后ADC的测量。有效组化疗前ADC值为(0.9468±0.2232)×10-3mm2/s,高于无效组的(0.7080±0.1040)×10-3mm2/s(P<0.05)。ROC曲线下面积为0.895,诊断界点为0.81×10-3mm2/s时,预测化疗有效的敏感度为86.4%,特异度为80.0%。[结论]乳腺癌新辅助化疗早期,用动态增强MRI的Vmax的变化具有预测化疗反应的价值。初始ADC值可能是预测化疗疗效的指标。
[Objective] To explore the value of using MRI to detect tumor changes in the early stage of neoadjuvant chemotherapy for breast cancer and predict the efficacy of the treatment. [Methods] 26 cases of neoadjuvant chemotherapy for stage Ⅱ and Ⅲ breast cancer and 27 lesions were all invasive ductal carcinoma. Dynamic enhanced MRI and diffusion weighted imaging (DWI) were performed before chemotherapy and after two cycles of chemotherapy, and the changes of SI, Vmax and EVD were measured and calculated by time signal intensity curve (TIC) Ewash and Vwash, and measured changes in apparent diffusion coefficient (ADC) values. Chemotherapy after 3 to 6 cycles of surgery, the Miller & Payne pathological efficacy evaluation as the gold standard, and the Ⅴ, Ⅳ and Ⅲ grade cases for the effective group, Ⅰ and Ⅱ for the invalid group. To analyze the value of enhanced MRI and DWI changes after 2 cycles of chemotherapy in predicting the curative effect. [Results] The clinical efficacy of 27 lesions, CR5 cases, PR18 cases, SD4 cases. The effective group was 22 cases (Ⅲ grade 15 cases, Ⅳ grade 4 cases, Ⅴ grade 3 cases); invalid group 5 cases, are Ⅱ grade. The mean value of SI was 96.82 ± 27.91. After chemotherapy, the SI of effective group was decreased by 21.09 ± 27.57 on average, while the effective group was increased by 3.40 ± 19.80 (P = 0.076), the mean of Vmax was 254.85 ± 82.75. After chemotherapy, the effective group Vmax (P = 0.019). The average value of Ewash was -13.32 ± 9.54. After chemotherapy, the two groups increased by 13.94 ± 18.85 and 11.36 ± 14.71 (P = 0.780). The mean of Vwash was 19.63 ± 16.71. After chemotherapy, both groups were decreased to 5.99 ± 15.23 and 12.87 ± 30.58, respectively (P = 0.472). 27 lesions can be measured before chemotherapy ADC. 25 lesions can be measured after chemotherapy ADC. The ADC value of the effective group was (0.9468 ± 0.2232) × 10-3mm2 / s, higher than that of the invalid group (0.7080 ± 0.1040) × 10-3mm2 / s (P <0.05). The area under the ROC curve was 0.895 and the diagnostic cutoff was 0.81 × 10-3 mm2 / s. The effective sensitivity and predictive accuracy of the chemotherapy were 86.4% and 80.0% respectively. [Conclusion] The change of Vmax in dynamic enhanced MRI in the early stage of neoadjuvant chemotherapy for breast cancer has the value of predicting the response to chemotherapy. Initial ADC values may be predictors of response to chemotherapy.