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[目的]探讨核磁共振成像(MRI)全身弥散加权成像(WB-DWI)在评估乳腺癌术前实施新辅助化疗疗效中的应用价值。[方法]采用前瞻性研究方法,选取接受术前新辅助化疗的64例患者(64个病灶)作为研究对象,对患者化疗前、化疗一个疗程结束时及化疗结束时分别行DWI成像检查,测量病灶变化及表观系数(ADC)值的变化及其相互关系。[结果]新辅助化疗64例患者,其中有效48例(75%)(CR 6例、PR 23例、SD 19例),无效16例(25%)。化疗前ADC值为(1.024±0.132)×10~(-3)mm·s~(-2)与第一化疗疗程结束时的(1.065±0.121)×10~(-3)mm·s~(-2)差异不显著(P>0.05),但与化疗结束时的(1.225±0.127)×10~(-3)mm·s~(-2)差异显著(P<0.05)。化疗前肿瘤最大径线值为(43.62±17.63)mm与第一化疗疗程结束时的(41.77±16.94)mm差异不显著(P>0.05),但与化疗结束时的(36.82±16.05)mm差异显著(P<0.05)。ADC值变化率与肿瘤最大径线呈显著的负相关关系(r=-0.513,P<0.001)。有效组患者的化疗前ADC值为(1.068±0.127)×10~(-3)mm·s~(-2)、化疗一个疗程后(1.154±0.118)×10~(-3)mm·s~(-2)、化疗结束(1.299±0.124)×10~(-3)mm·s~(-2)、变化率为21.63+4.57均显著高于无效组患者。DC值判定新辅助化疗有效患者的灵敏度为91.67%、特异性为87.5%、误诊率为12.5%、漏诊率为8.33%,ROC曲线下面积AUC为0.931。[结论]乳腺癌术前实施新辅助化疗中应用MRI全身弥散加权成像对患者的化疗效果进行评估具有可行性和一定的临床价值。
[Objective] To investigate the value of MRI whole body diffusion weighted imaging (WB-DWI) in assessing the effect of neoadjuvant chemotherapy before breast cancer surgery. [Methods] Sixty-four patients (64 lesions) receiving neoadjuvant chemotherapy before surgery were selected as prospective study methods. DWI imaging was performed on the patients before chemotherapy, at the end of one course of chemotherapy and at the end of chemotherapy. Changes of lesions and changes of apparent coefficient (ADC) values and their correlations. [Results] Among 64 neoadjuvant chemotherapy patients, 48 (75%) were effective (CR 6, PR 23, SD 19) and 16 (25%) were ineffective. The ADC value before chemotherapy was (1.024 ± 0.132) × 10 ~ (-3) mm · s ~ (-2) and (1.065 ± 0.121) × 10 ~ (-3) mm · s ~ (P <0.05). However, the difference was not significant (1.225 ± 0.127) × 10 -3 mm · s -2 at the end of chemotherapy. The maximum diameter of tumor before chemotherapy (43.62 ± 17.63) mm was not significantly different from that at the end of the first chemotherapy (41.77 ± 16.94) mm (P> 0.05), but was significantly different from that at the end of chemotherapy (36.82 ± 16.05) mm Significant (P <0.05). The rate of change of ADC value was significantly negatively correlated with the maximum diameter of tumor (r = -0.513, P <0.001). The ADC value before chemotherapy in the effective group was (1.068 ± 0.127) × 10 ~ (-3) mm · s ~ (-2), after one course of chemotherapy (1.154 ± 0.118) × 10 ~ (-3) mm · s ~ (-2), the end of chemotherapy (1.299 ± 0.124) × 10 ~ (-3) mm · s ~ (-2), the change rate of 21.63 + 4.57 were significantly higher than those in the invalid group. The sensitivity of DC was 91.67%, the specificity was 87.5%, the misdiagnosis rate was 12.5% and the rate of misdiagnosis was 8.33%. The area under the ROC curve was 0.931. [Conclusion] The application of MRI whole body diffusion weighted imaging in the preoperative neoadjuvant chemotherapy for breast cancer has the feasibility and certain clinical value in evaluating the chemotherapy effect of the patients.