【作者】 张晓鹏； 李洁； 陆爱萍； 欧阳涛； 孙应实； 曹崑； 唐磊； 单军； 汪宁；

【Author】 Zhang Xiao-Peng Li Jie Lu Ai-Ping Ou Yang-Tao Sun Ying-Shi Tang Lei Shan Jun Wang Ning Beijing Cancer Hospital & Clinical oncology Institute, Peking University, Radiology department, Beijing, 100036

【机构】 北京市肿瘤医院北京大学临床肿瘤学院放射科； 北京市肿瘤医院北京大学临床肿瘤学院病理科； 北京市肿瘤医院北京大学临床肿瘤学院乳腺中心；

【摘要】 目的:探讨乳腺癌新辅助化疗后动态增强MRI表现的形态学和时间信号强度曲线类型与病理学反应性的关系。方法:45例乳腺癌新辅助化疗结束后行乳腺DEC—MRI 检查和手术治疗。应用1．5T磁共振扫描机和乳腺专用扫描线圈,3D SPGR快速扫描序列进行动态增强扫描,Gd— DTPA增强前及增强后双乳连续动态采集共7期。应用 AW4．2图像工作站的Functool软件对残余强化的形态和时间信号强度曲线类型进行评估。对手术后切除标本进行病理学检查,参考乳腺癌新辅助化疗后Miller & Payne病理反应性分级方法,对比化疗前穿刺组织学活检切片,将乳腺癌化疗后病理反应性分为五级,5级为无浸润性癌残存,代表病理完全缓解,4级为浸润性癌组织减少超过90％,3级为浸润性癌组织减少30—90％,2级位浸润性癌组织减少小于 30％,1级为浸润性癌化疗后较前无变化。以4级和5级代表了组织学显著反应。分析不同病理反应性级别与DEE-MRI 残余强化的形态和时间信号强度曲线类型表现的差异,统计方法采用精确概率法。结果: 45例中病理反应性5级、4 级、3级和1-2级分别为7例、16例、16例和6例。7例5 级反应中有4例未见任何强化表现。组织学显著反应组23 例中有残余强化的共18例,其中非肿块性强化占61．1％(11／ 18),肿块性强化占38．9％(7／18)。非肿块性强化中组织学显著反应者占78．6％(11／14),而肿块性强化中组织学显著反应者仅占26．9％(7／26)。残余强化的肿块／非肿块形态表现在不同病理反应性分级的分布有显著差异(P=0．012, <0．05)。20例I型曲线中组织学显著反应者占70．0％(14／ 20),而6例III型曲线均为非组织学显著反应。时间信号强度曲线类型在不同的反应级别显著差异(P=0．001 <0．01)。结论:乳腺癌新辅助化疗后病理反应性与动态增强MRI形态及血流动力学表现特点相关。残余强化的非肿块性形态及I型时间信号强度曲线与组织学显著反应有关,肿块性形态和III型时间信号强度曲线与组织学非显著反应有关。更多还原

【Abstract】 Objective: To Investigate the relationship between pathological response status of residual disease and manifestations of residual enhancement in dynamic contrast-enhanced MRI in patient of breast cancer after neoadjuvant chemotherapy. Methods: Forty-five patients with pathologically confirmed breast carcinoma who finished courses of neoadjuvant chemotherapy had exanimation of breast MRI prior to operation. Dynamic contrast-enhanced MRI scan were performed on a 1.5 T scanner using 3D SPGR sequence before and 6 times after administration of Gd-DTPA. Pathological response was assessed by a pathologist according Miller & Payne five points classification without known breast MRI results. Grade 5 was defined as pCR(pathological complete response), Grade 4 and 5 were defined as MHR (major histopathological response). The morphology finding and time signal intensity curve type of residual enhancement were recorded for each patient and correlated with its pathological response status of residual disease. Fisher exact test was used for statistical analysis. Results: There were 7,16,16 and 6 cases demonstrated as pathological response of 5,4,3 and 1-2 grades respectively. Foue out of 7 cases in the grade 5 group represented without any enhancement in the area of tumor bed. Eighteen cases out of 23 MHR has residual enhancement, of which 11 (61.1%) cases were non-mass enhancement and only 7 (38.9%) case were mass enhancement. 78.6% (11/14) of non-mass enhancement, compaired with only 26.9% (7/26 ) of mass enhancement, were MHR. 70.0% (14/20) of type I curve was MHR, while all of 6 type III curves were non-MHR response. The type of time signal intensity curve in pathological response grades was different significantly (P=0.001 <0.01). Conclusion: Pathological response status of breast cancer after neoadjuvant chemotherapy could be characterized in dynamic contrast-enhanced MRI by morphological and kinetic curve. Non-mass enhancement and type I curve indicate good pathological response status, while mass enhancement and type III curve indicate non-MHR and focal residual disease.更多还原