Klostergaard Jim, Parga Kenia, Raptis Raphael G
Department of Molecular and Cellular Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA.
P R Health Sci J. 2010 Sep;29(3):223-31.
Magnetic resonance imaging (MRI) is occupying an increasing niche in the clinical diagnostic workup of several cancers, including breast cancers. Despite the high level of implementation of mammography, it has become apparent that MRI can play at least a complementary role in the imaging and diagnosis of primary breast cancers, including ductal carcinoma in situ, the earliest stage of breast cancer that is associated with an increased risk of invasive breast cancer. This can also be said of inflammatory breast cancer, of low incidence but with high impact on overall breast cancer mortality rates, and for which mammography is not ideal due to the typically diffused nature of this disease. Much of the value of breast MRI is dependent on its high sensitivity, resulting from the use of contrast agent enhancement in the detection of breast cancer. Interest has also increased in the application of diffusion-weighted MRI for early assessment of treatment response in this disease. Regarding ovarian and other gynecological cancers, MRI has already demonstrated value in the evaluation of patients with ovarian masses, uterine leiomyoma, endometrioma, and cervical cancer. Features on MRI suggestive of malignant ovarian tumors are varied, and span irregular or solid components to a cystic mass, prominent septations, evidence of peritoneal, hematogenous, or lymphatic spread, or local invasion. The majority of ovarian malignancies are diagnosed in advanced, incurable stages, where exploratory laparotomy provides the opportunity for maximal debulking. Although a role for MRI has yet to be established in this initial setting or in staging, some studies have shown that high sensitivity may be achieved with contrast agent-enhanced MRI for detection of recurrent disease, including demonstration of macroscopic intraabdominal dissemination and the hallmark omental "cake". Efforts in recent years have been focused on design of MRI contrast agents (MRI-CAs), which either target biomarkers, or take advantage of the different physiology of cancerous cells. MRI-CAs based on gadolinium complexes, ferrumoxides, or other metallic nanoparticles have been investigated. This review will focus on the recent progress in the application of MRI to the imaging of breast and ovarian cancers, and present a possible role for molecularly-targeted contrast agents in enriching the context for MRI-based diagnosis.
磁共振成像（MRI）在包括乳腺癌在内的多种癌症的临床诊断检查中所占的份额越来越大。尽管乳腺钼靶检查的应用水平很高，但很明显，MRI在原发性乳腺癌的成像和诊断中至少可以发挥辅助作用，包括导管原位癌，这是乳腺癌的最早阶段，与浸润性乳腺癌风险增加相关。炎症性乳腺癌也是如此，其发病率低，但对乳腺癌总体死亡率影响大，由于这种疾病通常具有弥漫性，乳腺钼靶检查对此并不理想。乳腺MRI的很大一部分价值取决于其高灵敏度，这是通过使用造影剂增强来检测乳腺癌实现的。扩散加权MRI在该疾病治疗反应早期评估中的应用也越来越受到关注。关于卵巢癌和其他妇科癌症，MRI已在评估卵巢肿块、子宫平滑肌瘤、子宫内膜瘤和宫颈癌患者方面显示出价值。MRI上提示恶性卵巢肿瘤的特征多种多样，包括不规则或实性成分、囊性肿块、明显的分隔、腹膜、血行或淋巴转移的证据或局部侵犯。大多数卵巢恶性肿瘤在晚期无法治愈的阶段被诊断出来，此时剖腹探查术为最大限度地减瘤提供了机会。尽管MRI在这种初始情况或分期中的作用尚未确立，但一些研究表明，造影剂增强MRI在检测复发性疾病方面可能具有高灵敏度，包括显示宏观的腹腔内播散和标志性的网膜“饼”。近年来的努力集中在MRI造影剂（MRI-CAs）的设计上，这些造影剂要么靶向生物标志物，要么利用癌细胞的不同生理学特性。基于钆配合物、铁氧化物或其他金属纳米颗粒的MRI-CAs已被研究。本综述将重点关注MRI在乳腺癌和卵巢癌成像应用中的最新进展，并介绍分子靶向造影剂在丰富基于MRI的诊断背景方面可能发挥的作用。
