Boulogianni G, Chryssogonidis I, Drevelegas A
Diagnostic Radiology Department, Interbalkan Medical Center, Thessaloniki, Greece.
Diagnostic Radiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Hippokratia. 2016 Jul-Sep;20(3):192-197.
The most common histological types of invasive breast carcinomas are the invasive ductal carcinoma (IDC) and the invasive lobular carcinoma (ILC). The purpose of our study was to evaluate the role of the diffusion-weighted imaging (DWI) and the in vivo proton magnetic resonance spectroscopy (H-MRS ) at 3 Tesla magnet in invasive breast cancer and correlate them with the dynamic contrast enhancement (DCE) and pathologic findings.
We retrospectively studied at 3Tesla magnet the apparent diffusion coefficient (ADC) values, the detection of choline in the H-MRS and the kinetic analyses obtained after DCE in 181 patients with histologically confirmed invasive breast carcinomas. Among these patients, 160 had IDC and 21 ILC. We used the DWI sequence with a b value of 1,000 mm/sec for the calculation of the ADC value, the fat-suppressed point-resolved spectroscopy (PRESS) sequence in order to evaluate the existence of a choline peak in the spectrum and the TW GRE FAT SAT VIBRANT sequence for the characterization of the kinetic curves. Finally, we correlated the pathologic type of invasive cancer, as well as the type of the kinetic curve with the ADC value and the detectability of choline resonance in the spectrum in each of the 181 patients.
The ADC values in the 158 out of 160 IDC patients, ranged from 0.5 x 10 to 1.2 x 10 mm/sec, with 78.1 % having ADC value of 1 x 10 mm/sec. Regarding the H-MRS, in 121 out of 160 IDC patients, choline was found in 72.3 %. The ADC values in the 21 ILC patients also ranged from 0.5 x 10 to 1.2 x 10 mm/sec with 57.1 % having ADC value of 1 x 10 mm/sec. Regarding the H-MRS, in 10 out of 21 ILC patients, detection of choline was positive in 60 % of them. In the 21 ILC patients, the kinetic analysis after the dynamic administration of contrast medium showed type I (persistent) curve in 4.3 %, type II (plateau) curve in 33.3 % and type III (washout) in 52.4 %. In the 158 IDC patients (missing in two cases) type I curve was obtained in 0.63 %, type II in 19.4 % and type III in 80 %. From the correlation analysis of the IDC results using Kruskal-Wallis Test and the non-parametric Kendall's tau-b test, the curve type was positively associated (Kendal tau-b: 0.254, p =0.005) with the presence of choline, while the ADC value was negatively associated (Kendal tau-b: -0.224, p =0.011) with the presence of choline. In the ILC cases, the sample was insufficient for the correlation to become statistically significant. However, the ADC values tended to be lower in IDC patients (78.1 % having ADC value 1 x 10 mm/sec) compared to ILC (57.1 % having ADC value 1 x 10 mm/sec). Choline was more commonly detected in the IDC (72.3 %) than ILC (60 %) patients.
Our results are consistent with previous findings that both ADC values and choline detection in the spectrum play a significant role in establishing the final diagnosis of malignancy, especially when the kinetic pattern of enhancement is misleading. Hippokratia 2016, 20(3): 192-197.
浸润性乳腺癌最常见的组织学类型是浸润性导管癌（IDC）和浸润性小叶癌（ILC）。我们研究的目的是评估3特斯拉磁共振成像中的扩散加权成像（DWI）和体内质子磁共振波谱（H-MRS）在浸润性乳腺癌中的作用，并将它们与动态对比增强（DCE）及病理结果相关联。
我们回顾性研究了181例经组织学确诊的浸润性乳腺癌患者在3特斯拉磁共振成像下的表观扩散系数（ADC）值、H-MRS中胆碱的检测以及DCE后的动力学分析。这些患者中，160例为IDC，21例为ILC。我们使用b值为1000mm²/sec的DWI序列来计算ADC值，使用脂肪抑制点分辨波谱（PRESS）序列来评估波谱中胆碱峰的存在，并使用TW GRE FAT SAT VIBRANT序列来表征动力学曲线。最后，我们将181例患者中浸润性癌的病理类型、动力学曲线类型与ADC值以及波谱中胆碱共振的可检测性进行了关联。
160例IDC患者中的158例，ADC值范围为0.5×10⁻³至1.2×10⁻³mm²/sec，其中78.1%的患者ADC值为1×10⁻³mm²/sec。关于H-MRS，160例IDC患者中的121例，72.3%检测到胆碱。21例ILC患者的ADC值范围也为0.5×10⁻³至1.2×10⁻³mm²/sec，其中57.1%的患者ADC值为1×10⁻³mm²/sec。关于H-MRS，21例ILC患者中的10例，60%检测到胆碱呈阳性。在21例ILC患者中，动态注射造影剂后的动力学分析显示，I型（持续）曲线占4.3%，II型（平台）曲线占33.3%，III型（廓清）曲线占52.4%。在158例IDC患者（2例缺失）中，I型曲线占0.63%，II型占19.4%，III型占80%。通过使用Kruskal-Wallis检验和非参数Kendall's tau-b检验对IDC结果进行相关性分析，曲线类型与胆碱的存在呈正相关（Kendal tau-b：0. .254,p =0.005），而ADC值与胆碱的存在呈负相关（Kendal tau-b：-0.224,p =0.011）。在ILC病例中，样本量不足以使相关性具有统计学意义。然而，与ILC患者（57.1%的患者ADC值为1×10⁻³mm²/sec）相比，IDC患者的ADC值往往较低（78.1%的患者ADC值为1×10⁻³mm²/sec）。IDC患者（72.3%）比ILC患者（60%）更常检测到胆碱。
我们的结果与先前的研究结果一致，即ADC值和波谱中胆碱的检测在最终恶性肿瘤诊断中都起着重要作用，特别是当增强动力学模式具有误导性时。《希波克拉底》2016年，20(3):192 - 197。
