扩散峰度成像在术前乳腺癌 MRI 检查中对已知乳腺癌患者的额外可疑病变的鉴别诊断
Diffusional kurtosis imaging for differentiation of additional suspicious lesions on preoperative breast MRI of patients with known breast cancer.
机构信息
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea.
Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, New York, NY 10016, United States.
出版信息
Magn Reson Imaging. 2019 Oct;62:199-208. doi: 10.1016/j.mri.2019.07.011. Epub 2019 Jul 16.
PURPOSE
To investigate the potential of diffusional kurtosis imaging (DKI) and conventional diffusion-weighted imaging (DWI) in the evaluation of additional suspicious lesions at preoperative breast magnetic resonance imaging (MRI) in patients with breast cancer.
MATERIALS AND METHODS
Fifty-three additional suspicious lesions in 45 patients with breast cancer, which were detected on preoperative breast MRI, were examined with a 3-T MR system. DKI and DWI data were obtained using a spin-echo single-shot echo-planar imaging sequence with b-values of 0, 50, 600, 1000, and 3000 s/mm. Histogram parameters (mean, standard deviation, minimum, maximum, 10th, 25th, 50th, 75th, 90th percentiles, kurtosis, skewness and entropy) of ADC from DWI and diffusivity (D), kurtosis (K) from DKI were calculated after postprocessing. Parameters were compared between benign vs. ductal carcinoma in situ (DCIS) vs. invasive breast lesions and diagnostic performances were evaluated by receiver operating characteristic (ROC) analysis. Correlation between the mean values of D and K was analyzed according to lesion type.
RESULTS
Multiple histogram parameters of D (mean, 25th, 50th percentile, 75th percentile, and entropy) differed between benign and invasive breast lesions (all P < 0.005), but none differed between benign vs. DCIS. D-90th percentile differed between DCIS vs. invasive cancer (P = 0.040). K-10th percentile differed between benign vs. DCIS (P = 0.015). ADC-75th percentile differed between benign vs. invasive cancer and ADC-75th percentile, ADC-90th percentile differed between DCIS vs. invasive cancer, respectively (all P < 0.005). ROC curve analysis showed high specificity for discrimination between benign and invasive cancer. D-mean and K-mean showed strong correlation in benign (r = -0.813) and invasive lesions (r = -0.853), but no significant correlation in DCIS.
CONCLUSION
DKI may aid in the differentiation of additional suspicious lesions at preoperative breast MRI. Both ADC and DKI may have lower potential in differentiating DCIS from benign lesions.
目的
探讨扩散峰度成像（DKI）与常规磁共振扩散加权成像（DWI）在术前乳腺磁共振成像（MRI）检测乳腺癌患者可疑附加病变中的应用价值。
材料与方法
本研究回顾性分析了 45 例乳腺癌患者术前 MRI 检查发现的 53 个可疑附加病变，所有患者均采用 3.0T 磁共振系统进行检查。采用自旋回波单次激发平面回波成像序列，b 值分别为 0、50、600、1000 和 3000 s/mm²，获取 DKI 和 DWI 数据。对 DWI 的 ADC 直方图参数（均值、标准差、最小值、最大值、10%、25%、50%、75%、90%、峰度、偏度和熵）和 DKI 的扩散系数（D）、峰度（K）进行后处理。比较良性、导管原位癌（DCIS）和浸润性乳腺癌病变之间的参数，并通过受试者工作特征（ROC）曲线分析评估诊断效能。根据病变类型分析 D 值和 K 值的平均值之间的相关性。
结果
良性与浸润性乳腺癌病变之间的 D 值（均值、25%、50%、75%和熵）的多个直方图参数存在差异（均 P<0.005），但良性与 DCIS 之间无差异。DCIS 与浸润性癌之间的 D-90th 百分位数存在差异（P=0.040）。良性与 DCIS 之间的 K-10th 百分位数存在差异（P=0.015）。良性与浸润性癌之间的 ADC-75th 百分位数和 ADC-90th 百分位数，DCIS 与浸润性癌之间的 ADC-75th 百分位数和 ADC-90th 百分位数存在差异（均 P<0.005）。ROC 曲线分析显示，ADC-75th 百分位数在鉴别良性与浸润性乳腺癌方面具有较高的特异性。在良性病变（r=-0.813）和浸润性病变（r=-0.853）中，D-均值和 K-均值具有较强的相关性，但在 DCIS 中无明显相关性。
结论
DKI 有助于术前乳腺 MRI 检测可疑附加病变的鉴别诊断。ADC 和 DKI 对鉴别 DCIS 与良性病变的潜力均较低。
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