Che S N, Li J, Xue M, Song Y, Zhao L Y, Guo N, Tian Y, Xie L Z, Zhao X M, Zhou C W
Department of Diagnostic Imaging, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
GE MR Research China, Beijing 100176, China.
Zhonghua Zhong Liu Za Zhi. 2021 Aug 23;43(8):872-877. doi: 10.3760/cma.j.cn112152-20210322-00254.
To explore the diagnostic value of synthetic magnetic resonance imaging (syMRI) quantitative parameters for benign and malignant breast lesions. From September 2018 to March 2019, a total of 43 cases of breast lesions which were confirmed by surgery and pathology in Cancer Hospital, Chinese Academy of Medical Sciences were enrolled in this study. All patients underwent syMRI sequence scans before and after enhancement except for conventional T2WI, DWI, and enhancement scans. GE AW4.7 workstation was used to generate syMRI parameter maps (T1, T2, proton density mappings), and ITK-SNAP software was used to delineate the volume of interest. The T1, T2, PD values before and after dynamic contrast enhanced (DCE) were obtained, and the change values of each parameter were calculated. Meanwhile, the apparent diffusion coefficient (ADC) and time intensity curve (TIC) of the lesions were measured. The differences of each parameter value were compared between benign and malignant breast lesions, and the receiver operating characteristic (ROC) curve was used to analyze the diagnostic performance of each parameter. Among the 43 enrolled cases, 13 were benign and 30 were malignant. Among the syMRI parameters, the pre-enhancement parameters including T1pre (median 1 663.07 ms), T2pre (median 103.33 ms), post-enhancement parameters ΔT1 (median 1 022.68 ms) and ΔT2 (median 27.67 ms) of benign group, significantly higher than those of the malignant group (the medians were 1 141.74, 92.53, 664.95, and 16.19 ms, respectively, <0.05). The ADC value of the benign group (median 1.66×10(-3)mm(2)/s) was significantly higher than that of the malignant group (median 1.00×10(-3)mm(2)/s, <0.05). The benign group included 6 cases of TIC curve type Ⅰ, 5 cases of type Ⅱ, and 2 cases of type Ⅲ. The malignant group included 2 cases of TIC curve type Ⅰ, 17 cases of type Ⅱ, and 11 cases of type Ⅲ. The difference between the two groups was statistically significant (<0.05). The area under the ROC curve (AUC) of T1pre before DCE was 0.869, higher than 0.806 of ADC and 0.697 of TIC. When the best cut-off value of 1 282.94 ms was chosen, the sensitivity and specificity of diagnosis were 76.9% and 93.3%, respectively. The combination of T1pre and T2pre can further improve the diagnostic performance (AUC=0.908). Among the syMRI quantitative parameters, T1pre, T2pre, ΔT1 and ΔT2 have good value for the differential diagnosis of benign and malignant breast lesions. T1pre has the best diagnostic performance, and the combination of T1pre and T2pre can further improve the diagnostic performance.
探讨合成磁共振成像（syMRI）定量参数对乳腺良恶性病变的诊断价值。2018年9月至2019年3月，选取中国医学科学院肿瘤医院43例经手术及病理确诊的乳腺病变患者纳入本研究。除常规T2WI、DWI及增强扫描外，所有患者均接受增强前后的syMRI序列扫描。采用GE AW4.7工作站生成syMRI参数图（T1、T2、质子密度映射图），并使用ITK-SNAP软件勾勒感兴趣区体积。获取动态对比增强（DCE）前后的T1、T2、PD值，并计算各参数的变化值。同时，测量病变的表观扩散系数（ADC）及时间-强度曲线（TIC）。比较乳腺良恶性病变各参数值的差异，并采用受试者操作特征（ROC）曲线分析各参数的诊断效能。43例纳入病例中，良性病变13例，恶性病变30例。在syMRI参数中，良性组的增强前参数包括T1pre（中位数1663.07 ms）、T2pre（中位数103.33 ms），增强后参数ΔT1（中位数1022.68 ms）和ΔT2（中位数27.67 ms），均显著高于恶性组（中位数分别为1141.74、92.53、664.95和16.19 ms，P<0.05）。良性组的ADC值（中位数1.66×10(-3)mm(2)/s）显著高于恶性组（中位数1.00×10(-3)mm(2)/s，P<0.05）。良性组TIC曲线Ⅰ型6例，Ⅱ型5例，Ⅲ型2例。恶性组TIC曲线Ⅰ型2例，Ⅱ型17例，Ⅲ型11例。两组差异有统计学意义（P<0.05）。DCE前T1pre的ROC曲线下面积（AUC）为0.869，高于ADC的0.806及TIC的0.697。当选取最佳截断值1282.94 ms时，诊断的灵敏度和特异度分别为76.9%和93.3%。T1pre与T2pre联合可进一步提高诊断效能（AUC=0.908）。在syMRI定量参数中，T1pre、T2pre、ΔT1和ΔT2对乳腺良恶性病变的鉴别诊断具有良好价值。T1pre诊断效能最佳，T1pre与T2pre联合可进一步提高诊断效能。
