标题：磁共振动态增强定量参数诊断乳腺癌的价值及其与恶性转化中血管生成的相关性

      作者：白丽，苏雪娟，陈体    南阳市第二人民医院医学影像科，河南 南阳 473000

      卷次： 2024年35卷4期

      【摘要】 目的 探究磁共振动态增强(DCE-MRI)定量参数对乳腺癌的诊断价值，并分析定量参数与恶性转化中血管生成的相关性。方法 前瞻性选取2020年3月至2022年1月南阳市第二人民医院收治的160例乳腺病变患者，其中浸润性导管癌、导管内原位癌、非典型增生、单纯增生乳腺病变患者各 40例。采用磁共振动态增强(DCE-MRI)扫描获取定量参数[细胞外血管外空间的体积分数(Ve)、转运常数(Ktrans)、速率常数(Kep)]，比较各组患者DCE-MRI定量参数及血管生成相关因子[血管内生长因子(VEGF)、血管内皮细胞生长因子受体 1 (Flk-1/KDR)表达、微血管密度]，并比较不同病变性质乳腺病变患者DCE-MRI定量参数，采用受试者工作特征曲线(ROC)分析DCE-MRI定量参数联合诊断乳腺癌的价值，采用Pearson相关性分析DCE-MRI定量参数与血管生成相关因子的关系。结果 浸润性导管癌组患者的Ve、Ktrans、Kep分别为0.17±0.05、(0.18±0.06) min、(1.37±0.32) min，明显高于导管内原位癌组的0.14±0.04、(0.15±0.04) min、(1.22±0.27) min，非典型增生组的0.12±0.04、(0.05±0.02) min、(0.74±0.07) min和单纯增生组的 0.10±0.03、(0.04±0.01) min、(0.53±0.02) min，差异均有统计学意义(P<0.05)；浸润性导管癌组患者的Flk-1/KDR半定量积分、VEGF半定量评分及微血管密度分别为(7.44±2.18)分、(7.85±2.46)分、(51.88±3.07)个/100倍镜，明显高于导管内原位癌组的(5.33±1.30)分、(5.72±1.44)分、(31.53±6.51)个/100倍镜，非典型增生组的(3.26±1.65)分、(3.36±1.73)分、(28.74±4.05)个/100倍镜和单纯增生组的(1.06±0.71)分、(1.26±0.74)分、(19.03±4.02)个/100倍镜，差异均有统计学意义(P<0.05)；恶性组患者的Ve、Ktrans、Kep分别为0.16±0.05、(0.17±0.05) min、(1.30±0.38) min，明显高于良性组的 0.11±0.03、(0.05±0.02) min、(0.64±0.11) min，差异均有统计学意义(P<0.05)；经Pearson相关性分析结果显示，Ve、Ktrans、Kep与Flk-1/KDR、VEGF表达及微血管密度均呈正相关(P<0.05)；经ROC分析结果显示，Ve、Ktrans、Kep诊断乳腺癌的AUC值均高于 0.7，但各项参数联合预测恶性转化中血管生成的AUC值最大，为 0.947 (P<0.05)。结论 DCE-MRI定量参数可显著提高乳腺癌患者阳性检出率，在一定程度上可反映癌前病变阶段组织血管生成趋势，临床应用价值较高。
      【关键词】 磁共振动态增强；乳腺癌；定量参数；恶性转化；血管生成相关因子
      【中图分类号】 R737.9 【文献标识码】 A 【文章编号】 1003—6350（2024）04—0558—06

Diagnostic value of quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging in breastcancer and its correlation with angiogenesis in malignant transformation.
BAI Li, SU Xue-juan, CHEN Ti.Department of Medical Imaging, Nanyang Second People's Hospital, Nanyang 473000, Henan, CHINA
【Abstract】 Objective To explore the diagnostic value of quantitative parameters of dynamic contrast-en-hanced magnetic resonance imaging (DCE-MRI) in breast cancer, and analyze the correlation between quantitative pa-rameters and angiogenesis in malignant transformation. Methods A prospective study was conducted on 160 patientswith breast lesions admitted to Nanyang Second General Hospital from March 2020 to January 2022, including 40 pa-tients with invasive ductal carcinoma, 40 patients with intraductal carcinoma in situ, 40 patients with atypical hyperpla-sia, and 40 patients with simple hyperplasia breast lesions. Dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) scanning was used to obtain quantitative parameters [volume fraction (Ve), transport constant (Ktrans), and rateconstant (Kep) of extracellular vascular space], and DCE-MRI quantitative parameters and angiogenesis-related factors [ex-pression of vascular growth factor (VEGF), vascular endothelial growth factor receptor 1 (Flk-1/KDR), microvascular den-sity] were compared among different groups of patients. DCE-MRI quantitative parameters were also compared among pa-tients with different types of breast lesions. The receiver operating characteristic curve (ROC) was used to analyze the val-ue of DCE-MRI quantitative parameters in the joint diagnosis of breast cancer. Pearson correlation analysis was used to in-vestigate the relationship between quantitative parameters of DCE-MRI and angiogenesis-related factors. Results TheVe, Ktrans, and Kep in the invasive ductal carcinoma group were 0.17±0.05, (0.18±0.06) min, and (1.37±0.32) min, respec-tively, which were significantly higher than 0.14±0.04, (0.15±0.04) min, and (1.22±0.27) min in the intraductal carcino-ma in situ group, as well as 0.12±0.04, (0.05±0.02) min, and (0.74±0.07) min in the atypical hyperplasia group, and 0.10±0.03, (0.04±0.01) min, and (0.53±0.02) min in the simple hyperplasia group, with statistically significant differences (P<0.05). The Flk-1/KDR semi-quantitative score, VEGF semi-quantitative score, and microvascular density in the inva-sive ductal carcinoma group were (7.44±2.18) points, (7.85±2.46) points, and (51.88±3.07) per 100 times of magnifica-tion, respectively, which were significantly higher than (5.33±1.30) points, (5.72±1.44) points, and (31.53±6.51) per 100times of magnification in the intraductal carcinoma in situ group, as well as (3.26±1.65) points, (3.36±1.73) points, and(28.74±4.05) per 100 times of magnification in the atypical hyperplasia group, and (1.06±0.71) points, (1.26±0.74) points,and (19.03±4.02) per 100 times of magnification in the simple hyperplasia group, with statistically significant differenc-es (P<0.05). The Ve, Ktrans, and Kep in the malignant group were 0.16±0.05, (0.17±0.05) min, and (1.30±0.38) min, respec-tively, which were significantly higher than 0.11±0.03, (0.05±0.02) min, and (0.64±0.11) min in the benign group, withstatistically significant differences (P<0.05). Pearson correlation analysis showed that Ve, Ktrans, and Kep were positivelycorrelated with Flk-1/KDR, VEGF expression, and microvascular density (P<0.05). ROC analysis results showed thatthe AUC values of Ve, Ktrans, and Kep in diagnosis of breast cancer were all higher than 0.7, but the AUC value of all param-eters in joint prediction of angiogenesis in malignant transformation was the largest (0.947), with a statistically signifi-cant difference (P<0.05). Conclusion Quantitative parameters of DCE-MRI can significantly improve the positive de-tection rate of breast cancer patients, and to a certain extent can reflect the trend of tissue angiogenesis at the stage of pre-cancerous lesions, which has high clinical application value.
      【Key words】 Dynamic contrast-enhanced magnetic resonance enhancement; Breast cancer; Quantitative parame-ter; Malignant transformation; Angiogenesis-related factors