Histogram analysis of apparent diffusion coefficient with multi- b- value DWI at 3.0T MRI: correlation with prognostic factors and subtypes of breast cancer
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摘要:
目的 探讨3.0T MRI多b值扩散加权成像表观扩散系数（apparent diffusion coefficient，ADC）直方图参数与乳腺癌分子分型及预后因素的相关性，并评估ADC直方图在各b值下诊断效能。 方法 回顾性分析2015年3月至2016年1月114例于天津医科大学肿瘤医院行乳腺MRI检查并经手术病理证实为浸润性导管癌患者的临床病理资料，共116个病灶。利用Image J软件对b值为0、500、800、1 000、1 500 s/mm2时ADC进行直方图分析，记录ADC最小值（ADCmin）、ADC平均值（ADCmean）、ADC众数（ADCmode）、偏度及峰度等参数。根据肿瘤分子分型、T分期（T1 vs. T2~3）、组织学级别（高级别vs.低级别）以及淋巴结转移情况（阳性vs.阴性）进行分组，采用Mann-Whitney U检验比较不同两组间参数差异，并绘制受试者工作特征曲线（receiver operating characteristic curve，ROC）。 结果 b值为500、800、1 000及1 500 s/mm2时，Luminal型的偏度均低于非Luminal型（均P < 0.05），HER-2过表达型的ADCmin均高于非HER-2过表达型（均P < 0.05），T1期肿瘤的峰度均低于T2~3期（均P < 0.05），且峰度与肿瘤大小具有相关性（均P < 0.05）。b值为500 s/mm2时，组织学低级别组的ADCmode及ADCmean较高级别组高（均P < 0.05）。在不同b值下，通过ROC曲线分析差异具有统计学意义的各直方图参数的曲线下面积（area under ROC curve，AUC）无显著性差异（均P > 0.05）。 结论 多b值扩散加权成像ADC直方图是一种肿瘤异质性的定量分析方法，在一定程度上反映乳腺癌的生物学行为和预后，各b值间ADC直方图对于乳腺癌分子分型及预后因素诊断效能无显著性差异。 Abstract:Objective To investigate the correlations between parameters of histograms of the apparent diffusion coefficient (ADC) with multi-b-value diffusion-weighted imaging (DWI) at 3.0T MRI and prognostic factors and molecular subtypes of breast cancer, to evaluate the diagnostic performance of ADC histograms at different b values. Methods A total of 114 patients (116 lesions) with invasive ductal carcinomas confirmed by surgical pathology who underwent breast magnetic resonance imaging from March 2015 to January 2016 in Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively. The histograms of ADC with b values of 0, 500, 800, 1000, and 1, 500 s/mm2 were generated using Image J software. Various parameters were calculated: for example, the minimum, mean, mode, skewness, and kurtosis. Different groups were based on the molecular subtypes, tumor size (T1 vs. T2-3), histologic grade (high vs. low), and lymph node status (positive vs. negative) that were recorded. Mann-Whitney U tests were used to compare the differences in ADC histogram parameters between two different groups. Receiver operating characteristic curves (ROC) were constructed. Results The skewness was lower in Luminal tumors than that in non-Luminal tumors with b values of 500, 800, 1, 000, and 1, 500s/mm2 (P < 0.05). The ADCmin was higher in human epidermal growth factor receptor-2 (HER-2) over-expression than in non-HER-2 over-expression (P < 0.05). The kurtosis was lower in stage T1 tumors than stage T2-3 tumors (P < 0.05), and kurtosis was correlated with tumor size (P < 0.05). ADCmode and ADCmean were different between different histological subtypes with a b value of 500 s/mm2 (P < 0.05). Under different b values, there were no significant differences in terms of areas under the curve for each histogram parameter, which had statistically significant differences (P > 0.05). Conclusions Multi-b-value DWI ADC histogram analysis, as a quantitative method to characterize tumor heterogeneity, can reflect the biological behavior and prognosis of breast cancer to some extent, and the diagnostic performance of ADC histograms showed no significant differences in differentiating molecular types and prognostic factors of breast cancer at different b values. -
表 1 各b值下ADC直方图参数与分子分型的关系
表 2 各b值下ADC直方图参数与预后因素的关系
表 3 各b值下ADC直方图参数ROC曲线分析结果
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