| Part 1 The value of 3.0T functional MRI multiple quantitative parameters(Ktrans, Kep, Ve, ADC values) in differential diagnosis of benign and malignant breast tumoursObjective: The study is to evaluate the value of 3.0T functional MRI multiple quantitative parameters(Ktrans, Kep, Ve, ADC values) in differential diagnosis of benign and malignant breast tumors.Materials and Methods: 38 cases of breast tumors patients in our hospital had complete data including 3.0T MR imaging, pathological and clinical data. These complete data were collected. All these patients underwent dynamic contrast-enhanced MRI(DCE-MRI) and diffusion weighted imaging(DWI) sequence using b=0,800 s/mm2 in 3.0T MRI scanner. Scanning technology met the requirement of this study. The images were clear, could be used for quantitative analysis. All these patients were confirmed by pathology within one week. They were divided into two groups. 14 cases were benign breast tumors. 24 cases were malignant breast tumors. The region of interest(ROI) was placed on the images of DCE-MRI and DWI-ADC. The following quantitative parameters were calculated: volume transfer constant(Ktrans), rate constant(Kep), extravascular extracellular volume fraction(Ve) and apparent diffusion coefficient(ADC). The differences of quantitative parameters(Ktrans, Kep, Ve, ADC values) between benign and malignant breast tumors were compared by independent samples t-test. The ROC curve of the quantitative parameters(Ktrans, Kep, Ve, ADC values) was drawn. Additionally, the areas under the ROC curve of the quantitative parameters(Ktrans, Kep, Ve, ADC values) were compared.Results: The values of Ktrans, Kep, Ve, ADC in benign breast tumors were(0.134±0.121) min-1,(0.273±0.137) min-1,(0.633±0.096), [(1.368±0.371) ×10-3] mm2/s. The values of Ktrans, Kep, Ve, ADC in malignant breast tumors were(0.339±0.128) min-1,(0.515±0.169) min-1,(0.680±0.116), [(0.815±0.253) ×10-3] mm2/s. The differences of Ktrans, Kep, ADC values between benign and malignant breast tumors were statistically significant(P<0.001). The difference of Ve value between benign and malignant breast tumors was not statistically significant(P=0.213). The sensitivities of Ktrans, Kep, ADC values were 89.17%, 93.83%, 92.81%.The specificities of Ktrans, Kep, ADC values were 94.56%, 85.71%, 88.52% using the maximum Youden’ index as the cut-off value. The areas under the ROC curve of Ktrans, Kep, ADC values were 0.929, 0.902, 0.926 respectively.Conclusions: The differences of 3.0T functional MRI quantitative parameters(Ktrans, Kep, ADC values) between benign and malignant breast tumors were statistically significant. The areas under the ROC curve of Ktrans, Kep, ADC values were greater than 0.9. So, the quantitative parameters(Ktrans, Kep, ADC values) could be used as the reference indicators in the differential diagnosis of benign and malignant breast tumors. The quantitative parameters(Ktrans, Kep, ADC values) may have potential value for clinical application.Part 2 Preliminary evaluation the correlation between 3.0T functional MRI multiple quantitative parameters(Ktrans, Kep, Ve, ADC values) and biological prognostic factors(ER, PR, HER-2, Ki-67) of breast cancerObjective: The study is to investigate the correlation between 3.0T functional MRI multiple quantitative parameters(Ktrans, Kep, ADC values) and biological prognostic factors(ER, PR, HER-2, Ki-67) of breast cancer, to provide valuable information for clinical treatment options and prognosis evaluation of breast cancer.Materials and Methods: 24 cases of female patients with breast cancer were confirmed by pathology. They had a complete record of routine pathologic and immunohistochemical results. All these patients underwent the DCE-MRI and DWI sequence using b=0,800 s/mm2 in 3.0T MRI scanner before the surgery and biopsy. Scanning technology met the requirement of this study. The images were clear, could be used for quantitative analysis. The ROI was placed on the images of DCE-MRI and DWI-ADC. The following quantitative parameters were calculated: volume transfer constant(Ktrans), rate constant(Kep), extravascular extracellular volume fraction(Ve) and apparent diffusion coefficient(ADC). Biological prognostic factors of breast cancer were detected by immunohistochemistry, including estrogen receptor(ER), progesterone receptor(PR), human epidermal growth factor receptor 2(HER-2) and Ki-67. According to the expression status of ER, PR and HER-2, all these cases were divided into positive group and negative group. The correlations between quantitative parameters(Ktrans, Kep, Ve, ADC values) and expressions of ER, PR and HER-2 were performed using Mann-Whitney U rank sum test. The correlations between quantitative parameters(Ktrans, Kep, Ve, ADC values) and expression of Ki-67 were performed using Spearman rank correlation analysis.Results: In these 24 cases of breast cancer, Kep value was higher in breast cancer with ER expression in negative than ER expression in positive(P=0.046), and Kep value was also higher in breast cancer with PR expression in negative than PR expression in positive(P=0.043). When the expression status of ER or PR was different, the differences of Ktrans, Ve, ADC values were not statistically significant(P>0.05). When the expression status of HER-2 was different, the differences of Ktrans, Kep, Ve, ADC values were not statistically significant(P>0.05). Ktrans value was positively correlated with Ki-67 expression(P<0.001, r=0.731). Kep value was positively correlated with Ki-67 expression(P=0.019, r=0.477). Ve value was not correlated with Ki-67 expression(P>0.05). ADC value was negatively correlated with Ki-67 expression(P=0.023, r=﹣0.418).Conclusions: The results of this study showed that Kep value was higher in breast cancer with ER expression in negative than ER expression in positive, and Kep value was also higher in breast cancer with PR expression in negative than PR expression in positive. Ktrans and Kep values of breast cancer were positively correlated with Ki-67 expression. ADC value of breast cancer was negatively correlated with Ki-67 expression. So, Ktrans, Kep and ADC values could be used as the reference indicators for evaluation biology behavior of breast cancer. Ktrans, Kep, ADC values may have potential clinical application value for preoperative noninvasive evaluation of the prognosis of breast cancer. |
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