Role of the Intravoxel Incoherent Motion Diffusion Weighted Imaging in the Pre-treatment Prediction and Early Response Monitoring to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer.
Role of the Intravoxel Incoherent Motion Diffusion Weighted Imaging in the Pre-treatment Prediction and Early Response Monitoring to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer.
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DOI：
10.1097/md.0000000000002420
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发表时间：
2016-01
期刊：
影响因子：
1.6
通讯作者：
Zhou C
中科院分区：
文献类型：
--
作者：
Che S;Zhao X;Ou Y;Li J;Wang M;Wu B;Zhou C
本研究的目的是探讨体素内非相干运动（IVIM）扩散加权成像（DWI）是否可以探测局部晚期乳腺癌接受新辅助化疗（NAC）患者的治疗前差异或监测早期反应。36例局部晚期乳腺癌患者采用多重b线DWI成像，基线时12b值范围为0 ~ 1000s /mm2, 28例患者在第二周期NAC后重复扫描。根据手术病理标本将受试者分为病理完全缓解组（pCR）和非病理完全缓解组（non-pCR）。采用Student t检验或非参数检验比较2周期NAC前后的参数（D, D *, f，最大直径[MD]和体积[V]）及其在pCR组和非pCR组之间的相应变化（Δparameter）。通过对受者-工作特征曲线的分析，判断不同参数的诊断效果。NAC前，pCR组f值显著高于非pCR组（32.40% vs 24.40%, P = 0.048）。第二周期NAC结束时，pCR组的D值显著高于非pCR组（P = 0.001; P = 0.015）， f值显著低于非pCR组（P = 0.507; P = 0.676），而pCR组的D∗值和V值略低于非pCR组（P = 0.507; P = 0.676）。2个NAC循环后，ΔD的pCR表达量（- 0.45 × 10 - 3 mm2/s）高于非pCR表达量（- 0.07 × 10 - 3 mm2/s） （P < 0.001）。pCR组的Δf值显著高于非pCR组（17.30% vs 5.30%, P = 0.001）。pCR组与非pCR组ΔD *无显著差异（P = 0.456）。ΔD值的预测性能最高（AUC[曲线下面积]= 0.924,95% CI[95%可信区间]= 0.759-0.990）。当最佳临界值设置为- 0.163 × 10 - 3 mm2/s时，敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别达到100% （95% CI = 66.4-100）、73.7% （95% CI = 48.8-90.9）、64.3% （95% CI = 35.6-86.0）和100% （95% CI = 73.2-99.3）。ivim衍生的参数，特别是D和f值，在局部晚期乳腺癌NAC治疗前预测和早期反应监测中显示出潜在价值。ΔD值对NAC术后病理反应的预测效果最好。
The aim of this study was to explore whether intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) can probe pre-treatment differences or monitor early response in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy (NAC). Thirty-six patients with locally advanced breast cancer were imaged using multiple-b DWI with 12 b values ranging from 0 to 1000 s/mm2 at the baseline, and 28 patients were repeatedly scanned after the second cycle of NAC. Subjects were divided into pathologic complete response (pCR) and nonpathologic complete response (non-pCR) groups according to the surgical pathologic specimen. Parameters (D, D∗, f, maximum diameter [MD] and volume [V]) before and after 2 cycles of NAC and their corresponding change (Δparameter) between pCR and non-pCR groups were compared using the Student t test or nonparametric test. The diagnostic performance of different parameters was judged by the receiver-operating characteristic curve analysis. Before NAC, the f value of pCR group was significantly higher than that of non-pCR (32.40% vs 24.40%, P = 0.048). At the end of the second cycle of NAC, the D value was significantly higher and the f value was significantly lower in pCR than that in non-pCR (P = 0.001; P = 0.015, respectively), whereas the D∗ value and V of the pCR group was slightly lower than that of the non-pCR group (P = 0.507; P = 0.676, respectively). ΔD was higher in pCR (−0.45 × 10–3 mm2/s) than that in non-pCR (−0.07 × 10−3 mm2/s) after 2 cycles of NAC (P < 0.001). Δf value in the pCR group was significantly higher than that in the non-pCR group (17.30% vs 5.30%, P = 0.001). There was no significant difference in ΔD∗ between the pCR and non-pCR group (P = 0.456). The prediction performance of ΔD value was the highest (AUC [area under the curve] = 0.924, 95% CI [95% confidence interval] = 0.759–0.990). When the optimal cut-off was set at −0.163 × 10−3 mm2/s, the values for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were up to 100% (95% CI = 66.4–100), 73.7% (95% CI = 48.8–90.9), 64.3% (95% CI = 35.6–86.0), and 100% (95% CI = 73.2–99.3), respectively. IVIM-derived parameters, especially the D and f value, showed potential value in the pre-treatment prediction and early response monitoring to NAC in locally advanced breast cancer. ΔD value had the best prediction performance for pathologic response after NAC.