The Value Of DCE-MRI And IVIM In The Diagnosis And NAC Evaluation Of Breast Cancer

PartⅠThe value of DCE-MRI and IVIM in the diagnosis of breast cancer Objective:To investigate the value of DCE-MRI and IVIM in the diagnosis of breast cancer.Materials and Methods:207 patients undergoing breast dynamic-contrast enhanced Magnetic Resonance Imaging（DCE-MRI）and intravoxel incoherent motion（IVIM）examinations were prospectively included in our study from November 2016 to January2018.There were 115 breast benign lesions,and 106 breast precancerous lesions and malignant lesions,which were all female patients（age range:25–90 years）.The DCE-MRI images were processed by Omni-Kinetic software with the modified Toft model and the quantitative parameters of K^trans,K_ep,V_e and V_p.IVIM images were processed by using MITK-Diffusion software.The ROI of IVIM images was outlined at the corresponding level with the images obtained by plain scan and contrast enhancement.The parameters of f,D,D*were derived through the software post-processing.K^trans,K_ep,V_e and V_p,f,D and D*between benign and malignant lesions were compaed by GraphPad Prism 6 statistical software.Independent-samples t test was used for the parameters in accordance with the Gaussian distribution and whose homogeneity of variance was satisfied.Otherwise,the parameters were analysed by Mann-Whitney U test.The criterion ofαvalue was 0.05.That P value was belowαvalue was considered statistically significant.The receiver operating characteristic curve（ROC）of DCE-MRI and IVIM were drawn and their area under curve（AUC）,cut-off value,sensitivity and specificity were obtained.Result:There was significant difference in K^trans,K_ep,f and D between benign lesions and malignant lesions（P<0.001）,and there were no difference in V_e,V_p and D*between benign lesions and malignant lesions（P=0.219,P=0.729,P=0.073）.By plotting the ROC curve,K^trans,K_epand D had high diagnostic efficacy between benign and malignant of breast,because their AUC were more than 90%（AUC=0.958,AUC=0.950,AUC=0.962）.Conclusion:The DCE-MRI parameters K^trans,K_ep,and the IVIM parameters f and D could distinguish the benign and malignant lesions of breast tumors,and the parameters K^trans,K_ep,D have a high diagnostic efficacy,which are of great values in improving the diagnostic accuracy of breast cancer.PartⅡThe value of DCE-MRI and IVIM in the evaluation of breast cancer NAC Objective:To investigate the value of DCE-MRI and IVIM in evaluation of breast cancer NAC.Materials and Methods:Fourty-two women with Neoadjuvant chemotherapy（NAC NAC）（26 to 89 years old）were enrolled in our study.They were diagnosed as breast cancer by puncture pathology from November 2016 to January 2018.NAC for breast cancer was EC program,21 days a course of treatment,four courses.DCE-MRI and IVIM were performed before chemotherapy,the end of the 1^stcourse and the end of the 4^thcourse of breast cancer NAC.Omni-Kinetic and MITK-Diffusion software were used to d analyze the DCE-MRI and IVIM images to get the parameters K^trans,K_ep,V_e,V_p,f,D and D*.According to the RECIST standard,the curative effect of breast cancer NAC was evaluated.The research data were divided into two groups:valid group including complete remission（CR）and partial remission（PR）combined into;invalid group including progression progress（PD）and stable disease（SD）.The parameters K^trans,K_ep,V_e,V_p,f,D and D*were between the valid and the invalid groups analyzed by GraphPad Prism 6 statistical softwaret.ANOVA for repeated measurement was used to compare the differences of parameters between groups when the parameters were in accordance with the Gaussian distribution and whose homogeneity of variance was satisfied.Otherwise,the parameters were analysed by Friedman test.The criterion ofαvalue was 0.05.That P value was belowαvalue was considered statistically significant.Result:There were forty-six lesions in this study,including 31 lesions（CR:6,PR:25）of the valid group and 15 lesions（SD:10,PD:5）of the invalid group.The morphological changes before and after NAC were analyzed.In the valid group and invalid group,the maximum diameter of the lesions was not statistically different between the end of the 1^stt course of NAC and the pre-NAC（P=0.090,P=0.740）.In the valid group,there was a statistically significant difference between the maximum diameter of the lesions at the end of the 4^thcourses of NAC and the one at the pre-NAC（P<0.001）.In the invalid group,the maximum diameter of lesions at the end of 4^thcourse of NAC was not statistically different from the one before NAC（P=0.992）.K^trans,K_ep,and D values before chemotherapy and at the end of the 1^stand 4^th course of chemotherapy were significantly different（P<0.001）.V_e,V_p,f and D*had no significant difference among the three examinations（P=0.990,P=0.170;P=0.057,P=0.452;P=0.745,P=0.676;P=0.437,P=0.275）.There was no significant difference in K^trans,K_ep,V_e,V_p,f,D and D*values between the end of the 1^st course of treatment and before NAC and between the end of the 4^thcourse of treatment and before NAC（P=0.352,P=0.567;P=0.105,P=0.069;P=0.069,P=0.631;P=0.414,P=0.171;P=0.168,P=0.262;P=0.096,P=0.938;P=0.879,P=0.221）.Conclusion:The parameters K^trans,K_epin DCE-MRI and D in IVIM have better roles in the evaluation of breast cancer NAC.PartⅢThe relationship between the efficacy of Breast Cancer NAC and lncRNA SPRY4-IT1Objective:To investigate the significance of lnc RNA SPRY4-IT1 expression in breast cancer NAC.Materials and Methods:Tumor tissue was collected from 37 patients including 24 cases of the valid group and 13 cases of the invalid group aged from 26 to 89 years old with breast cancer after NAC between February 2017 and January 2018.The expression level of lncRNAs was detected by RT-PCR,and the results were analyzed by independent-samples t test between the valid and invalid groups.Spearman rank correlation was used to analyze between the expression of lncRNA in different groups and the change of imaging parameters per and post NAC.The criterion ofαvalue was 0.05.That P value was belowαvalue was considered statistically significant.Results:1)There was a significant difference of the expression level of lncRNA SPRY4-IT1 in the valid and invalid groups of breast cancer NAC（P<0.001）.2)There was no correlation between the expression level of lncRNA SPRY4-IT1 and the changes of K^trans,K_ep,V_e,V_p,f,D and D*in the valid group（P=0.470,P=0.144,P=0.114,P=0.666,P=0.920,P=0.183,P=0.426）and the invalid group（P=0.899,P=0.145,P=0.833,P=0.443,P=0.461,P=0.759,P=0.264）of breast cancer NAC.Conclusion:The expression level of lncRNA SPRY4-IT1 is correlated with the efficacy of NAC in breast cancer,providing a basis for the treatment of breast cancer.