Dynamic Contrast-enhanced MR Imaging And Diffusion-weighted Imaging Of Breast Cancers: Correlation With Prognosis Factors Of Molecular Biology

Objective To investigate the value of expression and performance of dynamic contrast-enhanced imaging; To evaluate the value of apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) in distinguishing benign from malignant breast lesions; To discuss the technique of DWI and its diagnostic ability to differentiate benign from malignant breast lesions,determine the appropriate b value for breast examination ;To investigate the value of dynamic contrast-enhanced imaging and diffusion-weighted imaging for the diagnosis of breast lesions.Methods We analyzed eighty lesions from seventy-five patients who were operated and acquired with histopathological demonstration. All lesions were examined with MRI plain scan, the b value of b=500s/mm²,1000s/mm², diffusion-weighted imaging and dynamic contrast-enhanced MR imaging. The images were reviewed and made consensus on the shape, contour ,measure the differentiations of different ADC(b = 500, 1000s/mm² ) and the type of time-signal intensity curve(TIC), calculated the early enhancement rate after ejection of Gd-DTPA(△SI). Threshold of ADC for diagnosis was acquired by ROC analysis, and lesions were classified as benign and malignant. The diadynamic criteria were compared and determine the appropriate b value for breast examination. The validities of dynamic contrast-enhanced MR imaging, DWI, and combination of the two methods were evaluated.Results (1)Great majority benign lesions were smooth and well delineated, were homogeneously enhanced, the early enhancement rate was low, the distribution of curve types for benign lesions was typeⅠ.The typical malignant features were irregular shape, spiculated margin and rim enhancement, the early enhancement rate was obviously, the distribution of curve type was typeⅢ. diagnostic indices emerge: The sensitivity of imaging was 91.67% in the diagnosis of DCE-MRI,and the specificity and accuracy were 78.13% and 86.25%.(2)The threshold of ADC for diagnosis was 1.35×10^-3mm²/s(b=500s/mm²) and 1.09×10^-3 mm²/s(b=1000s/mm²) by ROC analysis. Under the b value of b=500,1000s/mm², the diadynamic criteria were higher, theχ²-test was used to test the significance of the different diadynamic criteria, but there was no significant difference between groups, both b value can be appropriate. The sensitivity and accuracy of b=500s/mm² is a little high, to select b=500s/mm² can improve the sensitivity and accuracy of imaging diagnosis. (3)Thecombination of dynamic contrast-enhanced MR imaging, diffusion-weighted imaging parallel tests is useful to increase sensitivity and accuracy, and can provide valuable and affluent information for the diagnosis of those lesions suspicious in dynamic contrast-enhanced MRI. Conclusion Both dynamic contrast-enhanced MR imaging and diffusion-weighted imaging have high sensitivity, specificity and accuracy, to recommend to be routine examinations. The combination of dynamic contrast-enhanced MR imaging, diffusion- weighted imaging parallel tests is useful to increase sensitivity and accuracy, and can provide valuable and affluent information for the diagnosis of those lesions suspicious in dynamic contrast-enhanced MRI. Objective To analyze the dynamic contrast-enhanced breast magnetic resonance scan (DCE-MRI) morphology, hemodynamic parameters and apparent diffusion coefficient (ADC value) and the correlation between molecular biology to explore the in vivo assessment of pr- ognosis of breast cancer possible.Methods Fifty-two lesions from fifty patients with breast cancer underwent dynamic contrast-enhanced MR imaging and diffusion-weighted imaging before operation. The morph- ological characteristics on DCE-MRI,the type of time signal-intensity curve(TIC), the early enhancement rate, the differentiations of different ADC( b = 500,1000s/mm² ) were recorded. The correlation between them and detected biomarkers (ER, PR, c-erbB-2, Ki-67) were statis- tically analyzed with the Spearman Rank Correlation.Results The ring-like enhancement correlated positively with the expression degree of Ki-67 (r=0.276); the type of TIC correlated negatively with the expression degree of PR (r= -0.295); the early enhancement rate correlated positively with the expression degree of c-erbB -2 (r=0.273). The spicular enhancing periphery of the tumor, the internal homogeneous, ADC value can not evaluate the prognosis of breast cancers in molecular biology.Conclusion Dynamic contrast-enhanced MR imaging play not only important role in the differential diagnosis of breast cancer, but also is indirectly helpful in vivo both in evaluat- ing the prognosis and in drawing up the treatment plan of the breast carcinoma. The statistical significant correlation between morphological characteristics,some kinetic enhancing para- meters on DCE-MRI and detected biomarkers was found. Ring-like enhancement, washing out TIC the early enhancement rate more than one hundred percent are suggestive of unheal- thy prognostic factors.