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目的:探讨MRI在评价新辅助化疗治疗浸润性乳腺癌方面的价值。方法:回顾性分析20例行术前新辅助化疗,并行化疗前、后MRI检查的浸润性乳腺癌病人。将其病理学反应分为5级;4级和5级为组织学显著反应(majorhistological response,MHR),并以此作为参考标准,以图像表现作为对照。所有影像资料由两位医师通过诊断工作站共同阅片,判断是否属MHR;意见不一致时,咨询另一位资深医师。用Kappa分析对MRI判读结果与参考标准间进行一致性检验。结果:MRI对化疗后浸润癌残余的诊断与参考标准间的一致性较好,Kappa值为0.6。新辅助化疗后乳腺癌病灶明显缩小(P<0.001),乳腺癌新辅助化疗前、后病灶的时间-信号强度曲线改变有统计学意义(P=0.014)。乳腺癌新辅助化疗前病灶平均ADC值为(0.89±0.14)×10-3mm2/s,化疗后病灶平均ADC值为(1.13±0.31)×10-3mm2/s,新辅助化疗前、后病灶ADC值的变化有统计学意义(P<0.05)。结论:MRI在乳腺癌新辅助化疗疗效的无创性评价方面具有较大价值。
Objective: To investigate the value of MRI in the evaluation of neoadjuvant chemotherapy for invasive breast cancer. Methods: Twenty cases of invasive breast cancer with preoperative and postoperative neoadjuvant chemotherapy and concurrent MRI before and after chemotherapy were retrospectively analyzed. The pathological reactions were divided into 5 grades; 4 grades and 5 grades for the major histological response (MHR), and as a reference standard, the image performance as a control. All images were reviewed by two doctors through a diagnostic workstation to determine if they were MHR. If the opinions were not consistent, consult another senior physician. Kappa analysis of MRI interpretation of the results and the reference standard consistency test. Results: The consistency between MRI diagnosis of residual cancer after chemotherapy and reference standards was better, with a Kappa value of 0.6. The neoadjuvant chemotherapy significantly reduced the size of breast lesions (P <0.001). The time-signal intensity curves of neoadjuvant chemotherapy before and after breast cancer changed significantly (P = 0.014). The average ADC value of neoplasms before neoadjuvant chemotherapy was (0.89 ± 0.14) × 10-3mm2 / s, and the average ADC value was (1.13 ± 0.31) × 10-3mm2 / s after neoadjuvant chemotherapy The value of change was statistically significant (P <0.05). Conclusion: MRI is of great value in the noninvasive evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer.