Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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A Method to Quantify Breast MRI for Predicting Tumor Invasion in Patients with Preoperative Biopsy- Proven Ductal Carcinoma in Situ (DCIS)

유방 자기공명영상법을 이용한 수술 전 관상피내암으로 진단된 환자의 침윤성 유방암을 예측하는 정량적 분석법

  • Ko, Myung-Su (Health Screening and Promotion Center, Asan Medical Center) ;
  • Kim, Sung Hun (Department of Radiology, Seoul St. Mary's Hospital) ;
  • Kang, Bong Joo (Department of Radiology, Seoul St. Mary's Hospital) ;
  • Choi, Byung Gil (Department of Radiology, Seoul St. Mary's Hospital) ;
  • Song, Byung Joo (Department of General Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cha, Eun Suk (Department of Radiology, School of Medicine, Ewha Womans University) ;
  • Kiraly, Atilla Peter (Siemens Corporation, Corporate Research) ;
  • Kim, In Seong (Siemens Ltd.)
  • 고명수 (서울아산병원 건강증진센터) ;
  • 김성헌 (가톨릭대학교 의과대학 영상의학과) ;
  • 강봉주 (가톨릭대학교 의과대학 영상의학과) ;
  • 최병길 (가톨릭대학교 의과대학 영상의학과) ;
  • 송병주 (가톨릭대학교 의과대학 외과) ;
  • 차은숙 (이화여자대학교 의과대학 이대목동병원 영상의학과) ;
  • ;
  • 김인성
  • Received : 2012.06.30
  • Accepted : 2013.03.22
  • Published : 2013.06.30
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Abstract

Purpose : To determine the quantitative parameters of breast MRI that predict tumor invasion in biopsy-proven DCIS. Materials and Methods: From January 2009 to March 2010, 42 MRI examinations of 41 patients with biopsy-proven DCIS were included. The quantitative parameters, which include the initial percentage enhancement ($E_1$), peak percentage enhancement ($E_{peak}$), time to peak enhancement (TTP), signal enhancement ratio (SER), arterial enhancement fraction (AEF), apparent diffusion coefficient (ADC) value, long diameter and the volume of the lesion, were calculated as parameters that might predict invasion. Univariate and multivariate analyses were used to identify the parameters associated with invasion. Results: Out of 42 lesions, 23 lesions were confirmed to be invasive ductal carcinoma (IDC) and 19 lesions were confirmed to be pure DCIS. Tumor size (p = 0.003; $6.5{\pm}3.2$ cm vs. $3.6{\pm}2.6$ cm, respectively) and SER (p = 0.036; $1.1{\pm}0.3$ vs. $0.9{\pm}0.3$, respectively) showed statistically significant high in IDC. In contrast, E1, Epeak, TTP, ADC, AEF and volume of the lesion were not statistically significant. Tumor size and SER had statistically significant associations with invasion, with an odds ratio of 1.04 and 22.93, respectively. Conclusion: Of quantitative parameters analyzed, SER and the long diameter of the lesion could be specific parameter for predicting invasion in the biopsy-proven DCIS.

목적: 수술전 관상내피암으로 진단된 환자에서 침윤성 유방암을 예측하는 정량적 파라미터를 알아보고자 한다. 대상과 방법: 2009년 1월부터 2010년 3월까지, 조직생검상 관상피내암으로 진단된 41명 환자의 42 자기공명영상을 분석하였다. 정량적 파라미터로는 초기조영증강정도, 최대조영증강 정도, 초기에 빠르면서 최대 조영증강을 보인 시점, 조영증강정도, 동맥기 조영증강비율, 겉보기확산계수, 병변의 지름과 용적을 분석하였다. 정량적 파라미터와 침윤성과 연관관계를 알기 위해 일변량 분석과 다변량 분석을 시행하였다. 결과: 42개의 병변중 23 병변이 침윤성 유방암, 19 병변이 관상피내암으로 확진되었다. 병변의 지름 (p=0.003; $6.5{\pm}3.2$ cm vs. $3.6{\pm}2.6$ cm, respectively)과 조영증강비율 (p=0.036; $1.1{\pm}0.3$ vs. $0.9{\pm}0.3$, respectively)가 통계학적으로 의미있게 침윤성 유방암에서 높게 나왔다. 그외 초기에 빠르면서 최대 조영증강을 보인 시점, 동맥기 조영증강비율, 겉보기 확산계수, 병변의 용적은 침윤성 유방암을 예측하는데 통계학적 의미는 없었다. 결론: 분석한 여러가지 정량적 파라미터 중 병변의 지름과 조영증강비율이 수술전 관상피내암으로 진단된 환자에서 침윤성 유방암을 예측하는데 도움이 된다.

Keywords

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