Prediction of the expression of TCM syndrome in breast cancer based on diffusion kurtosis imaging and dynamic con-trast enhancement imaging

JIN Yan; WANG Yanhui; ZHAO Qing; LI Caixia; ZHAO Fuxiang; WANG Weiwei

Abstract：Objective To investigate predictive value of diffusion kurtosis imaging(DKI)combined with dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)for the expression of TCM syndrome in breast cancer.Methods A total of 170 patients with breast cancer confirmed by pathology were collected,including a total of 88 cases of liver depression phlegm coagulation syndrome,45 cases of Chongren dysfunction syndrome,and 37 cases of right vacuity exuberant toxin syndrome.DKI and DCE-MRI scanning were performed in all patients.The clinicopathological characteristics and conventional MRI features and mean diffusion rate(MD),mean kurtosis value(MK),extravascular extracellular space distribute volume per unit tissue volume(Ve),rate constant(Kep)and volume transfer constant(Ktrans)were analyzed.The ROC was plotted to compare the diag-nostic efficiency.Results There were statistical differences in the lesion shape and enhancement mode among the liver depres-sion and phlegm coagulation syndrome,Chongren dysfunction syndrome,and right vacuity exuberant toxin syndrome group(P=0.003;P=0.027).The MK values of the liver depression phlegm coagulation syndrome,Chongren dysfunction syndrome,and right vacuity exuberant toxin syndrome groups gradually decreased(P<0.001),and the difference between the two groups was statistically significant(P<0.05).The Ktrans and Kep values were the highest in the right vacuity exuberant toxin syndrome group,followed by the Chongren dysfunction syndrome group,and the lowest in the liver depression phlegm coagulation syndrome group(P<0.001),with statistically significant differences between the two groups(P<0.05).The MD value of the liver depression phlegm coagulation syndrome group was lower than that of other TCM syndrome groups(P<0.01).The shape and enhance-ment mode of lesions in the conventional MRI model were significant to differentiate breast cancer with the syndrome of positive deficiency toxic incandescence from the syndrome of non-positive deficiency toxic incandescence.The area under the ROC curve was 0.772.The DKI model was MD+MK,with an AUC of 0.745;The DCE-MRI model was Ktrans+Kep,with an AUC of 0.902,which was greater than the DKI model and the conventional MRI model,and the difference was statistically significant(Z=3.002,P=0.003;Z=2.113,P=0.035).The AUC of the combined model of IVIM and DKI was 0.917,which was higher than that of the single model of DKI and conventional MRI(Z=3.834,P<0.001:Z=2.556,P=0.011).The accuracy of IVIM+DKI model was 91.8％,which were higher than those of DCE-MRI,DKI and conventional MRI single models,correspondingly.Conclu-sion The DKI and DCE-MRI models could be used to predict the expression of TCM syndrome in breast cancer.Ktrans had the highest diagnostic efficacy.DKI combined with DCE-MRI model was superior to single model in the prediction of the expres-sion of TCM syndrome in the breast cancer.