动态增强MRI在乳腺疾病良恶性鉴别诊断中的价值  

Value of dynamic enhanced MRI on differential diagnosis of benign and malignant breast lesions

作　　者：沈玉英[1] 蔡庆[1] 许传虓[1] 顾培华[1] 徐建良[1] 黄振健[1] 施增儒[2] 

机构地区：[1]南京医科大学附属苏州医院放射科,江苏苏州215001 [2]上海第二军医大学长征医院放射科,上海200003

出　　处：《中国医学影像技术》2006年第11期1678-1681,共4页Chinese Journal of Medical Imaging Technology

基　　金：江苏省高校自然科学研究指导性计划项目(01KJD320027)

摘　　要：目的探讨动态增强MRI对乳腺良恶性病变的鉴别诊断价值。方法80例女性患者,包括乳腺恶性病变44例(浸润性导管癌22例,浸润性小叶癌12例,髓样癌6例,导管原位癌4例);良性病变36例(纤维腺瘤20例,炎性病变5例,小叶增生11例)。所有患者行快速自旋回波(FSE)横断位T1WI加频谱特异式脂肪抑制(SPIR)、常规横断位T2W加SPIR扫描技术,均行快速三维动态增强扫描。评价其病变的形态学特征、早期增强率及信号强度-时间曲线。结果病灶增强形态特征、早期增强率及信号强度-时间曲线在良恶性乳腺病变中差异均有显著性意义(χ2值分别为31、20.2、51.6,P<0.001)。病灶形态特征诊断的敏感性68.2%(30/44),特异性77.8%(28/36),准确性72.5%(58/80);早期增强率诊断的敏感性72.7%(32/44),特异性77.8%(28/36),准确性75%(60/80);信号强度-时间曲线诊断的敏感性86.4%(38/44),特异性88.9%(32/36),准确性87.5%(70/80);三者相结合的联合诊断标准的敏感性95.4%(42/44),特异性94.4%(34/36),准确性95%(76/80)。结论病灶增强形态特征、早期增强率及信号强度-时间曲线在乳腺良恶性病变诊断中有一定作用,三者结合对乳腺疾病具有较高的诊断价值。Objective To evaluate diagnostic value of dynamic enhanced MRI in differentiation of benign from malignant breast lesions. Methods Dynamic enhanced scanning was performed in 80 females with breast lesions, including invasive ductal carcinomas （n=22）, invasive lobularcarcinomas （n= 12）, medullary carcinoma （n= 6）, ductalcarcinomasitu （n=4）, fibroadenoma （n = 20）, inflammation （n = 5）, lobular proliferate （n = 11 ）. Eighty cases underwent MR T1WI/SPIR, T2WI/SPIR. All of cases were examined with a 3D dynamic enhancement scan. The parameters for evaluation in dynamic enhanced MRI included lesion＇s morphological features, early enhancement rate and time-signal intensity curve pattern. Re- sults Significant difference existed in the morphological features, early enhancement rate, and time-signal intensity curve pattern between malignant and benign lesions （χ^2 =31, 20.2, 51.6, P〈0. 001）. The sensitivity, specificity and accuracy of lesion＇s morphological features were 68.2% （30/44）, 77.8% （28/36）, 72.5% （58/80） respectively; The sensitivity, specificity and accuracy of early enhancement rate were 72.7% （32/44）, 77.8% （28/36）, 75% （60/80） respectively; The sensitivity, specificity and accuracy of time-signal intensity curve were 86.4% （38/44）, 88.9% （32/36）, 87.5% （70/80） respectively; The sensitivity, specificity and accuracy of using their combined criteria were 95.4% （42/44）, 94.4 % （24/36）, and 95% （76/80） respectively, Conclusion The combined criteria of morphological features, early enhancement rate and time-signal intensity curve pattern has great value in differential diagnosis between malignant and benign lesions.

关 键 词：乳腺疾病 磁共振成像 动态增强 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]