MR动态增强及减影成像对乳腺良恶性疾病的诊断价值  

Diagnosis of Benign and Malignant Breast Lesions by Dynamic Contrast Enhanced MR Imaging and Digital Subtraction Imaging

作　　者：娄路馨[1] 彰俊杰[1] 时高峰[1] 

机构地区：[1]河北医科大学第四医院CT室,石家庄050011

出　　处：《临床放射学杂志》2007年第2期148-152,共5页Journal of Clinical Radiology

摘　　要：目的探讨MR动态增强成像技术所获得的参数及减影成像在乳腺良、恶性疾病诊断及鉴别诊断中的价值。资料与方法经病理证实乳腺病变50例,共计58个病灶。采用快速小角度激发扰相梯度回波序列(FLASH)行动态增强扫描。观察:时间-信号强度曲线类型,早期增强率,增强后病灶形态学特征及间接征象,于3D减影最大强度投影(MIP)图计数肿瘤血管数目。结果50例58个病灶经病理证实,其中恶性32个,良性26个。良性病变中时间-信号强度曲线57.7%为单向型,38.5%为平台型。恶性病变中71.9%为流出型。良、恶性病变的时间-信号强度曲线类型比较,差异有统计学意义(χ2=32.365,P<0.05)。良性肿瘤中95%边缘光滑,55%均匀强化;恶性肿瘤中93.8%的形态不规则,78.1%有毛刺和分叶,81.3%不均匀强化。良、恶性肿瘤的形态特点差异有统计学意义(χ2=44.25,P<0.05)。良性病变中73.1%无肿瘤血管;恶性病变中68.8%有多支肿瘤血管,良、恶性病变肿瘤血管计数差异有统计学意义(χ2=32.288,P<0.05)。结论乳腺增强MRI及减影成像能够提供清晰、丰富的形态学信息,时间-信号强度曲线反映了病变的血流动力学信息,两者的结合对乳腺良、恶性疾病的正确诊断和鉴别诊断具有重要价值。Objective To evaluate the diagnostic value in differentiating benign from malignant breast lesions by dynamic contrast enhanced MR imaging and digital subtraction imaging. Materials and Methods 50 cases with breast diseases （58 lesions） proved by pathology were collected. Dynamic MR contrast-enhanced imaging was done by FLASH 3D spoiled gradient echo sequence. The parameters included： the type of time-slgnal intensity curve, early-phase enhancement rate, morphology features, indirect features and the number of tumor vessels. Results Among 58 lesions, 26 were benign and 32 were malignant. The distribution of curve types for benign lesions, 57.7 % of them were monophasic, and 38.5 % of them were biphasic; for malignant lesions, 71.9 % of them were washout type. The distribution was significantly difference （X^2 = 32. 365, P 〈 0.05 ）. 95 % benign lesions showed smooth margins, 45 % of them showed the sign of lobulation, 55 % of them were homogeneously enhanced. 93.8 % of malignant lesions were irregular, 78.1% of them showed speculation and lobular, 81.3% of them were inhomogeneous enhanced. The distribution was significant difference （X^2 = 44. 255, P 〈 0. 05 ）. 73.1% of benign lesions showed no tumor vessels ; 68.8 % of malignant lesions showed more than one tumor vessel, which was significant difference between benign and malignant lesions （X^2 = 32.288, P 〈 0.05）. Conclusion MR Contrast enhanced and subtraction imaging of breast can offer clear and plenty information of morphology; time-signal intensity curves reflect the hemedynamic features. In combination of morphology with time signal intensity curves features have great value to make correct diagnosis.

关 键 词：乳腺 磁共振成像 动态 减影 

分 类 号：R655.8[医药卫生—外科学] R445.2[医药卫生—临床医学]