^1H—MRS在乳腺良恶性病变鉴别诊断中的价值  

Value of ^1H-MRS in the Diagnosis of Breast Lesions

作　　者：冯赟[1] 刘士远[1] 王晨光[1] 蒋涛[1] 陶晓峰[1] 王金林[1] 肖湘生[1] 

机构地区：[1]第二军医大学附属长征医院,上海200003

出　　处：《放射学实践》2008年第6期611-614,共4页Radiologic Practice

摘　　要：目的:探讨1H-MRS在乳腺良恶性病变鉴别诊断中的价值。方法:对65名患者共计68个病灶进行MRI检查,所有病例均经手术或穿刺病理证实。扫描序列包括T1WI与T2WI平扫、动态增强(DCE)与单体素1H波谱分析。将3.23ppm处出现胆碱峰视为1H-MRS乳腺恶性肿瘤表现。结果:平扫与DCE对乳腺恶性肿瘤的敏感性为94.59%(35/37),特异性为71.43%(35/49)。23个病灶(19个恶性肿瘤,4个良性病灶)于3.23ppm处检测到胆碱峰,1H-MRS对乳腺恶性肿瘤的敏感度为51.35%(19/37),特异度为87.10%(27/31),阳性预测值82.61%(19/23),阴性预测值65.85%(27/41)。MRI平扫、DCE与MRS结合的联合诊断程序对乳腺恶性肿瘤的敏感度为97.30%(36/37),特异度为90.00%(36/40)。1H-MRS阳性病例中,病灶最大径≥2.5cm占73.91%(17/23),2.0～2.5cm占21.74%(5/23),1.5～2.0cm为4.35%(1/23)。结论:1H-MRS对乳腺恶性肿瘤的敏感性较低,特异性较高,MRI平扫与动态增强的基础上进行MRS检查可提高诊断特异性。但乳腺MRS的应用受多种因素的制约,其中病灶大小的影响尤为重要。Objective： To investigate the value of ^1H-MRS in the diagnosis and differential diagnosis of breast lesions. Methods： A total of 68 lesions from 65 cases were subjected to T1 WI, T2 WI, DCE-MRI and ^1H-MRS in order. Choline peaks at 3, 23ppm in ~ H-MRS were considered as positive outcome for malignant breast tumors, Results： Choline peaks were detec ted in 23 lesions （19 malignant tumors and 4 benign lesions）, Sensitivity and specificity of ^1H-MRS for malignant breast tumors were 51.35% （19/37） and 87.10% （27/31） respectively,which could rise to 97.30% （36/37） and 90.00% （36/ 40） respectively in combination with conventional scan, DCE-MRI and ^1H-MRS, The maximum diameters of positive ^1H- MRS cases were ≥2.5cm,accounting for 73.91% （17/23） ;2.0-2.5cm,accounting for 21.74% （5/23） ;and 1. 5-2.0cm, accounting for 4.35% （1/23）,respectively, Conclusion： Sensitivity of ^1 H-MRS for malignant breast tumors was relatively low,while its specificity was much higher, Specificity of MRI could enjoy a significant increase with the additin of MRS to conventional scan and DCE-MRI. However,quality of breast ^1H-MRS was limited by multi factors,among which size of lesion was extraordinary important.

关 键 词：乳腺疾病 磁共振成像 磁共振波谱 诊断 鉴别 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]