动态增强磁共振成像与磁共振波谱在鉴别乳腺良恶性肿瘤中的价值比较  

The Value of Dynamic Enhanced Magnetic Resonance Imaging and MagneticResonance Spectroscopy in Diagnosing Breast Tumours

作　　者：杨开颜[1] 蒋涛[1] 翟仁友[1] 刘小娟[1] 

机构地区：[1]首都医科大学附属北京朝阳医院放射科,北京100020

出　　处：《实用放射学杂志》2008年第8期1090-1094,1107,共6页Journal of Practical Radiology

摘　　要：目的比较动态增强磁共振成像与磁共振波谱在诊断乳腺良、恶性肿瘤中的价值。方法回顾分析经病理证实的65例乳腺肿瘤,其中恶性39例,良性26例,所有病例均行磁共振3D T1WI动态增强扫描及磁共振波谱采集。在GEADW4.2工作站进行后处理及图像分析,分别计算良、恶性肿瘤的早期强化率,判断时间-信号强度曲线(TIC)类型,计算波谱曲线3.23ppm处胆碱(Cho)峰信噪比。结果动态增强扫描的早期强化率,时间-信号强度曲线(TIC)及MRS在鉴别良、恶性肿瘤方面均有显著意义(P<0.01)。早期强化率的变异程度较大,良、恶性病变间重叠范围较大,其敏感性为97.4%,特异性30.7%,准确性70.7%,阳性预测值为67.8%,阴性预测值为88.9%。时间-信号强度曲线(TIC)的敏感性为87.2%,特异性为69.2%,准确性为80.0%,阳性预测值为80.9%,阴性预测值为78.3%。MRS的敏感性为61.5%,特异性为92.3%,准确性为73.8%,阳性预测值为92.3%,阴性预测值为61.5%。动态增强扫描的早期强化率及TIC的敏感性(分别为97.4%和87.2%)均高于MRS(61.5%)(P<0.01),但其特异性均明显较MRS(92.3%)低(P<0.01),尤其是早期强化率,其特异性只有30.7%;阳性预测值(分别为67.8%和80.9%)亦较MRS(92.3%)低(P<0.01)。结论动态增强磁共振成像与磁共振波谱结合,可以提高乳腺癌的正确诊断率。Objective To compare the value of dynamic enhanced magnetic resonance imaging（DCE -MRI） and magnetic resonance spectroscopy（ MRS） in differential diagnosis between benign and malignant breast tumours. Methods Breast DCE - MRI and MRS were performed in 65 patients with breat tumors, including 39 malignant lesions and 26 benign lesions confirmed histologically. The early enhance- ment rate, time - intensity curves （TIC ） and signal - noise rate （ SNR） of choline peak in all benign and malignant tumours were calculated in GE ADW4.2 workstation. Results The early enhancement rate, time - intensity curves of T1W dynamic enhanced magnetic resonance imaging and choline peak SNR of magnetic resonance spectroscopy were significantly different （ P 〈 0.01 ） between benign and malignant lesions. The sensitivity and specificity of early enhancement rate , TIC and MRS were 97.4% , 30.7% ; 87.2% ,69.2% ; and 61.5% 92.3% respectively. The accuracy were 70.7% , 80.0% and 73.8% respectively . The positive predictive value and negative predictive value were 67.8% , 88.9% ; 80.9% , 78.3% ; and 92.3% , 61.5% , respectively. The sensitivities of early enhancement rate （ 97.4% ） and time - intensity curves （ 87.25 % ） of T1W DCE - MRI were higher than that of MRS （ 61.5 % ） （ P 〈 0.01 ） , but the specificities （ 30.7 % and 69.2 % respectively） were lower than that of MRS（92.3 % ） （P 〈 0.01 ） , and the positive predictive values （67.8 % and 80.9 % respectively） were lower than that of MRS（92.3% ）（P 〈 0.01 ）. Conclusion DCE - MRI combined with MRS can raise the diagnostic accuracy of breast cancer.

关 键 词：乳腺肿瘤 磁共振成像 磁共振波谱 

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