磁共振灌注成像参数图在小乳腺癌诊断中的初步应用  

Preliminary Application of Parametric Perfusion-weighted Imaging in Diagnosis of Small Breast Cancers

作　　者：唐建华[1] 严福华[1] 周梅玲[1] 叶芳[1] 徐鹏举[1] 沈继章[1] 陈财忠[1] 李轫晨[1] 张澍杰[1] 陈锦[1] 曾蒙苏[1] 

机构地区：[1]复旦大学附属中山医院放射科,上海市枫林路180号上海200032

出　　处：《中国医学计算机成像杂志》2009年第2期123-127,共5页Chinese Computed Medical Imaging

摘　　要：目的:研究小乳腺癌在各种MR灌注参数图像上的影像表现及其灌注特征,评价磁共振灌注成像参数图的临床应用价值。方法:29例女性小乳腺癌[共46个经病理证实的病灶(最大径≤2cm)]被纳入研究范畴。采用快速小角度激发(FLASH)序列行双侧乳腺动态高分辨对比增强MR成像(DCEMRI),共连续6个回合成像,绘制时间-信号强度曲线(TIC),并选取3个时间点,通过软件获得Washin、Washout、MIPt及PEI等4种乳腺灌注伪彩参数图像,分别测定整个病灶、病灶周边及中心以及对侧正常乳腺组织的各灌注参数值,分析小乳腺癌的灌注特点。结果:Washin、Washout、MIPt及PEI等4种灌注参数图像分别可以显示41个、19个、44个及45个小乳腺癌灶,检出率分别为89.1%、41.3%、95.7%及97.8%。Washin图不能检出的5个病灶中4个(80.0%)TIC为Ⅰ型曲线,Washout图检出的19个病灶中,15个(78.9%)为Ⅲ型曲线。46个小乳腺癌中,35个(76.1%)呈现明显不均匀异常灌注增强,其中26个周边灌注更明显。对各参数值的测定及分析结果显示小乳腺癌灶与正常乳腺组织之间、乳癌周边部分与中心部分间的各灌注参数值差异有统计学意义(P<0.05)。结论:乳腺动态高分辨对比增强MR灌注成像参数图对乳腺癌病灶的检出率较高,大部分小乳腺癌呈明显不均匀灌注增强,且增强早期即出现异常灌注,周边部分灌注更显著。乳腺MR灌注参数图像可为小乳腺癌的诊断和鉴别提供重要的补充信息。Purpose： To study the imaging features of small breast cancers and its characterization of perfusion on parametric images, and to evaluate the clinical value of parametric MR perfusion - weighted imaging. Methods： Twenty - nine women with 46 pathologically confirmed small breast cancers （ ≤ 2cm） underwent DCE MRI. The DCE MRI was performed using FLASH sequence and the time - signal intensity curve （TIC） was obtained. From 3 selected time points, the parametric perfusion images of Washin, Washout, maximum intensity projection over time （MIPt） and positive enhancement integral （PEI） were derived with special software for breast evaluation in MRI. The parameters of perfusion were measured respectively, and then the features of perfusion of small breast cancers were analyzed. Results： Forty - one, 19, 44 and 45 small breast cancers were found in four kinds of parametric images of Washin, Washout, MIPt and PEI, respectively. The sensitivities for the detection of small lesions were 89.1%, 41.3%, 95.7% and 97.8% respectively. Four among 5 small lesions （80.0%） missed in Washin images showed TIC of type Ⅰ. Fifteen among 19 small lesions （78.9%） found in washout images showed TIC of type Ⅲ. Thirty- five small lesions （76.195 ） showed significantly inhomogeneous enhancement in all 46 lesions and 26 of them were specialized in obvious peripheral enhancement. There was a significant difference between the parameters of lesions and normal breast tissue （P 〈 0.05）. Moreover, the difference of parameters between periphery and centre of lesions is also significant（P 〈 0.05）. Conclusion： High - spatial - resolution parametric perfusion - weighted imaging has a high sensitivity for the detection of small lesions of breast cancers. Most of small lesions show significantly inbomogeneous enhancement. In addition, parametric perfusion - weighted imaging of the breast could provide valuable information in the differential diagnosis.

关 键 词：乳腺肿瘤 磁共振成像 灌注 

分 类 号：R737.9[医药卫生—肿瘤]