MR扩散加权成像在乳腺良恶性病变鉴别诊断中的价值  

The Research on Distinguishing Benign From Malignant Breast Lesions by Diffusion Weighted MR Imaging

作　　者：罗银灯[1] 赵建农[1] 郭大静[1] 陈林丽[1] 陈维娟[1] 吴伟[1] 沈霞[1] 吴翠霞[1] 

机构地区：[1]重庆医科大学附属第二医院放射科,在读博士研究生400010

出　　处：《临床放射学杂志》2009年第8期1086-1090,共5页Journal of Clinical Radiology

摘　　要：目的探讨MR扩散加权成像(diffusion weighted imaging,DWI)及表观扩散系数(apparent diffusion coeffi-cient,ADC)在乳腺良恶性病变鉴别诊断中的价值。资料与方法43例经钼靶或彩超诊断为乳腺肿瘤的患者采用单次激发回波平面成像(echo planar imaging,EPI)技术行双侧乳腺DWI,扩散敏感系数(b值)分别为600、750、1000s/mm2。同时选取10名知情的健康志愿者及4例患者对侧正常乳腺作为对照组。观察乳腺病变在DWI上的大小、形态及信号特征,测量24个正常乳腺、手术病理证实的24个恶性病灶、23个良性病灶分别在b=600、750、1000s/mm2时的ADC值,比较良、恶性病变、正常腺体间ADC值差异及b=600、750、1000s/mm2时ADC值差异。根据恶性组平均ADC值的95%可信区间的上限,计算3组不同b值下诊断乳腺癌的敏感性、特异性和准确性。结果乳腺良、恶性病变、正常腺体间ADC值差异均有统计学意义(F=101.113,P<0.0001),恶性病变ADC值明显低于良性病变和正常腺体组织(P<0.0001),良性病变ADC值明显低于正常腺体组织(P<0.0001);3组b值间ADC值差异均有统计学意义(F=15.539,P<0.0001),b值越低,ADC值越大(P<0.05)。b=600、750、1000s/mm2时,根据恶性组平均ADC值的95%可信区间的上限诊断乳腺癌的敏感性分别为91.7%、70.8%和79.1%,特异性分别为89.4%、89.4%和93.6%,准确性分别为93.0%、69.0%和88.7%。结论根据ADC值可以对乳腺良、恶性病变做出鉴别诊断,其敏感性、特异性和准确性较高,具有较高的临床应用价值。Objective To investigate the value of apparent diffusion coefficient （ ADC ） of diffusion weighted magnetic resonance imaging （ DWI ） in distinguishing malignant from benign breast lesions. Materials and Methods DWI of 43 cases of suspected breast tumors were analyzed retrospectivelty. ADC in 24 normal breasts ,24 malignant breast lesions, and 23 benign breast lesions confirmed by post-operation pathology were calculated respectively, and their differences were compared. The differences of different ADCs （ b = 600, 750, 1000 s/mm^2 ） were also compared. SE-EP1 （ TR 3650ms - 4200ms, TE 80.5 - 90.3ms, thickness 5 mm） was used in order to acquire the imaging. Results There were significant differences among the ADC values of normal breast tissue, benign, and malignant lesions （F = 101. 113, P 〈0. 0001 ）. The ADC of malignant lesions was lower than those of normal breast tissue and benign lesions （P 〈 0. 0001 ）, and the ADC of benign lesions was lower than that of normal breast tissue（ P 〈0. 0001 ）. There were significant differences among the ADC value of the three b value groups （ F = 15. 539, P 〈 0.0001 ）. The lower the b value, the higher the ADC （P 〈 0.05 ）. Under the b value of b = 600,750, 1000 s/mm^2, the sensitivity were 91.7% , 70.8% and 79.1% respectively, and specificity 89.4%, 89.4% and 93.6% respectively, and the accuracy were 93.0% , 69.0% and 88.7% respectively, of ADC for the diagnosis of malignant lesion if the upper bound of 95% confidence interval was set as a differential level. Conclusion The differentiation of malignant from benign breast lesions by ADC is applicable,the sensitivity,the specificity and the accuracy are high.

关 键 词：乳腺肿瘤 磁共振成像 扩散加权成像 表观扩散系数 

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] R655.8[医药卫生—临床医学]