乳腺导管原位癌的MRI表现  

MRI characteristics of ductal carcinoma in situ of the breast

作　　者：许玲辉[1] 彭卫军[1] 顾雅佳[1] 李瑞敏[1] 刘晓航[1] 汪晓红[1] 毛健[1] 唐峰[1] 丁建辉[1] 

机构地区：[1]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院放射诊断科,200032

出　　处：《中华放射学杂志》2011年第2期159-163,共5页Chinese Journal of Radiology

摘　　要：目的评估乳腺导管原位癌（DCIS）的MRI形态及动态增强表现，提高对DCIS的认识，为早期发现及制定治疗计划提供影像支持。方法回顾性分析经手术病理证实，术前行乳腺MR检查的纯DCIS44例，DCIS伴微浸润27例，共71例，将其分成N1（乳腺纯DCIS）和N2（DCIS伴微浸润）2组。参照乳腺影像报告和数据系统（BI—RADS）标准，所有可疑病灶定义为斑点状（直径〈5mm）、肿块和非肿块3类。描述病灶形态特征（MI=斑点状，M2=线样、线样导管样，M3=导管分支样，M4=段样，M5=局灶性，M6=区域性，M7=弥漫性，M8=肿块）和时间一信号强度曲线（TIC，I型：持续七升型，Ⅱ型=平台型，Ⅲ型=廓清型，1V=与腺体同步强化）。应用X。检验对病灶的形态学特征进行统计学分析。结果71例共检出73个DCIS病灶。4个（5．5％）为斑点状病灶，64个（87．7％）为非肿块样病灶，5个（6．8％）为肿块样病灶。在64个非块样强化的病灶中，M3、M4、M5、M6分别有15、34、9和6个，其中以M3、M4最常见；在N1组（45个）中M3、M4、M5、M6分别有7、21、7和3个；N2组（28个）分别有8、13、2和3个；2组形态学表现差异无统计学意义（P〉0．05）。64个非块样强化的病灶中31个内部不均匀强化，M3、M4均占35．5％（11／31）；26个簇状小环状强化，M4占88．5％（23／26）；网状强化4个；丛状强化2个；均匀强化1个。5个肿块样病灶中，N1组3个，N2组2个；4个形态呈分叶状；4个边缘毛刺，1个边缘光整；5个肿块均为不均匀强化。可绘制TIC的25个病灶中I型8个，Ⅱ型11个，Ⅲ型3个，Ⅳ型3个。结论DCIS的典型形态表现为M3、M4，其中以段样分布的成簇小环状强化最具特点。DCIS的TIC常表现为I型和Ⅱ型。Objective To evaluate and recognize the dynamic and morphological MRI charactristics of ductal carcinoma in situ （DCIS） of the breast and provide imaging information for the early detection and treatment planning. Methods All MRI data in 71 patients with histollogically proved DCIS were analyzed retrospectively. The 71 patients were divided into two groups, N1 （pure DCIS, 44 patients） and N2 （DCIS with microinvasion, 27 patients）. According to the BI-RADS descriptors, all lesions were defined as a focus （smaller than 5 mm in diameter） , mass and no-mass-like three enhancement types. The morphological features （M1 = focus, M2 = linear or linear-branched, M3 = branching-ductal, M4 = segmental, M5 =focal, M6 = regional, M7 = diffuse, M8 = mass） and the time-intensity curve （TIC） pattern [ type I （ persistent enhancement curves ）, type Ⅱ（plateau）, type Ⅲ （washout） and type Ⅳ （the same enhancement as glandular tissue） ] were described. Chi-square test was used for the morphological characteristics of lesions. Results The 73 DCIS lesions were found in 71 patients, and 5.5 % （n = 4） were stippled lesions, 87.7% （n =64） were no-mass-like lesions, 6. 8% （n = 5）were mass-like lesions. In no-mass-like lesions （n = 64） , M3 was found in 15 cases, M4 in 34 cases, M5 in 9 cases and M6 in 6 cases, respectively, M3 and M4 were the most common distribution patterns. In N1 group（n =45） and N2 group （n =28）, M3, M4, M5, M6 were found in 7 and 8, 21 and 13, 7 and 2, 3 and 3 cases, respectively. There were no statistic differences between two groups （ P 〉 0. 05 ）. In 31 showed heterogeneous enhancement, both M3 and M4 were observed in 35.5% （11/31）. In 26 clustered ring enhancement lesions, M4 was observed in 88.5% （23/26）. Four lesions showed reticular enhancement ,2 lesions showed a clumped enhancement and 1 lesion showed homogeneous enhancement. In 5 mass-like lesions, N1 group had 3 cases, N2 group had 2 cases. Four lesions showed lobulated margin

关 键 词：癌 导管 乳腺 磁共振成像 图像增强 

分 类 号：R737.9[医药卫生—肿瘤]