应用乳腺影像报告和数据系统分析乳腺叶状肿瘤的影像表现  

Imaging manifestations of breast phyilodes tumors：based on BI-RADS

作　　者：姜蕾[1] 周意明[2] 李惠章[1] 陈起航[1] 周诚[1] 谭庆亭[3] 王征[4] 

机构地区：[1]卫生部北京医院放射科,北京100730 [2]首都医科大学附属朝阳医院放射科 [3]卫生部北京医院超声科 [4]卫生部北京医院病理科

出　　处：《实用放射学杂志》2012年第7期1031-1036,共6页Journal of Practical Radiology

摘　　要：目的应用乳腺影像报告和数据系统（B1-RADS）探讨乳腺叶状肿瘤的X线、超声及MRI表现，以期提高对该病的影像诊断能力。方法收集2004-2011年经手术病理证实的乳腺叶状肿瘤18例（20个病灶），其中良性6例，交界性5例，恶性7例。13例行乳腺X线摄影检查，13例做乳腺超声检查，4例行乳腺MRI检查。1例患者为单侧乳腺多发（3个）肿瘤，余17例为单发。按照BI—RADS术语，回顾性分析其影像表现及病变分类，并与大体及镜下病理表现对照。结果无论良性、交界性还是恶性，影像表现为：除1例于X线摄影表现为局部致密及2例于超声表现为椭圆形。余肿块均为分叶状；边界清楚；〈5cm肿块除1例回声不均匀，余回声（或信号）均匀，而〉5cm者因囊变易回声（或信号）不均匀；血供丰富；未见钙化；末侵犯乳头及皮肤；未见腋窝淋巴结转移。交界性及恶性者MRI动态增强曲线为Ⅲ型，扩散加权成像表现为高信号，波谱见胆碱峰。BIRADS病变分类多为4类。结论应用BIRADS有利于乳腺叶状肿瘤影像结果的综合比较。Objective To investigate the imaging manifestations of breast phyllodes tumor on mammography, sonogram and MRI, based on BI-RADS. Methods Eighteen patients with twenty breast phyllodes tumors,proven by pathology,were collected from 2004 to 2011 ,including 6 benign,5 boundary and 7 malignant tumors. 13,13 and 4 patients underwent mammography,sonograms and MRI examination,respectively. The tumors were multiple in unilateral breast in one patient and the others were single. According to BI RADS lexicons, the imaging manifestations were retrospectively analyzed with gross and histological pathology as comparison. Re-sults No matter benign,boundary or malignant phyllode tumors,they presented with the following imaging features：lobulated shape except 1 with focal asymmetry and 2 with oval shape, clear margin, abundant vascularization, homogeneous density/echo/signal inten sity for tumor less than 5 cm（except 1 malignant tumor） ,heterogeneity for tumor larger than 5 cm due to cystic or necrotic areas. No calcifications were seen. No signs of skin invasion and lymph node metastasis were noted. At MR imaging,the lesions were hyperin-tense on DWl, type Ill of density-time curve on dynamic contrast-enhanced images and choline peak presented on MRS. Conclusion BI-RADS is beneficial to analyse the imaging manifestations of breast phyllodes tumors comprehensively.

关 键 词：乳腺 叶状肿瘤 乳腺X线摄影 超声 磁共振成像 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]