3.0TMR扩散加权成像对乳腺良恶性病变的鉴别诊断价值  

Differential Diagnostic Value of Diffusion Weighted Imaging at 3.0 T of Benign and Malignancy Breast Lesions

作　　者：刘伟 叶春涛[1] 林光武[1] 臧雪如[1] 朱震方[1] 嵇鸣[1] 

机构地区：[1]复旦大学附属华东医院放射科MR室,上海200040

出　　处：《中国医学影像学杂志》2013年第1期20-23,共4页Chinese Journal of Medical Imaging

摘　　要：目的探讨3.0TMR扩散加权成像(DWI)在鉴别乳腺良恶性病变中的价值。资料与方法 65例经穿刺活检或手术病理证实的乳腺病变患者行MRI及DWI检查,b值取50、450、850s/mm2。计算DWI的病灶检出率,比较不同b值时正常腺体组织、良性病变、恶性病变的表观扩散系数(ADC),以及肿块样病变和非肿块样病变的ADC值。以恶性病变ADC值95%可信区间上限作为诊断阈值,计算不同b值的诊断敏感性、特异性、准确率、阳性预测值、阴性预测值。结果 DWI对病灶的检出率为95.4%(62/65),包括32例恶性病灶和30例良性病灶;3例导管原位癌未显示。b=50～850s/mm2时诊断敏感性、特异性、准确率、阳性预测值、阴性预测值分别为87.5%、83.3%、85.5%、84.8%、86.2%,高于b=50～450s/mm2时的84.4%、80.0%、82.3%、81.8%、82.8%。不同b值时正常腺体组织、良性病变、恶性病变之间ADC值差异均有统计学意义(P<0.01)。肿块样与非肿块样良恶性病变之间ADC值差异均有统计学意义(P<0.01)。结论 3.0TMR扩散加权成像有助于良恶性病变的鉴别,但诊断时需结合常规MR扫描避免漏诊、误诊。Purpose To investigate the diagnostic value of diffusion weighted imaging （DWl） at 3.0T in differentiating benign and malignant breast lesions. Materials and Methods Sixty-five cases of biopsy or surgical pathology proved breast lesions were underwent MRI and DWI examination, and b values were taken as 50, 450 mid 850 s/mm-2, respectively. Lesion detection rate of DWI was calculated, and apparent diffusion coefficient （ADC） value was compared among normal glandular tissue, benign lesions, malignant lesions using different b values, and between the mass lesions and the non-mass lesion. Taken 95% confidence interval limit of ADC in malignant lesions as a diagnostic threshold value the diagnostic sensitivity, specificity and accuracy, positive predictive value and negative predictive value of different b value were calculated. Results Lesion detection rate of DWI was 95.4% （62/65）, including 32 patients with malignant lesions and 30 cases of benign lesions; 3 cases of ductal carcinoma in situ were not shown. Diagnostic sensitivity, specificity and accuracy, positive predictive value and negative predictive value were 87.5%, 83.3%, 85.5%, 84.8%, 86.2% when b value was 50-850 s/mm2, higher than 84.4%, 80.0%, 82.3%, 81.8%, 82.8% when b value was 50-450 s/mm2. ADC value was demonstrated significant difference among normal glandular tissue, benign lesions and malignant lesions in different b value （P〈0.01）. ADC value also showed obvious difference between mass lesions and the non-mass lesions and between the benign and malignant lesions （P〈0.01）. Conclusion DWI at 3.0T is help to identify benign and malignant lesions, but the diagnosis should be combined with conventional MR imaging to avoid missing diagnosis and misdiagnosis.

关 键 词：乳腺肿瘤 磁共振成像 扩散加权成像 诊断 鉴别 

分 类 号：R737.9[医药卫生—肿瘤] R730.42[医药卫生—临床医学]