磁共振功能成像不同联合方法诊断乳腺良恶性病变的价值  

Value of Different Conjunctive Approach of Functional MRI in the Diagnosis of Breast Benign and Malignant Lesions

作　　者：刘伟 叶春涛[1] 林光武[1] 李蔚萍[2] 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 [2]复旦大学附属华东医院乳腺外科,上海200040

出　　处：《临床放射学杂志》2013年第1期56-60,共5页Journal of Clinical Radiology

摘　　要：目的探讨MR动态增强扫描(DCE)与扩散加权成像(DWI)不同联合方法鉴别乳腺良恶性病变的价值。方法 65例乳腺病变患者行3.0 T MR动态增强扫描与DWI检查,所有病例经穿刺活检或手术病理证实。动态增强扫描以Fischer评分表及影像报告数据系统判定良恶性;DWI b值设定为50～850 s/mm2,以恶性病变表观扩散系数平均值95%可信区间上限为鉴别良恶性病变的阈值。以病理结果为金标准,分别计算DCE、DWI的独立诊断效能与不同联合方法的诊断效能。联合方法包括平行试验、系列试验、积分累计法、DCE为主DWI为辅法。结果病理结果示良性病变30例,恶性病变35例。DCE病灶检出率98.5%,1例导管内原位癌漏诊;DWI病灶检出率95.4%,3例导管原位癌漏诊;DCE诊断敏感性、特异性、准确率分别为85.7%、80%、83.1%,DWI分别为80%、83.3%、81.5%。DCE与DWI联合诊断效能:平行实验94.3%,66.7%,81.5%,系列实验77.1%,96.7%,86.2%,积分累计法80%、86.7%、83.1%,DCE为主DWI为辅法88.6%,90%,89.2%。结论 DCE与DWI不同联合方法鉴别乳腺良恶性病变的诊断价值不同。DCE为主、DWI为辅法可作为一种联合诊断方法。Objective To explore the value of combining dynamic contrast enhancement with diffusion weighted imaging by different means in differential diagnosis of the breast benign lesions from the malignant lesions.Methods 65 cases with breast diseases proven by operation or biopsy received dynamic contrast enhancement and diffusion weighted imaging on 3.0 T MR.Fischer scoring system and BI RADS were used to distinguish the benign lesions from the malignant in DCE.The upper limit of average ADC value in 95% confidence interval of the malignant lesions was set as the threshold with the b value of 50~850 s/mm2 in DWI.Pathological results were adopted as the golden standard,the independent and conjunctive diagnostic efficacy of DCE and DWI was calculated and compared.The conjunctive methods included series tests,parallel tests,integral summary and DCE was used as the chief diagnostic approach while DWI as the adjunctive method.Results The detecting rate of DCE was 98.5% while it was 95.4% in DWI.The sensitivity,specificity and diagnostic accuracy of DCE and DWI was 85.7%,80%,83.1% and 80%,83.3%,81.5%,respectively.The value was 94.3%,66.7%,81.5% in series tests and 77.1%,96.7%,86.2% in parallel tests,respectively.The value was 80%,86.7%,83.1% in integral summary while it was 88.6%,90%,89.2% when using DCE chiefly and DWI adjunctively.Conclusion The diagnostic value is different when combining DCE with DWI by different means.It can become a conjunctive method using DCE as the chief approach while DWI as the adjunctive method.

关 键 词：乳腺 磁共振功能成像 动态增强扫描 扩散加权成像 

分 类 号：R737.9[医药卫生—肿瘤]