MRI非肿块样强化对乳腺导管原位癌与导管内乳头状瘤的鉴别诊断  

The useful signs to differentiate ductal carcinoma in situ from papilloma showing non-mass like lesions in breast MRI

作　　者：王丽君[1] 汪登斌[1] 李志[2] 阮玫[1] 柴维敏[2] 严福华[2] 

机构地区：[1]上海交通大学医学院附属新华医院,上海200092 [2]上海交通大学医学院附属瑞金医院

出　　处：《实用放射学杂志》2013年第2期215-219,共5页Journal of Practical Radiology

摘　　要：目的探讨乳腺MRI增强扫描对乳腺导管原位癌（DCIS）与导管内乳头状瘤的鉴别诊断价值。方法回顾性分析经病理证实的MRI表现为非肿块样强化的DCIS32例和导管内乳头状瘤33例，所有人选病例术前均行乳腺X线检查。分析2种病变的MRI和X线表现。结果（1）在MRI上，15例（46．9％）DCIS和30例（90．9％）导管内乳头状瘤病例出现结节样强化（P=0．000）。其中成簇分布结节多见于DCIS（73．3％），散在分布结节多见于导管内乳头状瘤（93．3％）。导管内乳头状瘤组伴导管扩张者占84．8％，高于DCIS组（34．4％）（P=0．000）。DCIS组多出现成簇小环状强化（68．8％，P=0．000），节段性分布（46．9％，P=0．000），而导管内乳头状瘤组多表现为导管样强化（84．8％，P=0．000）。（2）在X线上，78．1％的DCIS病例和24．2％的导管内乳头状瘤病例可见阳性表现。DCIS组伴微小钙化多于导管内乳头状瘤组，2组分别占92．0％和12．5％。结论DCIS与导管内乳头状瘤在MRI强化上各具有一定的特征性表现，有助于两者的鉴别诊断。Objective To investigate the value of contrast-enhanced MR imaging in differential diagnosis of ductal carcinoma in si- tu（DCIS） and papilloma of the breast. Methods In total,32 cases of DCIS and 33 cases of papilloma showing non-mass like enhance- ment at contrast-enhanced MR imaging（CE MRI） confirmed by surgicopathology, were retrospectively reviewed. All cases under- went X-ray examination of the breast preoperation. Both MR imaging and mammographical findings were assessed. Results （1）At CE MRI, nodule-like enhancement in 15 cases（46.9%） of DCIS and 30 cases （90. 9%） of papilloma was found （P = 0. 000）. Of which, clustered nodules were mostly found in DCIS （ 73.3 % ） while scattered nodules were mostly found in papilloma（ 93.3 % ）. The presence of dilated duct was found in 84.8% of papilloma and in only 34.4% of DCIS （P=0. 000）. DCIS showed clustered ring en- hancement （ 68.8 %, P= 0. 000） and segmental enhancement （46.9 %, P = 0. 000 ） more frequently, whereas ductal enhancement was more common in papilloma （84.8 %, P= 0. 000）. （2）Mammographically, 78.1% of DCIS and 24.2 % of papilloma have positive findings, among which DCIS showed microcacification more frequently than papilloma, accounting for 92.0% and 12.5 %, respec- tively. Conclusion CE MRI can demonstrate the relative characteristics of DCIS and intraductal papilloma, which is helpful in differ- ential diagnosis of these two disease entities.

关 键 词：磁共振成像 乳腺 导管原位癌 导管内乳头状瘤 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]