单、双指数模型扩散加权成像鉴别诊断乳腺良恶性病变的对比研究  

Diffusion Weighted Imaging Based on Monoexponential and Biexponential Models: A Comparative Study in Differential Diagnosis of Benign and Malignant Breast Lesions

作　　者：何杰[1] 张焱[1] 程敬亮[1] 胡瑛[1] 王岸飞[1] 宋承汝[1] 

机构地区：[1]郑州大学第一附属医院磁共振科,河南郑州450052

出　　处：《中国医学影像学杂志》2014年第1期30-33,35,共5页Chinese Journal of Medical Imaging

摘　　要：目的比较单指数模剞参数值与双指数模型参数在乳腺良恶性病变鉴别诊断中的应用价值。资料与方法对48例（共57处病灶）行单指数扩散加权成像（DWI）检查（b=0、800s／mm2）和多指数DWI检查（b=0、20、50、100、200、400、600、800、1000、1200、1500、2000s／mm2）的乳腺病变患者资料进行分析，其中21例良性病变（23处病灶，良性组），27例恶性病变（34处病灶，恶性组）。以患者自身对侧正常腺体作为对照（43处，对照组）比较3组的表观扩散系数（ADC）值、慢速表现扩散系数（Slow ADC）值、快速表现扩散系数（Fast ADC）值及快速扩散成分所占比率（ffast）值，并比较各参数对乳腺良、恶性病变的诊断效能。结果3组间ADC值和Slow ADC值两两比较，等异均有统计学意义（t=4．40-13．41，P〈0．05）；良性组与恶性组、恶性组与对照组间ffast值差异有统计学意义（t=3．22、6．39，P〈0．05）。ADC、Slow ADC、Fast ADC及ffast的ROC曲线下面积分别为0．82、0．89、0．63、0．75。根据Youden指数确定最件诊断切点值，其判断乳腺良恶性病变的敏感度分别是82.35％、94．12％、41．18％、85.29％；特异度分别是82．61％、86．96％、78.26％、73．91％。结论单指数模型的参数ADC值和双指数模型的参数Slow ADC值、ffast值均可以对乳腺良恶性病变进行鉴别诊断，其中Slow ADC的诊效能最大。Purpose To compare the value of monoexponential apparent diffusion coefficient （ADC） with single b-factor range and biexponential ADC with extender b-factor range in differential diagnosis of benign and malignant breast lesions. Materials and Methods The data of 48 patients with breast tumors （57 lesions） who underwent DWI with single b-factor range （b=0, 800 s/mm2） and DWI with extended b-factor range （b=0, 20, 50, 100, 200, 400, 600, 800, 1000, 1200, 1500, 2000 s/mm2） were analyzed （benign group： 21 patients with 23 lesions; malignant group： 27 patients with 34 lesions; control group： the same population with 43 contralateral normal healthy glandular tissues）. The value of ADC, Slow ADC, Fast ADC and fraction of Fast ADC （ffast） of lesions were compared, and the performance of the monoexponential model parameter and biexponential model parameters in identifying malignant lesions was also compared. Results There were significant differences between benign and malignant group, benign and control group, malignant and control group in value of ADC and Slow ADC （t=4.40- 13.41, P〈0.05）; significant differences also occurred between benign and malignant group, malignant and control group in ffast value （t=3.22 and 6.39, P〈0.05）. The areas under the ROC curve of ADC, Slow ADC, Fast ADC and ffast were 0.82, 0.89, 0.63 and 0.75, respectively. The sensitivity of ADC, Slow ADC, Fast ADC and ffast was 82.35%, 94.12%, 41.18%, 85.29%, respectively; and the specificity of ADC, Slow ADC, Fast ADC and ffast was 82.61 %, 86.96%, 78.26%, 73.91 %, respectively, in differential diagnosis of benign and malignant lesions of breast if the maximum Youden＇s index was taken as a cut-off. Conclusion ADC value in monoexponentialmodel and value of Slow ADC as well as ffast in biexponential model can be all used in differential diagnosis of benign and malignant breast lesions, among which Slow ADC value is with the best diagnostic efficacy.

关 键 词：乳腺肿瘤 磁共振成像 扩散加权成像 表观扩散系数 诊断 鉴别 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]