肉芽肿性乳腺炎的动态增强MRI和扩散加权成像表现及其与乳腺癌的鉴别  

Dynamic contrast enhanced MRI and diffusion weighted imaging features of granulomatous mastitis： compared with breast cancer

作　　者：周长玉[1] 许茂盛[1] 喻迎星[1] 刘玉凤[1] 丁雪委[1] 葛敏[1] 

机构地区：[1]浙江中医药大学附属第一医院放射科,杭州310006

出　　处：《中华放射学杂志》2014年第12期1000-1004,共5页Chinese Journal of Radiology

基　　金：浙江省卫生厅中医药重点研究计划（2011CZ004）

摘　　要：目的 探讨肉芽肿性乳腺炎（CM）的动态增强MRI和DWI表现,及其和乳腺癌的鉴别诊断特征.方法 回顾性分析经病理证实的45例GM和64例乳腺癌患者资料.所有患者均行乳腺DWI及动态增强扫描.采用x2检验比较2组患者病灶类型、部位、强化方式、乳头内陷、供血动脉增粗、皮肤增厚水肿及淋巴结肿大等特征差异.采用单因素方差分析比较GM患者脓肿区和非脓肿区ADC值、乳腺癌病灶ADC值差异.采用Wilcoxon检验比较2组患者病灶动态增强血流动力学参数值,包括早期强化率（EER）、峰值强化率（Emax）和峰值时间（Tmax）.结果 45例GM中,43例病变呈非肿块样,2例呈肿块样;16例累及乳晕,29例在乳腺区段内;40例为不均匀伴环形强化,5例为不均匀强化;24例乳头凹陷,42例供血动脉增粗,29例皮肤增厚水肿,17例淋巴结肿大.64例乳腺癌中,54例为肿块样病变,10例为非肿块样;5例累及乳晕,59例在乳腺区段内;30例为不均匀伴环形强化,34例为不均匀强化;16例乳头凹陷,51例供血动脉增粗,12例皮肤增厚水肿,20例淋巴结肿大.2组患者的病变类型、部位、强化方式、乳头凹陷、皮肤增厚水肿征象的差异有统计学意义（x2值分别为67.574、13.075、20.297、20.398和23.510,P均＜0.01）,供血动脉增强和淋巴结肿大的发生率差异无统计学意义（x2值分别为3.928和0.502,P＞0.05）.动态增强扫描GM病灶的EER、Emax和Tmax分别为146.58％、191.13％和195.00 s,乳腺癌病灶上述参数值分别为118.13％、159.43％和183.33 s,EER、Emx差异有统计学意义（Z值分别为-2.271和-2.948,P均＜0.01）,Tmax差异无统计学意义（Z值=-0.548,P＞0.05）.GM病灶脓肿区DWI呈高亮信号,非脓肿区呈高信号,非脓肿区信号低于脓肿区;乳腺癌病灶DWI呈高信号.GM脓肿区、非脓肿区与乳腺癌的平均ADC值分别为（8.0±2.6）× 10-3、（11.3±1.7）×10-3和（8.2±1.1）×103mm2/s,3组间ADC的差异有统计Objective To investigate the radiological features of granulomatous mastitis （GM） in dynamic contrast enhanced MRI （DCE-MRI） and DWI and to differentiate it from the breast cancer in diagnose.Methods Forty five cases of GM and 64 cases of breast cancer confirmed by surgical histopathology or biopsy were retrospectively analyzed in the study.All of the patients were examined preoperatively by DCE-MRI and DWI.Including lesion type,location,enhancement pattern,nipple retraction,supplying arteries,skin thickening and axillary adenopathy in the two groups were evaluated and analyzed by using x2 test.One-way ANOVA was employed to compare the ADC values between the abscess area of GM and non-abscess area,and the difference among the breast cancer lesion area.Dynamic enhancement MR pharmacokinetic parameters were used to measure including early-phase enhancement rate （EER）,peak enhancement ratio（Emax）,and time to peak ehhancement（Tmax）.The statistical differences of EER,Emax and Tmax between the two groups were calculated by using Wilcoxon test.Results In 45 cases of GM,DCE MR images showed nonmass-like lesions （43 patients） and mass-like lesions （2 patients）; the nipple involved（16 patients） and segment involved （29 patients）;rim-like with heterogeneous enhancement （40 patients） and heterogeneous enhancement （5 patients）; nipple retraction （24 patients） supplying arteries dilatation （42 patients）,skin thickening （29 patients）,and axillary adenopathy （17 patients）.Corresponding to the radiological features above,in the 64 breast cancer cases,it showed 54,10,5,59,30,34,16,51,12 and 20,respectively.There were statistical significance between GM and breast cancer in lesion type,location,enhancement pattern,and nipple retraction （x2=67.574,13.075,20.297,20.398 and 23.510,respectively,all P＜0.01）.But no differences were existed between 2 groups in supplying arteries and axillary adenopathy（x2=3.928 and 0.502,P＞0.05）.EER,Emax and Tmaxin GM were 146.58％,1

关 键 词：肉芽肿性乳腺炎 乳腺肿瘤 磁共振成像 

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