MR I时间-信号强度曲线终末时间结点选择对乳腺病变诊断的价值  

Value of selecting terminal dot of time-signal intensity curve in differentiating malignant from benign lesions in dynamic breast MR imaging

作　　者：赵欣[1] 苏丹柯[1] 刘丽东[1] 朱旭娜[1] 谢东[1] 张卫[1] 刘思远[1] 

机构地区：[1]广西医科大学附属肿瘤医院影像中心,广西南宁530021

出　　处：《实用放射学杂志》2015年第3期393-396,共4页Journal of Practical Radiology

基　　金：广西科技攻关项目（桂科攻14124004-1-11）。

摘　　要：目的：探讨 MRI时间-信号强度曲线（TIC）终末时间结点选择与曲线类型判定的相关性及其对乳腺病变定性诊断效能的影响,以期提高TIC对乳腺病变的诊断价值。方法收集经病理证实的乳腺疾病患者323例（良性132例,恶性191例）,术前或活检前行磁共振动态增强扫描（DCE-MRI）；统计分析良恶性病变达峰时间分布有无差异；采用 ROC曲线分析比较TIC 5个时间结点在不同诊断界值下对乳腺良恶性病变的诊断效能。结果良恶性病变达峰时间分布存在统计学差异（χ2=191.39,P＜0.05）。选择时间结点3（增强时相249 s）作为终末时间结点判定TIC类型且以诊断界值≥2级（即Ⅱ、Ⅲ型曲线诊断为恶性）作为恶性病变的诊断标准,其 ROC曲线下面积为0.912,且与选取其他时间结点诊断乳腺恶性病变的曲线下面积有统计学差异（P＜0.05）,诊断敏感度、特异度分别为93.03%、73.75%。结论 MRI TIC终末时间结点的正确选择有助于提高乳腺良恶性病变的鉴别诊断准确性。Objective To assess the correlation between the selection of terminal dot of time-signal intensity curve and the determination of curve types,and to explore its influence on the diagnosis efficacy of breast lesions in order to improve the diagnostic value of TIC. Methods Histopathologically confirmed 323 patients with breast lesions,who were conducted dynamic contrast-enhanced MRI.The time-to-peak velocity distributions in benign and malignant lesions were analyzed;the area under receiver operating characteristic （ROC）curve of TIC at five time points was used to compare benign and malignant lesions under different diagnostic cutoff values. Results The distributions of time-to-peak velocity in benign and malignant lesions were significantly different （χ2= 191.39,P〈0.05）.The dot 3（Enhance phase：249 s）was selected as the terminal dot and determined the type of TIC so as to determine the malignant lesions with a cutoff value ≥ 2 （ie,Ⅱ,Ⅲ type of curve as diagnosis of malignancy）as the diagnostic critical value.The area under the ROC curve was 0.912.There were significant differences （P〈0.05）of the area under the curves between the selected dot and other dots diagnosed as malignant breast lesions,and diagnostic sensitivity and specificity were 93.03% and 73.75% respectively.Conclusion The correct selection of MRI TIC terminal time point will help improve the accuracy of the differential diagnosis on benign and malignant breast lesions.

关 键 词：乳腺肿瘤 磁共振成像 时间-信号曲线 ROC曲线 

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