3．0T磁共振扩散张量成像对乳腺肿块性病变的鉴别诊断价值  

3. 0 T MR diffusion tentor imaging in the differential diagnosis of breast mass lesions

作　　者：司丽芳[1] 刘小娟[1] 杨开颜[1] 王丽[1] 蒋涛[1] 

机构地区：[1]首都医科大学附属北京朝阳医院放射科,100020

出　　处：《中华医学杂志》2016年第19期1510-1514,共5页National Medical Journal of China

摘　　要：目的通过比较乳腺肿块性病变中良恶性病变及正常腺体组织的表观扩散系数（ADC）、各向异性分数（FA）和最大本征张量值（入1）的差异，探讨扩散张量成像（DTI）参数对乳腺肿块性病变的鉴别诊断价值。方法收集2013年12月至2015年10月71例（74个病变）乳腺动态增强MRI（DCE—MRI）表现为肿块性病变并且同时行DTI检查的患者，测量病变部位及对侧相应部位正常腺体组织的ADC、FA和入1值，并采用t检验进行比较，绘制受试者工作特征（ROC）曲线分析ADC、FA、λ1值对良恶性病变的诊断效能，计算DCE—MRI联合ADC值与DCE—MRI联合λ1值对病变诊断的敏感度和特异度。结果恶性病变的ADC、FA及λ1值分别为（1．09±0．18）×10^-3mm2／s、0．22±0．02和（0．97±0．19）×10^-3 mm2／s，良性病变的ADC、FA及λ1值分别为（1．52±0．19）×10^-3mm2／s、0．21±0．02和（1．79±0．19）×10^-3mm2／s，二组指标差异均有统计学意义（均P〈0．05）；ADC、FA及λ1值鉴别乳腺良恶性病变的ROC曲线下面积（AUC）分别为0．990、0．605、0．978。FA鉴别良恶性病变的ROC曲线下面积低于ADC及λ1值（P〈0．01、P〈0．01），但ADC与λ1值ROC曲线的AUC差异无统计学意义（P=0．1316）。DCE—MRI联合ADC与DCE—MRI联合λ1值诊断的敏感度和特异度差异无统计学意义（88．6％比97．1％，x2=0．86，P=0．3533；84．6％比97．4％，x2=2．51，P=0．1130）。结论ADC值和λ1值对乳腺肿块性病变良恶性鉴别诊断有重要的价值。Objective To investigate the differential diagnostic value of DTI parameters in breast mass lesions by comparing apparent diffusion coefficient （ADC）, fractional aniotropy （FA） and maximum eigenvalue （ λ1 ） of normal glandular tissue, benign lesions and malignant lesions. Methods A total of 71 women patients with 74 mass lesions between December 2013 and October 2015 were enrolled from Beijing Chao-Yang Hospital. MRI protocol included dynamic contrast-enhanced MRI （DCE-MRI）and diffusion tentor imaging （DTI） were executed. The ADC, λ1 and FA of lesions and normal glandular tissue were calculated. The ADC, λ1 and FA of lesions were compared by paired t test between the benign/malignant tumors and the contratlateral healthy breast tissue. ROC curve analysis was performed to compare diagnostic performance based on the area under the curve （ AUC ）. The sensitivity and specificity of the DCE-MRI combined with ADC and DCE-MRI combined with λ1 were calculated. Results The ADC, FA and λ1 values of malignant lesions were （ 1.09 ± 0. 18 ） × 10^-3 mm2/s, 0. 22 ± 0. 02 and （ 0. 97 ± 0. 19 ） × 10^-3 mm-3/s , these values of benign lesions were （ 1.52 ± 0. 19 ） × 10 ^-3 mm2/s, 0. 21 ± 0. 02 and （ 1.79 ± 0. 19 ） × 10^ -2 mm2/s, there were statistically significant differences （ all P 〈 0. 05 ）. Area under the curve of ADC, FA and λ1 were 0. 990, 0. 605 and 0. 978, respectively. The AUC of FA was lower than that of ADC and λ1 （P 〈 0. 01, 〈 0. 01 ）, but there was no difference between the AUC of ADC and that of λ1 （P = 0. 131 6）. The sensitivity DCE-MRI combined with ADC and DCE-MRI combined with λ1 was 88.6% vs 97. 1% （ P = 0. 353 3 ）, the specificity was 84. 6% vs 97. 4% （ P = 0. 113 0）. Conclusion ADC and λ1 is helpful to differentiate malignant from benign in mass lesions.

关 键 词：乳腺肿瘤 磁共振成像 弥散张量成像 

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]