基于体素内不相干运动的扩散加权成像对乳腺肿块病灶良恶性的诊断价值  

The Diagnostic Value of MR Intravoxel Incoherent Motion( IVIM) in Evaluation of Breast Mass Lesions

作　　者：周卫平[1] 陈宏伟[1] 昝星有[2] 刘学玲[1] 姜新宇[1] 郭榆江[3] 方向明[1] ZHOU Weiping CHEN Hongwei ZAN Xingyou et al(Department of Radiology, Wuxi People＇ s Hospital of Nanjing Medical University, Wuxi ,Jiangsu Province 214023, P. R. China)

机构地区：[1]南京医科大学附属无锡人民医院医学影像科,无锡214023 [2]南京医科大学附属无锡人民医院超声医学科,无锡214023 [3]南京医科大学附属无锡人民医院甲乳外科,无锡214023

出　　处：《临床放射学杂志》2016年第11期1664-1668,共5页Journal of Clinical Radiology

基　　金：国家自然科学基金面上项目资助(编号:81271629)

摘　　要：目的探讨基于体素内不相干运动(IVIM)的扩散加权成像(DWI)对乳腺肿块病灶的诊断价值。方法前瞻性纳入术前行MRI检查且动态对比增强(DCE)表现为乳腺肿块的患者78例(87个病灶),分为良性组(n=29)与恶性组(n=58)。通过单、双指数模型分别获得表观扩散系数(ADC)、单纯水分子扩散系数(D)、灌注相关的扩散系数(D*)和灌注分数(f)参数值。采用独立样本t检验分析组间各参数差异。绘制受试者工作特征曲线(ROC),分析各参数对乳腺肿块病灶的诊断效能。结果恶性组ADC、D低于良性组(P<0.001),恶性组D*高于良性组(P=0.04)。恶性组与良性组间f无明显差异(P>0.05)。以病理为金标准,ADC、D、D*值诊断乳腺恶性肿块病灶的曲线下面积(AUC)分别为0.88、0.92、0.62,D与ADC间差异有统计学意义(P=0.03)。ADC、D、D*分别以1.19×10^(-3)mm^2/s、1.05×10^(-3)mm^2/s、7.55×10^(-3)mm^2/s为诊断阈值,敏感度分别为86.2%、89.7%、89.7%,特异度分别为89.7%、93.1%、37.9%,准确率分别为87.4%、89.7%、55.2%。结论 IVIM参数D对乳腺肿块病灶的诊断效能优于ADC,具有较高的敏感度和特异度,D*诊断效能一般,f诊断价值有限。Objective To investigate the diagnostic value of MR intravoxel incoherent motion model of diffusion weigh- ted imaging（DWI） in the differentiation of breast mass lesions. Methods 78 patients with enhanced breast masses （ n = 87 ） after the examination of DCE imaging of MRI were prospectively collected before surgical operation. These lesions were pathologically classified into benign group（ n = 29） and malignant group（ n = 58 ）. IVIM related parameters （pure diffusion coefficient（ D）, pseudo-diffusion coefficient（ D ＊ ）and perfusion fraction（f） and ADC value were measured for both groups and the D, D ＊ , f and ADC values of benign and malignant lesions were compared by independent samples t - test analysis. The receiver operating characteristic （ROC） analysis was performed to assess the diagnostic efficiency of these parameters. Results ADC and D values of the malignant group were significantly smaller than those of the benign group （ P 〈 0.001 ）, while D ＊ value of the malignant group was significantly higher than that of the benign group （ P = 0.04 ）. The AUCs of ADC, D and D ＊ values were O. 88,0.92 and 0.62 for distinguishing malignant mass lesions from benign lesions ; there were significant differences between ADC and D（X^2 = 4.55 ,P =0.03）. At a cutoff of 1.19 ×10 ^-3mm^2/s, 1.05× 10^ -3mm^2/s , 7.55 ×10^-3mm^2/s for ADC,D,D＊ , the sensitivities were 86.2% ,89.7% ,89.7% the specificities were 89.7% ,93. 1% ,37.9%, and the accuracies were 87.4% ,89.7% ,55.2% ,respectively. Conclusion The diagnostic efficiency of D derived from IVIM model for breast mass lesions is higher than that of ADC derived from conventional DWI, with higher a sensitivity and specificity, reducing missed diagnosis and misdiagnoses. The diagnostic efficiency of D ＊ performs poorly.

关 键 词：磁共振扩散成像 体素内不相关运动 乳腺肿瘤 鉴别诊断 

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]