磁共振扩散加权成像IVIM模型在乳腺良恶性疾病鉴别中的价值  

The value of intravoxel incoherent motion diffusion-weighted MRI in differentiating benign breast lesions from malignant lesions

作　　者：赵晓君[1] 刘锟[1] 张弦[1] 严志汉[1] 周忠洁[1] 

机构地区：[1]浙江省温州医科大学附属第二医院放射影像科,温州325027

出　　处：《中华内分泌外科杂志》2017年第5期359-363,共5页Chinese Journal of Endocrine Surgery

基　　金：国家自然科学基金（81400863）;温州市公益性社会发展科技项目（Y20170835）

摘　　要：目的探讨体素内不一致运动磁共振成像在乳腺良恶性病变鉴别当中的价值。方法收集温州医科大学附属第二医院经病理证实的50例乳腺良、恶性病变（其中良性20例，恶性35例）患者的相关资料，所有患者均行多b值DWI检查（b=0-2000s／mm2）；使用IVIM模型和单指数模型获得病变的灌注不相关扩散系数（D）、灌注相关扩散系数（D＊）和灌注分数（f）及标准化表观扩散系数（ADC standard），并采用两独立样本t检验分析，通过受试者工作特性曲线（receiver operating characteristic curve, ROC）评估各项参数的诊断效能。结果乳腺良性病变组D值、D％值、f值及ADC值分别为（1．31±0．47）×10^-3mm2／s、（26．47±13．81）×10^-3mm2／s、（17．35±3．78）％、（1．37±0．37）×10^-3mm2／s。乳腺恶性肿瘤组上述各参数值分别为（O．95±0．28）×10^-3mm2／s、（24．58±14．62）×10^-3mm2/s、（23．69±4．35）％、（1．03±0．14）×10^-3mm2/s，2组间D值、f值及ADC值差异均有统计学意义（t值分别为3．203、-5．139、3．991，P均〈0．05）；D＊值差异无统计学意义（t=0．441，P〉0．05）。ROC曲线分析得出D值的诊断效能最大（AUC=0．866），而联合D值和f值的AUC可达到0．934。结论IVIM模型获得的相关参数有助于乳腺良恶性病变的鉴别，以IVIM模型中D值的诊断敏感性和特异性最高，联合D值和f值的诊断效能最高。Objective To study the diagnostic value ofintravoxel incoherent motion （IVIM） diffusion-weight- ed MRI in differentiating benign from malignant breast lesions. Methods 50 female patients with lesions veri- fied by pathology were included in this study, all of them underwent muhi-b value （b=0-2000s/mm2） DWI scanning. Tissue diffusivity（D）, pseudo-diffusivity（D＊）, perfusion fraction（f） and apparent diffusion coefficient （ADC） were acquired using IVIM model. The difference of these parameters in benign and malignant breast lesions was ana- lyzed statistically.The diagnostic performance of these parameters was evaluated by ROC analysis. Results In benign lesions, D, D＊, f and ADC value was （1.31 ±0.47）×10^-3mm2/s, （26.47±13.81）×10^-3 mm2/s, （17.35±3.78）%, （1.37±0.37）×10^-3 mm2/s, respectively. In malignant lesions, D, D＊, f and ADC value was （0.95±0.28）×10^-3 mm2/s, （24.58±14.62）×10^-3 mm2/s,（23.69±4.35）%,（1.03±0.14）×10^-3mm2/s, respectively. There were statistically signifi- cant differences between benign and malignant lesions in D, f and ADC value （t=3.203, -5.139, 3.991 ,P〈0.05）. There was no statisticaly significant difference in D＊ value （P〉0.05）. ROC analysis showed that AUC of D value was 0.866, which was the highest one. AUC was increased to 0.934 by combining D with f value for diagnosis. Conclusions The parameters acquired from IVIM model are useful to differentiate benign from malignant breast lesions. D value obtained from IVIM model may have relatively high sensitivity and specificity, D Combined with f value can obtain the best diagnostic performance.

关 键 词：乳腺肿瘤 磁共振成像 扩散加权成像 体素内不相干运动 

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]