多模态磁共振成像对乳腺良恶性肿瘤鉴别诊断的价值  

The value of multimode magnetic resonance imaging in differential diagnosis of benign and malignant breast tumors

作　　者：刘学竞 单嫣娜[1] 韩志江[1] LIU Xue-jing;SHAN Yan-na;HAN Zhi-jiang(Department of Radiology, Hangzhou First People＇s Hospital, Hangzhou 310006, China)

机构地区：[1]杭州市第一人民医院放射科,浙江杭州310006

出　　处：《中国临床医学影像杂志》2018年第5期320-323,共4页Journal of China Clinic Medical Imaging

摘　　要：目的 :探讨3T磁共振不同序列单独及联合应用对乳腺良恶性肿瘤鉴别诊断的价值,通过ADC阈值来优化DCEMRI与DWI的诊断效能。方法 :回顾性分析经手术或穿刺活组织病理证实的573例608枚病灶的术前MRI图像资料,建立方程式将ADC阈值与BI-RADS分类结合,获得DCE-MRI联合DWI优化分级的方法,统计T_1WI与T_2WI,DWI,T_1WI、T_2WI联合DWI,DCE-MRI,DCE-MRI联合DWI优化分级五种方法及对良、恶性病变鉴别诊断的敏感度、特异度及准确度,绘制ROC曲线并分析曲线下面积(AUC)。结果:T_1WI与T_2WI,DWI,T_1WI、T_2WI联合DWI,DCE-MRI,DCE-MRI联合DWI优化分级五种方法诊断的敏感度、特异度分别为78.2%、66.2%,92.4%、78.4%,94.9%、79.7%,97.5%、67.6%,99.1%、81.1%。ROC AUC分别为0.783,0.846,0.909,0.923,0.939。结论 :T_1WI、T_2WI联合DWI的敏感性较高,特异性较低,但在条件不允许进行增强检查时仍具有一定的临床应用价值。DCE-MRI联合DWI多参数分析方法的敏感性、特异性及AUC均最高,显著提高MRI检查对乳腺良恶性肿瘤的诊断价值。Objective： To explore the value of different sequences of 3T magnetic resonance in the differential diagnosis of benign and malignant breast tumors. To optimize the diagnostic performance of DCE-MRI and DWI by the threshold ADC values. Methods： A retrospective analysis of preoperative MRI images of 573 cases with 608 histopathologically verified breast lesions by surgery or biopsy were conducted. A reading method that adapted ADC thresholds to the assigned BI-RADS classification was developed. Sensitivity, specificity, diagnostic accuracy and the area under the curve（AUC） were calculated. BIRADS-adapted reading was compared with previously published reading methods such as T1WI and T2WI, DWI, T1WI, T2WI and DWI, DCE-MRI in the same population. Result： The sensitivities of T1WI and T2WI, DWI, T1WI, T2WI combined with DWI, DCE-MRI and DCE-MRI combined with DWI were 78.2%, 66.2%, 92.4%, 78.4% and 94.9% respectively. And the specificities were 79.7%, 97.5%, 67.6%, 99.1% and 81.1%, respectively. The AUC was 0.783, 0.846, 0.909, 0.923 and 0.399,respectively. Conclusion： Non-enhanced sequences of 3T magnetic resonance have high sensitivity and low specificity, but it still has some clinical significance when the patient cannot do the DCE-MRI. Multi-parametric breast 3T MRI with BI-RADS-adapted reading improves diagnostic accuracy.

关 键 词：乳腺肿瘤 磁共振成像 诊断 鉴别 

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