扩散磁共振定量参数在乳腺原位癌与浸润性乳腺癌中的鉴别诊断  

Differential diagnosis of diffusion magnetic resonance quantitative parameters in breast carcinoma in situ and invasive breast cancer

作　　者：张勇[1] ZHANG Yong(Department of Radiology,Yankuang Group General Hospital,Zoucheng 273500,China)

机构地区：[1]兖矿集团总医院放射科

出　　处：《磁共振成像》2019年第8期604-608,共5页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的探讨通过磁共振扩散加权成像(diffusion weighted imaging,DWI)中肿瘤感兴趣区域的表观扩散系数(apparent diffusivity coefficient,ADC)值与DWI的直方图参数实现对乳腺原位癌和浸润性乳腺癌的鉴别诊断。材料与方法收集经病理证实的乳腺癌患者137例,其中乳腺原位癌患者37例,浸润性乳腺癌Ⅰ级患者31例,浸润性乳腺癌Ⅱ级患者40例,浸润性乳腺癌Ⅲ级患者29例。患者DWI图像经西门子MR后处理工作站和MATLAB软件分别获取患者肿瘤位置的ADC值及DWI的直方图参数。研究采用Mann-Whitney检验及受试者工作特征(receiver operator characteristic,ROC)曲线评判乳腺原位癌与浸润癌,以及浸润性乳腺癌不同分级之间的鉴别诊断。结果ADC值在乳腺原位癌与浸润性乳腺癌中差异有统计学意义(P=0.029),ROC曲线下面积为0.712,敏感性为0.647,特异性为0.842,ADC在浸润性乳腺癌的不同分级中差异无统计学意义。直方图参数中强度最大值在乳腺原位癌与浸润性乳腺癌以及浸润性乳腺癌不同分级中差异均有统计学意义,强度最大值在乳腺原位癌与浸润性乳腺癌(P=0.037,ROC曲线下面积为0.699,敏感性为0.671,特异性为0.868),浸润性乳腺癌Ⅰ级与浸润性乳腺癌Ⅱ级(P=0.024,ROC曲线下面积为0.703,敏感性为0.725,特异性为0.684),浸润性乳腺癌Ⅱ级与浸润性乳腺癌Ⅲ级(P<0.01,ROC曲线下面积为0.777,敏感性为0.700,特异性为0.862)中均有鉴别能力。结论ADC值在乳腺原位癌与浸润性乳腺癌中差异有统计学意义,DWI图像的直方图参数(最大强度值)在乳腺原位癌与浸润性乳腺癌,以及浸润性乳腺癌不同分级中差异均有统计学意义。Objective:To investigate the differential diagnosis of breast carcinoma in situ and invasive breast cancer by using the ADC value and the histogram parameters from diffusion weighted imaging(DWI).Materials and Methods:A total of 137 patients with breast cancer,including 37 breast cancers in situ,31 invasive breast cancers in gradeⅠ,40 cases of invasive breast cancer with gradeⅡand 29 cases of invasive breast cancer with gradeⅢwere systematically collected in this study.DWI was used to obtain the ADC values of tumor location and histogram parameters by Siemens MR postprocessing workstation and MATLAB software respectively.Mann-Whitney test and ROC curve were used to evaluate the differential diagnosis between breast carcinoma in situ and invasive carcinoma,as well as different grades of invasive breast cancer.Results:There was significant difference in ADC between breast carcinoma in situ and invasive breast cancer(P<0.029).The area under the curve(AUC)was 0.712,the sensitivity was 0.647,and the specificity was 0.842,ADC was not significantly different in different grades of invasive breast cancer.The maximum intensity of histogram parameters was significantly different in primary breast cancer and invasive breast cancer,and the maximum intensity was found in primary breast cancer VS invasive breast cancer(P=0.037,AUC=0.699,sensitivity 0.671,specificity 0.868),Ⅰgrade of invasive breast cancer VS theⅡgrade of invasive breast cancer(P=0.024,AUC=0.703,sensitivity 0.725,specificity 0.684),Ⅱgrade of invasive breast cancer andⅢgrade of invasive breast cancer(P<0.01,AUC=0.777,sensitivity 0.700,specificity 0.862).Conclusions:There is statistical difference in ADC between breast carcinoma in situ and invasive breast cancer.The histogram parameters(maximum intensity value)of diffusion magnetic resonance imaging are found with statistical differences in breast carcinoma in situ and invasive breast cancer as well as different grades of invasive breast cancer.

关 键 词：扩散加权成像 表观扩散系数 直方图参数 乳腺原位癌 浸润性乳腺癌 

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]