最小表观扩散系数、表观扩散系数差及动态增强磁共振成像对乳腺导管微小浸润癌的诊断价值  

Values of Minimal Apparent Diffusion Coefficient,Difference between Ratios of Apparent Diffusion Coefficients,and Dynamic Contrast-enhanced Magnetic Resonance Imaging Features in Diagnosing Breast Ductal Carcinoma In Situ with Microinvasion

作　　者：吴朋[1] 崔蕾[2] 郭宏兵[1] 王成瑶 崔书君[1] WU Peng;CUI Lei;GUO Hongbing;WANG Chengyao;CUI Shujun(Department of Imaging,the First Hospital Affiliated to Hebei North University,Zhangjiakou,Hebei 075000,China;Breast Surgery,the First Hospital Affiliated to Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院医学影像部,河北张家口075000 [2]河北北方学院附属第一医院乳腺外科,河北张家口075000

出　　处：《中国医学科学院学报》2019年第6期737-745,共9页Acta Academiae Medicinae Sinicae

基　　金：河北省医学科学研究重点课题计划(20180867)~~

摘　　要：目的探讨最小表观扩散系数(ADCMin)、表观扩散系数差(ADCDR)及动态增强磁共振成像(DCE-MRI)特征对乳腺导管原位癌与微小浸润的鉴别诊断,提高对微小浸润癌诊断价值。方法收集本院2016年10月至2018年6月27例乳腺导管微小浸润癌(DCIS-Mi)和31例乳腺导管原位癌(DCIS)患者,术前行乳腺磁共振成像检查,检查前签署知情同意书。应用Philips Ingenia 3.0T超导磁共振扫描仪和乳腺专用相控阵列表面线圈进行乳腺检查。在表观扩散系数(ADC)图中从多个感兴趣区中选出ADCMin和最大表观扩散系数,同时计算ADCDR,此外,分析MRI-DCE特点。结果DCIS-Mi的ADCMin明显低于DCIS[(1.15±0.03)×10-3 mm2/s比(1.34±0.04)×10-3 mm2/s,t=-7.192,P=0.002],ADCDR值高于DCIS[(0.32±0.03)×10-3 mm2/s比(0.18±0.08)×10-3 mm2/s,t=-10.228,P<0.001];DCIS-Mi早期强化率高于DCIS[159.71(157.82,162.49)%比147.29(143.59,160.22)%,Z=-3.578,P=0.007]。DCIS-Mi表现为非肿块样强化,以节段为主,内部强化特点为不均匀或簇环状强化表现。多因素Logistic回归分析显示,非肿块内部特点、肿块边缘、肿块内部强化特点、时间信号曲线、早期强化率、ADCMin及ADCDR为诊断DCIS-Mi最佳变量,最佳变量通过受试者操作特性曲线分析显示,ADCMin、ADCDR、非肿块内部强化特点和肿块内部强化特点的曲线下面积、敏感性及特异性较高,临界值分别为:1.12×10-3 mm2/s、0.31×10-3 mm2/s、1.50、1.50。结论DCE-MRI联合ADC值有助于鉴别乳腺DCIS-Mi和DCIS,尤其ADCMin、ADCDR、非肿块内部强化和肿块内部强化对鉴别诊断有一定帮助。Objective To explore the values of minimal apparent diffusion coefficient(ADCMin),difference between ratios of apparent diffusion coefficients(ADCDR),and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the treatment of breast ductal carcinoma in situ with microinvasion(DCIS-Mi).Methods Totally 27 patients with DCIS-Mi and 31 patients with breast ductal carcinoma in situ(DCIS)were collected in our hospital from October,2016 to June,2018.Philips Ingenia 3.0T superconducting magnetic resonance scanner and dedicated phase-controlled array surface coil were used for breast examinations.ADCMin and maximum apparent diffusion coefficient(ADCMax)were selected from multiple regions of interest(ROI)in the apparent diffusion coefficients(ADC)figure,and ADCDR was calculated.In addition,DCE-MRI characteristics were analyzed.Results The ADCMin of DCIS-Mi was significantly lower than that of DCIS[(1.15±0.03)×103 mm2/s vs.(1.34±0.04)×10-3 mm2/s,t=-7.192,P=0.002],the ADCDR was significantly higher than that of DCIS[(0.32±0.03)×10-3 mm2/s vs.(0.18±0.08)×10-3 mm2/s,t=-10.228,P<0.001],and the early enhancement rate of DCIS-Mi was higher than that of DCIS[159.71(157.82,162.49)%vs.147.29(143.59,160.22)%,Z=-3.578,P=0.007].The background parenchymal enhancement of DCIS-Mi was moderate,severe,and non-lump-like,mainly segmental,and the internal enhancement was heterogeneous or clustered circular.Multivariate Logistic regression analysis showed that non-internal characteristics of the mass,the edge of the mass,internal enhancement characteristics of the mass,time-intensity curve,early enhancement rate,ADCMin and ADCDR were the optimal variables for the diagnosis of DCIS-Mi,and the optimal variables were shown by receiver operating characteristic(ROC)curve analysis:the area under curve,sensitivity and specificity of ADCMin,ADCDR,non-tumor internal enhancement,and tumor internal enhancement were higher,with the critical values being 1.12×10-3 mm2/s,0.31×10-3 mm2/s,1.50,and 1.50,respectively.Conclusion DCE-MRI combine

关 键 词：导管原位癌 弥散加权成像 动态增强扫描 磁共振成像 病理组织学 

分 类 号：R445.2[医药卫生—影像医学与核医学]