3.0 T MR体素内不相干运动及扩散峰度成像评估乳腺良恶性病变的价值研究  

The value of 3.0 T MR IVIM and DKI in evaluating benign and malignant breast lesions

作　　者：张锲 陈雪 顾晓雯 张继斌[1] 秦明明[1] 许建铭[1] ZHANG Qie;CHEN Xue;GU Xiaowen;ZHANG Jibin;QIN Mingming;XU Jianming(Department of Radiology,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,China)

机构地区：[1]南京医科大学附属苏州医院,苏州215002

出　　处：《磁共振成像》2020年第12期1115-1118,1128,共5页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的评估3.0 T MR功能成像的体素内不相干运动(intravoxel incoherent motion,IVIM)及扩散峰度成像(diffusionkurtosisimaging,DKI)独立及联合应用对于乳腺良恶性病变的诊断效能。材料与方法前瞻性收集术前行多参数MR功能成像并获得明确病理结果的50例女性乳腺病变患者(共54个病灶),利用MITK及DKE软件获得扩散系数(diffusion coefficient,D)、伪扩散系数(pseudo-diffusivity coefficient,D*)、灌注分数(perfusion fraction,f)以及平均扩散峰度系数(mean kurtosis,MK)、平均扩散系数(mean diffusivity,MD)。分析各个参数在乳腺良恶性病变中的统计学差异并利用ROC曲线评估有显著差异参数的诊断效能。结果 D、MD、f及MK值在乳腺良恶性病变组间差异均有统计学意义(P<0.05),D*值的差异无统计学意义(P>0.05)。以病理结果为金标准获得D、f、MK及MD值的AUC分别为0.927、0.664、0.944及0.876,以0.91×10^-3 mm^2/s、14.58%、0.75及1.47×10^-3mm^2/s作为最佳诊断阈值,鉴别乳腺良恶性病变的敏感度和特异度依次为(90.91%,95.24%)、(57.58%,76.19%)、(87.88%,85.71%)及(81.82%,80.95%)。结论 IVIM及DKI参数中的MK值具有较大的AUC,D值具有较高的敏感度和特异度,联合诊断中的D+MK值的AUC及敏感度最大。IVIM及DKI对于乳腺良恶性病的鉴别诊断具有临床价值,联合应用可以提高诊断效能。Objective:To evaluate the independent and combined diagnostic efficacy of 3.0 T MR intravoxel incoherent motion(IVIM)and diffusion kurtosis imaging(DKI)for benign and malignant breast lesions.Materials and Methods:Prospective collection of 50 female breast lesions(54 lesions in total)who underwent preoperative multi-parameter MR functional imaging and obtained definite pathological results.The diffusion coefficient(D),pseudodiffusivity coefficient(D*),perfusion fraction(f)and mean diffusion kurtosis coefficient(MK),mean diffusion coefficient(MD)were obtained by using MITK and DKE software.The statistical differences of each parameter were analyzed and ROC curve was used to evaluate the diagnostic efficacy of the parameters with significant differences.Results:There were statistically significant differences between malignant and benign lesions in parameters of D,f,MK and MD values(P<0.05),while there was no significant difference in D*value(P>0.05).Using pathological results as the gold standard,the AUC of D,f,MK and MD values diagnosis of breast benign and malignant lesions were 0.927,0.664,0.944 and 0.876,respectively.Using 0.91×10^-3 mm^2/s,14.58%,0.75 and 1.47×10^-3 mm^2/s as the cut-off of the four parameters,the sensitivity and specificity of differentiating malignant and benign lesions were(90.91%,95.24%),(57.58%,76.19%),(87.88%,85.71%)and(81.82%,80.95%),respectively.Conclusions:The MK value in IVIM and DKI parameters has larger AUC,while the D value has high sensitivity and specificity.The AUC and sensitivity of D+MK were the highest in the combined diagnosis.IVIM and DKI have clinical value in the differential diagnosis of breast benign and malignant diseases,and the combined application can improve the diagnostic efficiency.

关 键 词：乳腺肿瘤 体素内不相干运动 扩散峰度成像 磁共振成像 

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]