锥光束乳腺CT与乳腺MRI对X线/超声BI-RADS 4类病变的诊断价值对比研究  

Comparative Study of Cone Beam Breast CT and Breast MRI in Diagnosis of BI-RADS 4 Lesions on X-ray or Ultrasound

作　　者：张迎 马悦 李颖[3] 于湛[4] 叶兆祥 刘佩芳 路红 ZHANG Ying;MA Yue;LI Ying(Department of Breast Imaging,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin's Clinical Research Center for Cancer,Key Laboratory of Breast Cancer Prevention and Therapy,Tianjin Medical University,Ministry of Education,Tianjin 300060,P.R.China)

机构地区：[1]天津医科大学肿瘤医院乳腺影像诊断科,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心,乳腺癌防治教育部重点实验室,300060 [2]天津医科大学肿瘤医院放射科,300060 [3]解放军总医院第一医学中心放射科,北京100853 [4]郑州大学第一附属医院放射科,450003

出　　处：《临床放射学杂志》2021年第9期1703-1708,共6页Journal of Clinical Radiology

基　　金：国家重点研发计划基金资助项目(编号:2018YFC1315600,2017YFC0112600,2017YFC0112601,2017YFC0112602,2017YFC0112604);天津市科技计划项目资助项目(编号:19ZXDBSY00080)。

摘　　要：目的比较锥光束乳腺CT(CBBCT)与乳腺MRI对X线/超声(US)诊断为BI-RADS 4类病变的诊断效能,以评价其临床应用价值。方法回顾性分析经X线/US诊断为BI-RADS 4类病变、同时接受乳腺MRI与CBBCT检查的46例患者(50个病灶)的影像学及病理学资料。参照2013版乳腺影像和报告系统(breast imaging reporting and data system, BI-RADS),对病变进行诊断评估。BI-RADS 4B及以上定义为恶性,BI-RADS 4A及以下定义为良性,以病理诊断为金标准,分别计算CBBCT、MRI及MRI联合CBBCT对X线/US诊断为BI-RADS 4类病变的诊断敏感性、特异性及准确性,采用受试者操作特征(ROC)曲线比较3种检查方式的诊断效能,同时比较CBBCT及MRI测量的病变范围。结果 50个病灶中,良性病灶10个,恶性病灶40个。CBBCT对X线/US诊断为BI-RADS 4类病变的诊断敏感性、特异性、准确性及ROC曲线下面积(AUC)分别为97.5%、70.0%、92.0%、0.838;MRI的诊断敏感性、特异性、准确性及AUC分别为95.0%、90.0%、94.0%、0.925,两者差异无统计学意义(P>0.05);MRI与CBBCT联合应用的诊断敏感性、特异性、准确性及AUC可提高至97.5%、90.0%、96.0%、0.938。CBBCT对于肿块型病变范围的测量与MRI差异无统计学意义(P=0.095)。结论 CBBCT对X线/US BI-RADS 4类病变诊断的敏感性及准确性与乳腺MRI相当,但特异性相对较低,MRI与CBBCT联合应用具有提高病变诊断效能的潜力。Objective To compare the diagnostic value of cone-beam breast CT(CBBCT) and MRI in the evaluation of BI-RADS 4 breast lesions verified by X-ray or ultrasound. Methods The preoperative CBBCT and MRI images of 46 patients(50 lesions)were included in this retrospective study.All patients had previously undergone mammography(MG) or ultrasound and had at least one breast lesion of BI-RADS 4.The diagnostic results of CBBCT and MRI were classified based on breast imaging reporting and data system(BI-RADS).Pathological diagnosis of the lesions were set as the gold standard.The lesions of BI-RADS 4 B and above were defined as malignant, the lesions of BI-RADS 4 A and below were defined as benign.The diagnostic sensitivity, specificity, accuracy of CBBCT,MRI and MRI combined with CBBCT for BI-RADS 4 lesions on X-ray or ultrasound were calculated respectively, and the receiver operating characteristic(ROC) curve was used to evaluate the diagnosis performances of three methods.Also, the scope of lesions measured on CBBCT and MRI were compared. Results There were 10 benign lesions and 40 malignant lesions in 50 breast lesions.The sensitivity, specificity, accuracy and area under curve(AUC) of CBBCT inthe diagnosis of BI-RADS 4 lesions on X-ray or ultrasound were 97.5%,70.0%,92.0% and 0.838.The sensitivity 、specificity、accuracy and AUC of breast MRI were 95.0%,90.0%,94.0% and 0.925.The sensitivity, specificity, accuracy and area under curve(AUC) of MRI combined with CBBCT were 97.5%,90.0%,96.0% and 0.938,respectively(P>0.05).There were no significant difference between CBBCT and MRI in measuring the scope of mass type lesions(P=0.095). Conclusion The sensitivity and accuracy of CBBCT and breast MRI in diagnosing BI-RADS 4 lesions on X-ray or ultrasound are similar, and the specificity of CBBCT is lower than that of MRI.MRI combined with CBBCT has the potential to improve the diagnostic efficacy of BI-RADS 4 breast lesions on X-ray or ultrasound.

关 键 词：BI-RADS 乳腺磁共振成像 锥光束乳腺CT 

分 类 号：R737.9[医药卫生—肿瘤]