肉芽肿性乳腺炎的MRI影像特征分析  

MRI Imaging Feature Analysis of Granulomatous Mastitis

作　　者：陶娟[1] 刘园[1] 杨金荣 陈乐庆 刘洁[1] 彭舒怡 杨帆[1] TAO Juan;LIU Yuan;YANG Jinrong(Department of Radiology,Union Hospital Tongji Medical College,Huazhong University of Science and Technology,Hubei Province Key Laboratory of Molecular Imaging,Wuhan,Hubei Province 430022,P.R.China)

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,湖北省分子影像重点实验室,武汉430022

出　　处：《临床放射学杂志》2021年第10期1878-1883,共6页Journal of Clinical Radiology

基　　金：中华国际医学交流基金2020 SKY影像基金科研公益项目(编号:Z-2014-07-2003-22)。

摘　　要：目的探讨肉芽肿性小叶性乳腺炎(IGLM)的MRI影像表现特征,提高对IGLM的诊断准确率。方法搜集本院2013年1月1日至2020年12月31日经病理证实的43例IGLM患者。所有患者均按乳腺MRI常规检查方案扫描(包括平扫及动态增强扫描),其中2017年3月之后的32例行扩散加权成像(DWI)检查。回顾性分析其临床病史资料及乳腺MRI影像表现[包括病变形态、信号、动态增强方式、时间信号强度曲线(TIC)、表观扩散系数(ADC)值等影像学特征]。结果随着对IGLM认识的加深,来本院行乳腺MRI检查患者逐年增加,2013年1月至2017年12月仅17例,而2020年1月至12月有11例。本研究对象均为女性,年龄24~50岁,平均(32.7±5.06)岁。以产后3年内发生率较高(55.8%);病程在3个月以内多见(81.4%),临床以发现肿块较多见(95.3%);均为单侧乳腺发病,其中位于左侧27例(62.8%),右侧16例(37.2%)。乳腺MRI示23例为肿块型强化(53.5%),20例为非肿块型强化(46.5%)。32例发生在一个象限(74.4%),27例为单个病灶(62.8%),病灶大小不等,直径0.8~9.5 cm。31例有小囊腔形成,以厚壁环状强化居多,12例呈实性强化。MRI显示病灶邻近区皮下、灶周水肿较为多见。TIC主要为Ⅱ型(51.2%)或Ⅰ型(39.5%),4例为Ⅲ型。32例有DWI检查资料的患者中,DWI呈不同程度高信号,强化区ADC值平均约1.018×10^(-3)mm^(2)/s,囊腔内不强化区ADC值约0.879×10^(-3)mm^(2)/s。结论乳腺MRI可以完整清晰显示病变,IGLM在临床表现和乳腺影像上与恶性肿瘤一定程度上鉴别困难,但是在对IGLM认识逐渐提高后,结合乳腺MRI上病灶内环形强化囊性病变形成、邻近皮下脂肪间隙或灶周伴水肿特征,以及结合年龄、生产及哺乳史,可以更好地诊断肉芽肿性乳腺炎。Objective To explore the MRII imaging features of idiopathic granulomatous lobular mastitis(IGLM),in order to improve the diagnostic accuracy of IGLM.Methods Forty-three patients with IGLM confirmed by pathology in our hospital from January 1st,2013 to December 31st,2020 were collected.All patients underwent breast MRI scan(including plain scan and dynamic contrast-enhanced scan)according to the routine breast MRI examination protocol,and a total of 32 patients underwent DWI examination after March 2017.Clinical data and breast MRI findings(including lesion morphology,signal intensity,dynamic enhancement type,time intensity curve(TIC),ADC value and other imaging features)were retrospectively analyzed.Results With the profound understanding of IGLM,the number of patients undergoing breast MRI examination in our hospital increased year by year,with only 17 cases from 2013 to December 2017,and 11 cases from January to December 2020.The subjects were all female and ranged in age from 24 to 50 years,with an average age of 32.7±5.06 years.The incidence rate was higher within 3 years postpartum(55.8%),the course of disease was more common within 3 months(81.4%),and the mass was more common in clinical(95.3%).All cases occurred in unilateral breast,including 27 cases(62.8%)on the left side and 16 cases(37.2%)on the right side.Mass type enhancement was found in 23 cases(53.5%)and non-mass type enhancement in 20 cases(46.5%).32 cases(74.4%)occurred in one quadrant,and 27 cases(62.8%)were single lesions with different sizes,about 0.8-9.5cm in diameter.Small cysts formed in 31 cases,most of which were thick-walled annular enhancement,and 12 cases showed solid enhancement.MRI showed that edema was more common in the subcutaneous and perifocal areas adjacent to the lesion.TIC mainly manifested for typeⅡ(51.2%)or typeⅠ(39.5%),4 cases forⅢtype.Only 32 cases had DWI examination,and the DWI showed different degrees of high signal.The average ADC value of the enhanced area was about 1.018×10^(-3)mm^(2)/s,and the ADC value o

关 键 词：肉芽肿性小叶性乳腺炎(IGLM) 乳腺MRI 环形强化 TIC ADC值 

分 类 号：R445.2[医药卫生—影像医学与核医学] R655.8[医药卫生—诊断学]