超声造影与MRI鉴别诊断乳腺钙化性病变良恶性的对比研究  

BI-RADS classification based on contrast-enhanced ultrasound and MRI for differentiating benign from malignant calcified breast lesions

作　　者：丁炎[1] 周锋盛[1] 朱巧英[1] 吴鹏西[1] DING Yan;ZHU Fengsheng;ZHU Qiaoying;WU Pengxi(Department of Medical Ultrasound,Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]无锡市人民医院超声医学科,江苏无锡214023

出　　处：《南京医科大学学报（自然科学版）》2022年第1期103-107,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省卫计委妇幼健康科研项目(F201567);太湖人才双百后备拔尖人才(HB2020001)。

摘　　要：目的:比较基于超声(ultrasound,US)、超声造影(contrast-enhanced ultrasound,CEUS)和MRI的BI-RADS分类在鉴别诊断乳腺良恶性钙化性病变中的价值。方法:对60例乳腺钙化性病变患者行US、CEUS和MRI检查,分析US及MRI图像特征并根据第五版BI-RADS标准进行相应分类得到US-BI-RADS和MRI-BI-RADS,根据乳腺病变的US-BI-RADS分类结合CEUS图像特征重新分类得到CEUS-BI-RADS分类。将3种技术的3、4A类病变判定为良性,4B类及以上病变判定为恶性,以组织病理学为金标准,构建受试者工作特征(receiver operating characteristic,ROC)曲线评估比较3种影像学方法对乳腺良恶性钙化性病变的诊断效能。结果:在60例乳腺钙化性病变中,良性37例(61.67%),恶性23例(38.33%)。US-BI-RADS、MRI-US-RADS和CEUS-BI-RADS的误诊率分别为18.3%、15.0%和8.3%。CEUS-BI-RADS对4A和4B病变的诊断准确性高于US-BI-RADS和MRI-BI-RADS。CEUS-BI-RADS在鉴别乳腺良恶性钙化性病变的诊断性能方面显示:灵敏度和AUC(91.3%、0.915)高于US-BI-RADS(87.0%、0.819)和MRI-BI-RADS(87.0%、0.851),但差异均无统计学意义(P>0.05);CEUS-BI-RADS的特异度和约登指数(91.9%、0.832)高于US-BI-RADS(78.4%、0.654)和MRI-BI-RADS(83.8%、0.708),差异均有统计学意义(P<0.05)。结论:CEUS和MRI对乳腺良恶性钙化性病变的鉴别诊断均有重要价值,CEUS的诊断效能优于MRI。Objective:To compare the diagnostic efficacy of ultrasound(US),contrast-enhanced ultrasound(CEUS)and MRI in the differential diagnosis of benign and malignant calcified breast lesions.Methods:Sixty patients with calcified breast lesions were examined by US,CEUS and MRI.The characteristics of US and MRI images were analyzed and the corresponding BI-RADS classifications were performed to obtain US-BI-RADS and MRI-BI-RADS.The CEUS-BI-RADS classification was obtained according to the US-BI-RADS classification of breast lesions combined with CEUS image characteristics.BI-RADS 3 and 4 A lesions were judged as benign and BI-RADS 4 B and above lesions were judged as malignant,and histopathology was used as the gold standard to construct receiver operating characteristic(ROC)curves to assess and compare the diagnostic efficacy of the three imaging methods for benign and malignant breast calcified lesions.Results:The misdiagnosis rates of US-BI-RADS,MRI-US-RADS and CEUS-BI-RADS were18.3%,15.0%and 8.3%respectively.The diagnostic accuracy of CEUS-BI-RADS for lesions in 4 A and 4 B was higher than that of USBI-RADS and MRI-BI-RADS.The specificity and Youden index of CEUS-BI-RADS(91.9%,0.832)were higher than those of US-BIRADS(78.4%,0.654)and MRI-BI-RADS(83.8%,0.708),and the differences were statistically significant(P<0.05 for all).Conclusion:Both CEUS and MRI are of great value in the differential diagnosis of benign and malignant calcified breast lesions,and the diagnostic efficacy of CEUS is superior to that of MRI.

关 键 词：超声造影 BI-RADS MRI 乳腺 钙化 

分 类 号：R737.9[医药卫生—肿瘤]