动态增强MRI联合能谱成像对致密型乳腺病变的诊断价值分析  

Diagnostic value of dynamic contrast-enhanced MRI combined with contrast-enhanced spectral mammography for dense breast lesions

作　　者：韩旭 邹丹丹 胡菲 李彦国[1] HAN Xu;ZOU Dan-dan;HU Fei;LI Yan-guo(Department of Radiology,First Hospital of Qinhuangdao,Hebei 066000,China)

机构地区：[1]秦皇岛市第一医院放射科,河北秦皇岛066000

出　　处：《影像诊断与介入放射学》2022年第5期358-363,共6页Diagnostic Imaging & Interventional Radiology

基　　金：秦皇岛市科学技术研究与发展计划(201902A125)。

摘　　要：目的探究动态增强磁共振(DCE-MRI)联合能谱成像(CESM)技术诊断致密型乳腺内病变的临床效能。方法选取本院135例致密型乳腺内病变患者展开研究,对所有患者依次采用单独DCE-MRI、CESM及DCE-MRI联合CESM检查方案。比较致密型乳腺内病变患者应用不同方案检测病变部位、致密类型及病变良恶性。致密型乳腺内病变应用不同诊断方案的效果通过绘制受试者工作特征(ROC)曲线确定。结果DCE-MRI、CESM检查及两项联合在定位诊断中的检出例数依次为107例、112例、130例,检出率79.26%、82.96%、96.30%。DCE-MRI、CESM检查及两项联合在致密类型诊断中的检出例数依次为113例、118例、129例,检出率83.70%、87.41%、95.56%。DCE-MRI、CESM检查以及两项联合在良恶性(定性)诊断中的检出例数依次为117例、121例、132例,检出率86.67%、89.63%、97.78%。与DCE-MRI检查相比,致密型乳腺内病变患者CESM检查的病变位置、致密类型及病变良恶性检出率更高,但差异无统计学意义;与DCE-MRI、CESM单独检查相比,DCE-MRI联合CESM的病变位置、致密类型及病变良恶性检出率均显著升高。DCE-MRI、CESM、DCE-MRI联合CESM的敏感度分别为88.90%、93.30%、97.80%,特异度为75.60%、71.10%、95.60%,AUC为0.822、0.872、0.967,与DCE-MRI、CESM单独检查相比,DCE-MRI联合CESM诊断致密型乳腺内病变位置、致密类型及病变良恶性的AUC、特异度、敏感度均明显升高(Z_(病变位置)=2.434,Z_(致密类型)=2.332,Z_(良恶性)=2.465;P均<0.05)。结论应用CESM联合DCE-MRI技术检查可帮助致密型乳腺内病变患者确定病变位置、致密类型和良恶性,有助于实现及早筛查良恶性病变。Objective To investigate clinical efficacy of the dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)of the breast combined with contrast-enhanced spectral mammography(CESM)in the diagnosis of dense breast lesions.Methods 135 patients with 135 dense breast lesions underwent DCE-MRI,CESM and DCE-MRI combined with CESM.Detection rates of lesion location and density as well as differentiation of benignity and malignancy were compared by receiver operating characteristic(ROC)curve analysis.Results Lesion location detection rate was 79.26%(107/135)on DCE-MRI,82.96%(112/135)on CESM,and 96.30%(130/135)on combined techniques.The detection rate of dense lesions was 83.70%(113/135)on DCE-MRI,87.41%(118/135)on CESM,and 95.56%(129/135)on combined techniques.Accurate differentiation of benign and malignant lesions was 86.67%(117/135)on DCE-MRI,89.63%(121/135)on CESM,and 97.78%(132/135)on combined techniques.Compared with DCE-MRI,CESM had a higher detection rate of lesions in location,density,and benign/malignant differentiation(P>0.05).The combined technique significantly increased the lesion detection rates(Z_(lesion location)=2.434,Z_(dense type)=2.332,Z_(benign and malignant)=2.465;All P<0.05)with 97.80%sensitivity,95.60%specificity,and area under the ROC curve of 0.967 compared to that of DCE-MRI(88.90%,75.60%,0.822)and CESM(93.30%,71.10%,0.872).Conclusion CESM combined with DCE-MRI improves the detection of dense breast lesions.

关 键 词：乳腺能谱成像 动态增强磁共振显像 时间-信号强度曲线 致密型乳腺内病变 受试者工作特征曲线 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]