特发性肉芽肿性乳腺炎磁共振乳腺水肿表现及相关因素分析  

Magnetic resonance imaging features and related factors of breast edema in idiopathic granulomatous mastitis

作　　者：赵秋枫[1] 李琼[1] 王嵩[1] 晁慧美 孟畑 ZHAO Qiufeng;LI Qiong;WANG Song;CHAO Huimei;MENG Tian(Department of Radiology,Longhua Hospital of Shanghai University of TCM,Shanghai 200032,China;Department of TCM Breast Surgery,Longhua Hospital of Shanghai University of TCM,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院放射科,上海200032 [2]上海中医药大学附属龙华医院中医乳腺科,上海200032

出　　处：《磁共振成像》2023年第12期49-53,59,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：上海中医药大学预算内项目(编号:2021LK043)。

摘　　要：目的探讨特发性肉芽肿性乳腺炎(idiopathic granulomatous mastitis,IGM)磁共振乳腺水肿表现及其相关影响因素。材料与方法回顾性分析2021年1月至2022年12月,我院收治的IGM患者129例,均经穿刺活检或手术病理证实,所有患者均行乳腺磁共振增强检查。收集患者的病程、血清催乳素及血管内皮生长因子水平,从乳腺磁共振图像上分析病灶乳晕后累及与否、累及乳腺深度、象限数及累及范围,评价T2WI图像有无乳腺水肿表现,并进行乳腺水肿评分。乳腺水肿组与无乳腺水肿组、无或轻度乳腺水肿组与中重度乳腺水肿组间临床及影像学因素的差异比较采用χ2检验及t检验,使用多因素logistic回归分析与乳腺水肿及水肿程度相关的临床及影像学因素。结果129例IGM患者中,累及单侧乳房者124例,双侧乳房者5例,共有139个患乳,其中127个患乳(91.4%)可见乳腺水肿,12个患乳(8.6%)无乳腺水肿。对139个患乳进行乳腺水肿评分,其中12个患乳(8.6%)乳腺水肿评分1分,15个患乳(10.8%)乳腺水肿评分2分,68个患乳(48.9%)乳腺水肿评分3分,44个患乳(31.7%)乳腺水肿评分4分。多因素logistic回归显示病灶范围是磁共振乳腺水肿表现的独立风险因素(P=0.003),比值比(odds ratio,OR)为1.091[95%置信区间(confidence interval,CI):1.035~1.150],血催乳素、血管内皮生长因子及病灶范围是中重度磁共振乳腺水肿表现的独立风险因素(P<0.05),OR值分别为22.807(95%CI:2.281~228.008)、24.140(95%CI:2.937~198.409)、1.102(95%CI:1.035~1.174)。结论磁共振乳腺水肿表现在IGM中发生率较高,乳腺水肿程度与血催乳素、血管内皮生长因子水平及病灶范围相关。Objective:To evaluate the MRI characteristics of breast edema in idiopathic granulomatous mastitis and the associated clinical and radiological factors.Materials and Methods:This retrospective study included 129 patients with idiopathic granulomatous mastitis(IGM)from January 2021 to December 2022 in our hospital.All patients were proved by biopsy or surgical pathology and underwent breast MRI before biopsy.The course of disease,serum prolactin(PRL)and vascular endothelial growth factor(VEGF)were collected.The presence or absence of retroareola involvement,the depth of breast involvement,the number of quadrants and the extent of involvement were analyzed from breast magnetic resonance images.Then the appearance of breast edema on T2WI images and breast edema score(BES)were evaluated.The differences in these clinical and radiological characteristics between with and without breast edema groups,and between no or slight breast edema and moderate to severe edema groups were compared withχ2 test and t test.The logistic regression was used for multivariable analysis of significant variables.Results:Among the 129 patients with IGM,124 cases involved unilateral breast and 5 cases involved bilateral breasts.And totally 139 breasts were analyzed.There were 127 breasts with breast edema(91.4%)and 12 breasts with no breast edema(8.6%).For BES estimation,there were 12 breasts with BES 1(8.6%),15 breasts with BES 2(10.8%),68 breasts with BES 3(48.9%)and 44 breasts with BES 4(31.7%).On multivariate analysis,the significant independent predictors for MRI breast edema features was extension of the lesion[P=0.003,odds ratio(OR)=1.091,95%confidence interval(CI):1.035-1.150],the significant independent predictors for the moderate to severe breast edema features were serum PRL,VEGF and extension of the lesion(P<0.05),OR=22.807(95%CI:2.281-228.008),24.140(95%CI:2.937-198.409),1.102(95%CI:1.035-1.174),respectively.Conclusions:The incidence of breast edema on MRI is high in IGM,and the degree of breast edema is related to the levels of

关 键 词：乳腺炎 特发性肉芽肿性乳腺炎 乳腺 乳腺水肿 评分 磁共振成像 

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]