单、双指数扩散加权成像联合动态增强磁共振成像对乳腺TICⅡ型良恶性病变的鉴别诊断价值  

Differential Diagnostic Value of Mono-and Bi-exponential Diffusion-Weighted Imaging and Dynamic Enhanced Magnetic Resonance Imaging for TIC TypeⅡBenign and Malignant Breast Lesions

作　　者：马姝[1] 杨自力[2] 赵凡 王唯伟 MA Shu;YANG Zili;ZHAO Fan(Department of Breast Surgery,Affiliated Hospital of Jining Medical University,Jining,Shandong Province 270029,P.R.China)

机构地区：[1]济宁医学院附属医院乳腺外科,272029 [2]济宁医学院附属医院影像科,272029

出　　处：《临床放射学杂志》2024年第1期29-33,共5页Journal of Clinical Radiology

基　　金：山东省中医药科技项目(编号:Q-2022132);济宁市重点研发计划项目(编号:2021YXNS035)。

摘　　要：目的探讨单、双指数扩散加权成像联合动态增强磁共振成像(DWI+IVIM+DCE-MRI模型)对TICⅡ型乳腺良恶性病变的诊断价值方法回顾性分析经病理证实的乳腺肿块患者115例,TICⅡ型良性组30例,恶性组85例,所有病例均行DWI、IVIM及DCE-MRI检查。分析两组间的表观扩散系数(ADC)、纯扩散系数(D)、灌注相关扩散系数(D^(*))、灌注分数(f)及容量转移常数(K^(trans))、血管外细胞外间隙容积比(V_(e))、速率常数(K_(ep))值;绘制ROC曲线比较其诊断效能。结果TICⅡ型良性组ADC、D值高于恶性组,而K^(trans)、K_(ep)、V_(e)值低于恶性组,差异有统计学意义(P<0.05)。ADC、D、K^(trans)、K_(ep)、V_(e)的AUC差异不具有统计学意义(Z=0.01~1.64,P>0.05),但D值的特异度及准确度最高。DWI模型的AUC为0.725,IVIM模型的AUC为0.818;DCE-MRI模型的AUC为0.800;DWI+IVIM模型、DWI+DCE-MRI模型的AUC分别为0.860、0.861,诊断效能均高于DWI模型(Z=2.76,P=0.01;Z=3.380,P=0.001)。将DWI、IVIM及DCE-MRI三者联合后,诊断效能高于DWI+IVIM及DWI+DCE-MRI(Z=2.08,P=0.04;Z=1.877,P=0.04)。结论DWI+IVIM+DCE-MRI对TICⅡ型乳腺良恶性病变有较好的鉴别诊断价值,有利于患者术前精准治疗。Objective To explore the diagnostic value of Mono-and Bi-exponential diffusion-weighted imaging com-bined with dynamic enhanced magnetic resonance imaging(DWI+IVIM+DCE-MRI model)for TIC typeⅡbenign and malignant breast lesions.Methods A total of 115 cases of patients with breast lesion confirmed by pathology were collect-ed,including 30 cases in the TICⅡtype benign group and 85 cases in the malignant group.DWI,IVIM and DCE-MRI scanning were performed in all patients.The true diffusion coefficient(D),perfusion-related diffusion coefficient(D^(*)),perfusion fraction(f),volume transfer constant(K^(trans)),extravascular extracellular space distribute volume per unit tissue volume(V_(e))and rate constant(K_(ep))were analyzed.The ROC was plotted to compare the diagnostic efficiency.Results The values of ADC and D in benign TICⅡtype group were lower than those in malignant group,while the values of K^(trans),K_(ep),V_(e)were higher than that in malignant group(P<0.05).The differences in the AUC of ADC,D,K^(trans),K_(ep),and V_(e)were not statistically different(Z=0.01-1.64,P>0.05),but the D value had the highest specificity and accuracy.The AUC of the DWI,IVIM and DCE-MRI models were 0.725,0.818 and 0.800,respectively.The AUC of DWI+IVIM mod-el and DWI+DCE-MRI model were 0.860 and 0.861,respectively,and the diagnostic efficiencies were higher than that of DWI model(Z=2.76,P=0.01;Z=3.380,P=0.001).After combining DWI,IVIM and DCE-MRI,the diagnostic effi-cacy was higher than DWI+IVIM and DWI+DCE-MRI(Z=2.08,P=0.04;Z=1.877,P=0.04).Conclusion DWI+IVIM+DCE-MRI has a good differential diagnostic value for the benign and malignant TICⅡtype breast lesions,which is conducive to the precise preoperative treatment of patients.

关 键 词：乳腺肿瘤 扩散加权成像 体素内不相干运动 动态增强磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]