多模态MR对≥5 cm的纤维腺瘤和叶状肿瘤鉴别诊断价值  

Diagnostic value of multimodal MR in differentiating fibroadenoma from phyllodes tumor with maximum diameter≥5 cm

作　　者：王丽佳[1] 冯会[1] 潘江洋[1] 许茜[1] 王琦[1] WANG Lijia;FENG Hui;PAN Jiangyang;XU Qian;WANG Qi(Department of CT&MRI,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院CT&MRI科,河北石家庄050011

出　　处：《实用放射学杂志》2024年第3期377-380,410,共5页Journal of Practical Radiology

摘　　要：目的分析≥5 cm的乳腺纤维腺瘤(FA)和乳腺叶状肿瘤(PT)的临床及MR特征.方法选取经手术病理证实且有完整MR资料、瘤体最大径≥5 cm的FA 33例,PT 34例,回顾性分析临床及MR特征.结果肿瘤最大径≥5 cm的PT和FA均好发于围绝经期女性[(47.35±11.36)岁︰(49.42±11.73)岁,P>0.05],但FA患者年龄跨度更大(19~79岁).2组中,PT瘤体更大(中位数7.06 cm,最大肿瘤长径达17.3 cm),组间差异有统计学意义(P<0.001).FA组较PT组更容易出现粗大钙化(5︰0,P=0.011).PT组较FA组在T1WI序列更易出现高信号(50%︰9.1%,P<0.001).2组肿块边缘分叶(97.1%︰81.8%)、T2WI低信号分隔(32.4%︰30.3%)、纤维腺体组织(FGT)和背景实质增强(BPE)4项特征差异无统计学意义(P>0.05).FA组的时间-信号强度曲线(TIC)均表现为Ⅰ型和Ⅱ型,PT组则有4例表现为Ⅲ型(11.8%),2组间差异有统计学意义(P=0.008).PT组的表观扩散系数(ADC)值[(1.48±0.17)×10-3mm2/s],稍低于FA组的ADC值[(1.55±0.20)×10-3mm2/s],2组间差异无统计学意义(P>0.05).受试者工作特征(ROC)曲线分析显示,区分≥5 cm PT和FA的最佳诊断界断值为6.36 cm,曲线下面积(AUC)0.927[95%置信区间(CI)0.860~0.994;P<0.001],T1WI高信号AUC 0.705,标准误为0.065(95%CI 0.578~0.831;P=0.004).结论≥5 cm的FA与PT中,PT表现为更大的肿瘤,T1WI序列更容易出现高信号,而粗大钙化则更多见于FA.Objective To analyze the clinical and MR characteristics of fibroadenoma(FA)and phyllodes tumor(PT)with maxi-mum diameter≥5 cm.Methods A total of 33 cases with FA and 34 cases with PT were selected,and all lesions with maximum diameter≥5 cm were confirmed by surgical pathology.The clinical and MR characteristics were analyzed retrospectively.Results PT and FA with tumor maximum diameter≥5 cm were more common in perimenopausal women[(47.35±11.36)years old vs(49.42±11.73)years old,P>0.05],while the FA patient was with the wider age range(19-79 years old).There was statistically significant difference in tumor maximum diameter between PT group and FA group(P<0.001),and tumor maximum diameter of PT group(median 7.06 cm,tumor maximum diameter 17.3 cm)was significantly larger than that of FA group.Coarse calcification was more common in the FA group compared to the PT group(5 vs 0,P=0.011).High signal on T1WI was more common in PT group rela-tive to FA group(50%vs 9.1%,P<0.001).There were no significant differences between the two groups in four characteristics,including tumor margin lobulation(97.1%vs 81.8%),T2WI low signal separation(32.4%vs 30.3%),fibroglandular tissue(FGT),and background parenchymal enhancement(BPE)(P>0.05).Time-signal intensity curve(TIC)of FA group showed typeⅠandⅡcurves,while 4 cases(11.8%)in PT group showed typeⅢcurves,and there was statistically significant difference in TIC between the two groups(P=0.008).The apparent diffusion coefficient(ADC)values of PT group[(1.48±0.17)×10-3mm2/s]was slightly lower than that of FA group[(1.55±0.20)×10-3 mm2/s],and there was no significant difference in ADC between the two groups(P>0.05).The receiver operating characteristic(ROC)curve showed that the best diagnostic cut-off value for distinguishing between PT and FA with maximum diameter≥5 cm was 6.36 cm,the area under the curve(AUC)was 0.927[95%confidence in-terval(CI)0.860-0.994;P<0.001].The AUC of the T1 WI high signal was 0.705,and the standard error was 0.065(95%CI 0.578-0.831;P=0.

关 键 词：乳腺纤维腺瘤 乳腺叶状肿瘤 磁共振成像 

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