基于DCE-MRI的3D-MIP重建及多参数评估BI-RADS 4类乳腺肿瘤  

3D-MIP reconstruction and multi parameter evaluation of BI-RADS 4 breast tumors based on DCE-MRI

作　　者：梁泓冰 宁宁 赵思奇 李远飞 武玥琪 宋清伟[1] 杨洁 高雪[3] 张莫云 张丽娜[1] LIANG Hongbing;NING Ning;ZHAO Siqi;LI Yuanfei;WU Yueqi;SONG Qingwei;YANG Jie;GAO Xue;ZHANG Moyun;ZHANG Lina(Department of Radiology,First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;School of Public Health,Dalian Medical University,Dalian 116044,China;Department of Pathology,First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院放射科,大连116011 [2]大连医科大学公共卫生学院,大连116044 [3]大连医科大学附属第一医院病理科,大连116011

出　　处：《磁共振成像》2024年第5期94-101,共8页Chinese Journal of Magnetic Resonance Imaging

基　　金：2022辽宁省成人教育学会继续教育教学改革研究课题项目(编号:LCYJGZXYB22100);2022年度大连市医学重点专科“登峰计划”一般项目(编号:2022DF042)。

摘　　要：目的探讨动态对比增强MRI(dynamic contrast-enhancement MRI,DCE-MRI)瘤周血管特征结合瘤内血流动力学参数在乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)4类肿瘤中的鉴别诊断价值。材料与方法回顾性分析2018年8月至2023年3月于大连医科大学附属第一医院行乳腺MRI检查为BI-RADS 4类且病理结果明确肿瘤的女性病例102例,其中良性组43例,恶性组59例。记录患者年龄、病灶最大径(dmax)、乳腺DCE-MRI基本影像学特征、瘤周血管特征及瘤内血流动力学参数值。通过单因素和多因素logistic回归分析比较两组间多参数的差异,利用受试者工作特征(receiver operating characteristic,ROC)曲线以及曲线下面积(area under the curve,AUC)分析瘤周血管特征指标与瘤内参数值联合应用对BI-RADS 4类乳腺良恶性两组肿瘤鉴别的诊断效能。应用DeLong检验对AUC进行比较。结果乳腺良性组和恶性组病例在年龄、dmax、背景实质强化(background parenchymal enhancement,BPE)、纤维腺体组织量(fibroglandular tissue,FGT)、瘤周相邻血管征(adjacent vascular sign,AVS)数目、瘤周血管最大径、患侧瘤周与健侧同一象限血管直径差值(△d)、瘤周血管出现期相以及瘤内容积转移常数(volume transfer constant,K^(trans))、速率常数(flux rate constant,K_(ep))、最大增强斜率(maximum slope of increase,MSI)和时间-信号强度曲线(time-signal intensity curve,TIC)类型的差异均具有统计学意义(P<0.05),而病变位置、信号增强率(signal enhancement ratio,SER)和血管外细胞外间隙容积比(volume fraction of extravascular extra vascular space,V_(e))差异无统计学意义(P>0.05)。通过多因素logistic回归分析结果显示,△d、dmax、MSI和K^(trans)为区分两组间的独立影响因素,其中优势比最大的是MSI值(AUC为0.923)。将瘤周血管特征△d分别与dmax、MSI和K^(trans)进行两者联合模型比较,以△d与MSI联合模型的诊Objective:To ascertain whether dynamic contrast-enhancement MRI(DCE-MRI)is a useful diagnostic tool for intratumoral and peritumoral vascular features in breast imaging reporting and data system(BI-RADS)4 of tumors.Materials and Methods:A retrospective collection of 102 female cases with BI-RADS4 breast MRI examination and clear pathological results from August 2018 to March 2023 at the First Affiliated Hospital of Dalian Medical University,43 cases were benign group and 59 cases were breast malignant group.Record the patient's age,maximum lesion diameter(dmax),and basic imaging features of breast DCE-MRI,as well as peritumor vascular characteristics and intratumor hemodynamic parameters.Differences in several parameters between the two groups were analyzed by univariate and multivariate Logit models.The diagnostic efficacy of combining various peritumor vascular characteristic indexes and intratumor parameter values to differentiate between benign and malignant BI-RADS4 lesions in the breast was analysed using the receiver operating characteristic,(ROC)curves and the area under the curve(AUC).Evaluate AUC with the DeLong test.Results:There were statistically significant differences in number of adjacent vascular signs(AVS),maximum diameter(dmax)of peritumoral blood vessels,the difference in diameter of blood vessels around the tumor between the affected and healthy sides(Δd),peritumoral vascular appearance phase,volume transfer constant(K^(trans)),flux rate constant(K_(ep)),maximum slope of enhancement(MSI),type of time signal intensity curve(TIC),background parenchymal enhancement(BPE)and fibrous glandular tissue(FGT)between the two groups of benign and malignant breast cases(P<0.05),while there was no statistically significant difference between signal enhancement ratio(SER)and volume fraction of extracellular space(V_(e))(P>0.05).Δd,dmax,MSI and K^(trans)were independent factors that affected how the two groups differentiated from one another,according to multiple logistic regression analysis,with MSI value

关 键 词：乳腺肿瘤 动态对比增强 瘤周血管 最大密度投影 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]