不同ADC阈值对磁共振BI-RADS 4类病变的诊断效能比较  

The comparison of the diagnostic efficacy of different ADC thresholds for MRI BI-RADS 4 lesions

作　　者：吴芳 胡红杰[2] 何杰 苏东颖 饶钦盼 宋侠 樊树峰 Wu Fang

机构地区：[1]浙江中医药大学附属第二医院,310010 [2]浙江大学医学院附属邵逸夫医院,310009

出　　处：《浙江临床医学》2025年第3期349-352,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2024KY1230)。

摘　　要：目的比较基于弥散加权成像(DWI)序列的不同ADC阈值对磁共振(MRI)乳腺影像报告和数据系统(BI-RADS)4类病变的诊断效能。方法回顾性分析2018年6月至2021年9月经病理证实的乳腺MRI检查归类为BI-RADS 4类病变的患者的MRI影像和临床资料,其中良性230例,恶性242例。选择病灶ADC图的最暗区测量平均ADC值。定义以下3个阈值:ADCMax-malig为恶性病变的最大ADC值;ADCYouden为约登指数最大时的ADC值;ADCnl为选择阴性似然比≤0.1,特异度最高的ADC值为阈值。比较应用三种阈值诊断的敏感度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率和活检减少的数量,以及对BI-RADS 4类病变降级的效能。结果良性组和恶性组患者年龄、病灶大小、ADC值、BI-RADS分类、最大径分布(以1 cm为界)比较差异均有统计学意义(P<0.05)。ADC区分良性和恶性病变的AUC为0.861(0.819~0.893)。采用三种方法计算的ADC阈值均可以不同程度的降低活检,ADCMax-malig降低活检数量最少(2.3%),假阳性率最高(95.2%);ADCYouden在特异度、阳性预测值和降低活检方面均优于ADCnl,但假阴性数量最多(15.3%),安全性和稳定性较ADCnl差,且只能对恶性概率<9.6%的BI-RADS 4类病变进行降级。应用ADCnl后活检可减少28.2%,假阴性数量相对较少(5.0%),且能对恶性概率<16.9%的BI-RADS 4类病变进行降级。结论选择阴性似然比≤0.1,特异度最高的ADC值可用于降低乳腺BI-RADS 4类病变不必要的活检,且可以对BI-RADS 4A类病变进行降级,ADCnl=1.53×10^(-3)mm^(2)/s这个阈值安全、稳定,值得推广。Objective To compare the efficacy of different ADC thresholds based on diffusion-weighted imaging(DWI)sequences in downgrading Breast Imaging Reporting and Data System(BI-RADS)category 4 lesions on magnetic resonance imaging(MRI).Methods A retrospective analysis was conducted on MRI images and clinical data of patients with pathologically confirmed BI-RADS category 4 breast lesions from June 2018 to September 2021,including 230 benign and 242 malignant cases.The mean ADC value was measured in the darkest region of the lesion on the ADC map.Three thresholds were defined:ADCMax-malig,the maximum ADC value of malignant lesions;ADCYouden,the ADC value at the maximum Youden index;and ADCnl,the ADC value with the highest specificity at a negative likelihood ratio(LR)≤0.1.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),false-positive rate(FPR),false-negative rate(FNR),and the number of biopsies avoided were compared among the three thresholds.The efficacy of downgrading BI-RADS category 4 lesions was also evaluated.Results Significant differences were observed between the benign and malignant groups in terms of age,lesion size,ADC values,BI-RADS classification,and maximum diameter distribution(using 1 cm as the cutoff)(P<0.05).The area under the curve(AUC)for ADC in distinguishing benign from malignant lesions was 0.861(0.819~0.893).All three ADC thresholds reduced the number of biopsies to varying degrees.ADCMax-malig resulted in the least biopsy reduction(2.3%)and the highest FPR(95.2%).ADCYouden outperformed ADCnl in specificity,PPV,and biopsy reduction but had the highest FNR(15.3%)and poorer safety and stability compared to ADCnl.ADCYouden could only downgrade BI-RADS 4 lesions with a malignancy probability<9.6%.In contrast,ADCnl reduced biopsies by 28.2%,had a relatively low FNR(5.0%),and could downgrade BI-RADS 4 lesions with a malignancy probability<16.9%.Conclusion The ADC threshold with a negative LR≤0.1 and the highest specificity(ADCnl=1.53×10^(-3)mm^(2)/s)can e

关 键 词：乳腺肿瘤 磁共振成像 表观扩散系数 乳腺影像报告和数据系统 

分 类 号：R737.9[医药卫生—肿瘤]