乳腺X线摄影检出的恶性微钙化在MR上的影像表现
|
摘要
目的:探讨乳腺X线摄影检出的恶性微钙化病变在MR上的影像表现。方法:回顾性分析乳腺X线摄影上表现为微钙化且手术病理证实为乳腺癌的80例患者资料,均行乳腺MR检查及X线引导下金属丝定位。分析其X线、MR表现及两者的关系。统计学采用卡方检验或Fisher's精确检验。结果:共83个病灶,导管内癌45个,浸润性癌38个。X线表现:67个为单纯钙化,16个钙化伴局部密度增高;细小多形性(49个)及簇状分布(35个)是最常见的钙化形态及分布方式。MR表现:非肿块样强化57个,肿块样强化16个,未见异常强化10个。92. 9%(26/28)的段样分布钙化MR上表现为段样分布强化。段样分布钙化灶在MR上以段样分布强化更常见(P=0. 000)。81. 3%(13/16)的肿块样强化见于簇状分布钙化。肿块样强化更多见于簇状分布的钙化灶(P=0. 000)。MR上假阴性钙化灶多见于簇状分布钙化灶,但没有显著差异(P=0. 061)。结论:恶性微钙化在MR上的强化类型以非肿块样强化常见,少部分表现为肿块样强化。其强化表现与钙化在X线上的分布方式有关。
Objective: To explore the imaging manifestations of breast microcalcifications and improve the MR diagnosis. Methods: Eighty patients with mammographically detected microcalcifications pathologically proven breast cancer who underwent breast MRI before surgical biopsy,were retrospectively analyzed. The imaging features of mammography and MR were analyzed and compared with χ2 test or Fisher's exact test. Results: Of the 83 lesions,pathologic examination revealed 45 carcinoma in situ and 38 invasive carcinoma. Mammography showed pure microcalcifications in 67 lesions,calcifications with local asymmetry in 16 lesions. Fine pleomophic morphology( 49 cases) and grouped distribution( 35 cases) were the most common appearance. MRI demonstrated 57 lesions with non-mass enhancement,16 mass enhancement and 10 occult lesions. 92. 9%( 26/28) of segmental distribution calcifications showed segmental distribution enhancement on MR. Segmental distribution enhancement on MR was more common in segmental calcification( P = 0. 000). 81. 3%( 13/16) of mass enhancement was seen in clustered calcification. Mass enhancement was more common in clustered calcifications( P = 0. 000). False negativity on MR was mostly seen in clustered calcifications,but there was no significant difference( P = 0. 061). Conclusion: Malignant calcifications detected by mammography may have variable morphologic features on MR images,with non-mass enhancement morphology being the most common manifestation,mass enhancement less common. The enhancement morphology on MR was related to the distribution pattern of calcification on mammography.
Objective: To explore the imaging manifestations of breast microcalcifications and improve the MR diagnosis. Methods: Eighty patients with mammographically detected microcalcifications pathologically proven breast cancer who underwent breast MRI before surgical biopsy,were retrospectively analyzed. The imaging features of mammography and MR were analyzed and compared with χ2 test or Fisher's exact test. Results: Of the 83 lesions,pathologic examination revealed 45 carcinoma in situ and 38 invasive carcinoma. Mammography showed pure microcalcifications in 67 lesions,calcifications with local asymmetry in 16 lesions. Fine pleomophic morphology( 49 cases) and grouped distribution( 35 cases) were the most common appearance. MRI demonstrated 57 lesions with non-mass enhancement,16 mass enhancement and 10 occult lesions. 92. 9%( 26/28) of segmental distribution calcifications showed segmental distribution enhancement on MR. Segmental distribution enhancement on MR was more common in segmental calcification( P = 0. 000). 81. 3%( 13/16) of mass enhancement was seen in clustered calcification. Mass enhancement was more common in clustered calcifications( P = 0. 000). False negativity on MR was mostly seen in clustered calcifications,but there was no significant difference( P = 0. 061). Conclusion: Malignant calcifications detected by mammography may have variable morphologic features on MR images,with non-mass enhancement morphology being the most common manifestation,mass enhancement less common. The enhancement morphology on MR was related to the distribution pattern of calcification on mammography.
引文
[1]Baltzer PAT,Bennani-Baiti B,Stottinger A,et al.Is breast MRI a helpful additional diagnostic test in suspicious mammographic microcalcifications[J]?Magn Reson Imaging,2018(46):70-74.
[2]Hrkac Pustahija A,Ivanac G,Brkljacic B.US and MRI in the evaluation of mammographic BI-RADS 4 and 5 microcalcifications[J].Diagn Interv Radiol,2018,24(4):187-194.
[3]Bennani-Baiti B,Baltzer PA.MR imaging for diagnosis of malignancy in mammographic microcalcifications:A systematic review and Meta-analysis[J].Radiology,2017,283(3):692-701.
[4]Bennani-Baiti B,Dietzel M,Baltzer PA.MRI for the assessment of malignancy in BI-RADS 4 mammographic microcalcifications[J].PLo S One,2017,12(11):e0188679.
[5]Stehouwer BL,Merckel LG,Verkooijen HM,et al.3-T breast magnetic resonance imaging in patients with suspicious microcalcifications on mammography[J].Eur Radiol,2014,24(3):603-609.
[6]Li E,Li J,Song Y,et al.A comparative study of the diagnostic value of contrast-enhanced breast MR imaging and mammography on patients with BI-RADS 3-5 microcalcifications[J].PLo S One,2014,9(11):e111217.
[7]Jiang Y,Lou J,Wang S,et al.Evaluation of the role of dynamic contrast-enhanced MR imaging for patients with BI-RADS 3-4microcalcifications[J].PLo S One,2014,9(6):e99669.
[8]Akita A,Tanimoto A,Jinno H,et al.The clinical value of bilateral breast MR imaging:Is it worth performing on patients showing suspicious microcalcifications on mammography[J]?Eur Radiol,2009,19(9):2089-2096.
[9]Cilotti A,Iacconi C,Marini C,et al.Contrast-enhanced MR imaging in patients with BI-RADS 3-5 microcalcifications[J].Radiol Med,2007,112(2):272-286.
[10]Stomper PC,Geradts J,Edge SB,et al.Mammographic predictors of the presence and size of invasive carcinomas associated with malignant microcalcification lesions without a mass[J].AJR Am JRoentgenol,2003,181(6):1679-1684.
[11]Weigel S,Decker T,Korsching E,et al.Calcifications in digital mammographic screening:Improvement of early detection of invasive breast cancers[J]?Radiology,2010,255(3):738-745.
[12]Bae S,Yoon JH,Moon HJ,et al.Breast microcalcifications:Dagnostic outcomes according to image-guided biopsy method[J].Korean J Radiol,2015,16(5):996-1005.
[13]WANG J,WANG X,LIANG JW,et al.Clinical application of localized biopsy on breast microcalcification[J].Chin J Surg,2007,45(13):881-882.[王靖,王翔,梁建伟,等.乳腺微小钙化灶定位切除的临床应用[J].中华外科杂志,2007,45(13):881-882.]
[14]XU XZ,SONG Y,ZHANG BL,et al.Diagnostic value of X-ray stereotactic vacuum-assisted biopsy for breast micro-calcification[J].Cancer Research and Clinic,2015,27(4):243-245.[徐晓洲,宋颖,张柏林,等.X线立体定位真空辅助活组织检查对乳腺微小钙化灶的诊断价值[J].肿瘤研究与临床,2015,27(4):243-245.]
[15]CAI B,WANG T,LI L,et al.Calcification and histopathological features of infiltrating ductal carcinoma and ductal carcinoma in situ[J].Chin J Med Imaging Technol,2013,29(1):67-70.[蔡斌,汪湍,李莉,等.浸润性导管癌与导管原位癌的钙化特点与组织病理学特征[J].中国医学影像学技术,2013,29(1):67-70.]
[16]Scott-Moncrieff A,Sullivan ME,Mendelson EB,et al.MR imaging appearance of noncalcified and calcified DCIS[J].Breast J,2018,24(3):343-349.
[17]Greenwood HI,Heller SL,Kim S,et al.Ductal carcinoma in situ of the breasts:Review of MR imaging features[J].Radiographics,2013,33(6):1569-1588.
[2]Hrkac Pustahija A,Ivanac G,Brkljacic B.US and MRI in the evaluation of mammographic BI-RADS 4 and 5 microcalcifications[J].Diagn Interv Radiol,2018,24(4):187-194.
[3]Bennani-Baiti B,Baltzer PA.MR imaging for diagnosis of malignancy in mammographic microcalcifications:A systematic review and Meta-analysis[J].Radiology,2017,283(3):692-701.
[4]Bennani-Baiti B,Dietzel M,Baltzer PA.MRI for the assessment of malignancy in BI-RADS 4 mammographic microcalcifications[J].PLo S One,2017,12(11):e0188679.
[5]Stehouwer BL,Merckel LG,Verkooijen HM,et al.3-T breast magnetic resonance imaging in patients with suspicious microcalcifications on mammography[J].Eur Radiol,2014,24(3):603-609.
[6]Li E,Li J,Song Y,et al.A comparative study of the diagnostic value of contrast-enhanced breast MR imaging and mammography on patients with BI-RADS 3-5 microcalcifications[J].PLo S One,2014,9(11):e111217.
[7]Jiang Y,Lou J,Wang S,et al.Evaluation of the role of dynamic contrast-enhanced MR imaging for patients with BI-RADS 3-4microcalcifications[J].PLo S One,2014,9(6):e99669.
[8]Akita A,Tanimoto A,Jinno H,et al.The clinical value of bilateral breast MR imaging:Is it worth performing on patients showing suspicious microcalcifications on mammography[J]?Eur Radiol,2009,19(9):2089-2096.
[9]Cilotti A,Iacconi C,Marini C,et al.Contrast-enhanced MR imaging in patients with BI-RADS 3-5 microcalcifications[J].Radiol Med,2007,112(2):272-286.
[10]Stomper PC,Geradts J,Edge SB,et al.Mammographic predictors of the presence and size of invasive carcinomas associated with malignant microcalcification lesions without a mass[J].AJR Am JRoentgenol,2003,181(6):1679-1684.
[11]Weigel S,Decker T,Korsching E,et al.Calcifications in digital mammographic screening:Improvement of early detection of invasive breast cancers[J]?Radiology,2010,255(3):738-745.
[12]Bae S,Yoon JH,Moon HJ,et al.Breast microcalcifications:Dagnostic outcomes according to image-guided biopsy method[J].Korean J Radiol,2015,16(5):996-1005.
[13]WANG J,WANG X,LIANG JW,et al.Clinical application of localized biopsy on breast microcalcification[J].Chin J Surg,2007,45(13):881-882.[王靖,王翔,梁建伟,等.乳腺微小钙化灶定位切除的临床应用[J].中华外科杂志,2007,45(13):881-882.]
[14]XU XZ,SONG Y,ZHANG BL,et al.Diagnostic value of X-ray stereotactic vacuum-assisted biopsy for breast micro-calcification[J].Cancer Research and Clinic,2015,27(4):243-245.[徐晓洲,宋颖,张柏林,等.X线立体定位真空辅助活组织检查对乳腺微小钙化灶的诊断价值[J].肿瘤研究与临床,2015,27(4):243-245.]
[15]CAI B,WANG T,LI L,et al.Calcification and histopathological features of infiltrating ductal carcinoma and ductal carcinoma in situ[J].Chin J Med Imaging Technol,2013,29(1):67-70.[蔡斌,汪湍,李莉,等.浸润性导管癌与导管原位癌的钙化特点与组织病理学特征[J].中国医学影像学技术,2013,29(1):67-70.]
[16]Scott-Moncrieff A,Sullivan ME,Mendelson EB,et al.MR imaging appearance of noncalcified and calcified DCIS[J].Breast J,2018,24(3):343-349.
[17]Greenwood HI,Heller SL,Kim S,et al.Ductal carcinoma in situ of the breasts:Review of MR imaging features[J].Radiographics,2013,33(6):1569-1588.