磁共振动态增强联合扩散加权成像对乳腺良恶性病变的诊断价值
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摘要
目的:探讨磁共振动态增强(DCE-MRI)及扩散加权成像(DWI)对乳腺良恶性病变的定性诊断价值。方法:回顾性分析经手术病理证实的122例乳腺病变患者的临床和影像学资料,所有病例术前行双乳MRI检查。分析病灶的形状、边界、强化方式、早期强化率(EER)、时间-信号强度曲线(TIC)及表观扩散系数(ADC)值,参照Fischer评分标准对影像表现进行评分,根据乳腺影像报告与数据系统第5版(BI-RADS)进行分类诊断。与病理结果对照,计算DCE-MRI、DWI、DCE联合DWI对乳腺病变的诊断敏感度、特异度和符合率,并采用ROC曲线分析其诊断效能。结果:122例中恶性80例,良性42例。DCE-MRI诊断敏感度为87.5%,特异度87.5%,符合率86.9%。以恶性病变ADC值的95%可信区间上限1.225×10-3 mm~2/s作为鉴别诊断阈值,敏感度为85.7%,特异度78.9%,符合率83.6%。DCE联合DWI的诊断敏感度达93.8%,特异度90.5%,符合率92.6%。DCE联合DWI鉴别乳腺良恶性病变的AUC(0.915)高于单独诊断(0.866,0.855)。结论:DCE-MRI鉴别乳腺良恶性病变的诊断效能较高,DWI可提供辅助诊断信息,DCE与DWI联合诊断能明显提高对乳腺病变的术前定性诊断准确性。
Objective:The purpose of this study was to evaluate dynamic contrast enhancement MRI(DCE-MRI)and diffusion weighted imaging(DWI)in the differentiation diagnosis between benign and malignant breast lesions.Methods:122 cases with pathological confirmed breast lesions received MRI examinations.The MRI features of the lesions including shape,margin,pattern of enhancement,early enhancement rate(EER),time intensity curve(TIC),and apparent diffusion coefficient(ADC)value were retrospectively analyzed and scored according to Fischer Scoring System and were graded according to Breast Imaging Reporting and Data System(BI-RADS 5 th ed).Compared with pathological diagnosis,MRI sensitivity,specificity and accuracy were calculated,and then the efficacy of DCE,DWI and DCE combined with DWI were analyzed.Results:80(80/122)cases of malignant lesions and 42(42/122)cases of benign lesions were analyzed.The diagnostic sensitivity,specificity and accuracy of DCE-MRI were 87.5%,87.5%and 86.9%.If taken ADC value(1.225×10-3 mm~2/s)as the upper endpoint of the 95%confidence interval for diagnostic criteria of malignancy,the diagnostic sensitivity,specificity and accuracy of DWI were 85.7%,78.9% and 83.6%.When DCE combined with DWI,the diagnostic sensitivity was 93.8%,the specificity was 90.5%and accuracy was 92.6%.The AUC of DCE combined with DWI(0.915)was better than that of each alone(0.866,0.855).Conclusion:DCE-MRI has high efficacy in differentiation of benign and malignant breast lesions,DWI is helpful.DCE-MRI combined with DWI can significantly improve the value of preoperative qualitative diagnosis of breast lesions.
Objective:The purpose of this study was to evaluate dynamic contrast enhancement MRI(DCE-MRI)and diffusion weighted imaging(DWI)in the differentiation diagnosis between benign and malignant breast lesions.Methods:122 cases with pathological confirmed breast lesions received MRI examinations.The MRI features of the lesions including shape,margin,pattern of enhancement,early enhancement rate(EER),time intensity curve(TIC),and apparent diffusion coefficient(ADC)value were retrospectively analyzed and scored according to Fischer Scoring System and were graded according to Breast Imaging Reporting and Data System(BI-RADS 5 th ed).Compared with pathological diagnosis,MRI sensitivity,specificity and accuracy were calculated,and then the efficacy of DCE,DWI and DCE combined with DWI were analyzed.Results:80(80/122)cases of malignant lesions and 42(42/122)cases of benign lesions were analyzed.The diagnostic sensitivity,specificity and accuracy of DCE-MRI were 87.5%,87.5%and 86.9%.If taken ADC value(1.225×10-3 mm~2/s)as the upper endpoint of the 95%confidence interval for diagnostic criteria of malignancy,the diagnostic sensitivity,specificity and accuracy of DWI were 85.7%,78.9% and 83.6%.When DCE combined with DWI,the diagnostic sensitivity was 93.8%,the specificity was 90.5%and accuracy was 92.6%.The AUC of DCE combined with DWI(0.915)was better than that of each alone(0.866,0.855).Conclusion:DCE-MRI has high efficacy in differentiation of benign and malignant breast lesions,DWI is helpful.DCE-MRI combined with DWI can significantly improve the value of preoperative qualitative diagnosis of breast lesions.
引文
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[14]徐琳,汪登斌,王丽君,等.MR-DWI的ADC与rADC在乳腺疾病良恶性鉴别诊断中的比较[J].放射学实践,2014,20(10):1103-1107.
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[16]张东坡,李优伟,郑作锋,等.表观扩散系数对乳腺肿块样和非肿块样强化病变的诊断价值[J].放射学实践,2015,30(4):346-350.
[17]Giardini R,Piccolo C,Rilke F,et al.Primary non-Hodgkin's lymphomas of the female breast[J].Cancer,1992,69(3):725-735.
[18]王康,王之,彭屹峰,等.原发性乳腺非霍奇金淋巴瘤影像特点分析[J].放射学实践,2016,31(12):1201-1204.
[19]张盛箭,何慕真,郑璐琳,等.原发性乳腺淋巴瘤的影像学及临床病理学特征[J].中华肿瘤杂志,2016,38(7):521-525.
[2]American College of Radiology BI-RADS Committee.Breast Imaging Reporting and Data System(5th ed)[J].Reston,American College of Radiology,2013.137-142
[3]Kuhl CK,Mielcareck P,Klaschik S,et al.Dynamic breast MR imaging:are signal intensity time course data useful for differential diagnosis of enhancing lesions[J].Radiology,1999,211(1):101-110.
[4]Han M,Kim TH,Kang DK,et al.Prognostic role of MRI enhancement features in patients with breast cancer:value of adjacent vessel sign and increased ipsilateral whole-breast vascularity[J].AJR,2012,199(4):921-928.
[5]Nam SY,Ko ES,Lim Y,et al.Preoperative dynamic breast magnetic resonance imaging kinetic features using computer-aided diagnosis:Association with survival outcome and tumor aggressiveness in patients with invasive breast cancer[J/OL].PLoS One,2018,13(4):e0195756.DOI:10.1371/journal.pone.e0195756.
[6]Jiang L,Hu X,Xiao Q,et al.Fully automated segmentation of whole breast using dynamic programming in dynamic contrast enhanced MR images[J].Med Phys,2017,44(6):2400-2414.
[7]吴晓燕,张贵祥,李康安,等.增强与非增强组合序列MRI对乳腺病变筛查的比较研究[J].放射学实践,2014,29(12):1424-1428.
[8]张涛涛,杨晓棠.乳腺肿瘤血管生成与DCE-MRI参数的相关性研究[J].国际医学放射学杂志,2016,39(2):142-145.
[9]李俊,赵卫.3.0T磁共振动态增强及扩散加权成像对乳腺病变的诊断价值[J].实用放射学杂志,2013,29(12):1940-1944.
[10]夏琬君,程敬亮,路彦涛,等.MRI动态增强7项参数对乳腺良恶性病灶的诊断价值[J].实用放射学杂志,2014,30(12):1986-1988.
[11]张亚平,董光,耿海,等.DCE-MRI和DWI对乳腺腺病和乳腺癌的诊断价值[J].实用放射学杂志,2017,33(4):533-536.
[12]李相生,王萍,孙鹏,等.3.0T MR多期动态增强扫描在鉴别乳腺导管原位癌与乳腺腺病中的价值[J].现代肿瘤医学,2015,23(3):395-399.
[13]刘世忠,吴雄娟,詹奕彦,等.MR动态增强曲线、DWI及ADC值用于乳腺疾病定性诊断的敏感性及特异性评估[J].中国CT和MRI杂志,2017,15(10):67-70.
[14]徐琳,汪登斌,王丽君,等.MR-DWI的ADC与rADC在乳腺疾病良恶性鉴别诊断中的比较[J].放射学实践,2014,20(10):1103-1107.
[15]Aribal E,Asadov R,Ramazan A,et al.Multiparametric breast MRI with 3T:effectivity of combination of contrast enhanced MRI,DWI,and 1 H single voxel spectroscopy in differentiation of breast tumors[J].Eur J Radiol,2016,85(5):979-986.
[16]张东坡,李优伟,郑作锋,等.表观扩散系数对乳腺肿块样和非肿块样强化病变的诊断价值[J].放射学实践,2015,30(4):346-350.
[17]Giardini R,Piccolo C,Rilke F,et al.Primary non-Hodgkin's lymphomas of the female breast[J].Cancer,1992,69(3):725-735.
[18]王康,王之,彭屹峰,等.原发性乳腺非霍奇金淋巴瘤影像特点分析[J].放射学实践,2016,31(12):1201-1204.
[19]张盛箭,何慕真,郑璐琳,等.原发性乳腺淋巴瘤的影像学及临床病理学特征[J].中华肿瘤杂志,2016,38(7):521-525.