摘要
本研究旨在探讨磁共振动态增强成像和扩散加权成像在乳腺良恶性病变鉴别诊断方面的最新进展及临床应用价值。共收集21例患者,23个病灶,皆是临床触诊发现乳腺单侧或双侧肿块,X线钼靶摄影或B超怀疑恶性的病例,进行MRI动态增强成像(DCE-MRI)和扩散加权成像(DWI)扫描。得出如下结论:(1)MRI动态增强在对乳腺良恶性疾病的鉴别中,形态不规则,边缘模糊、有毛刺,边界不清,充填型环形强化,Ⅲ型曲线是典型乳腺癌的影像表现;而形态为圆形或类圆形,边缘清晰光滑,均匀强化或无强化,Ⅰ型曲线对乳腺良性病变有诊断意义。(2)在扩散加权成像中,乳腺良恶性病变的ADC诊断阈值为1.20×10-3mm2/s,ADC≤1.20×10-3mm2/s为恶性,ADC>1.20×10-3mm2/s为良性。ADC值鉴别良恶性病变敏感性、特异性和准确性较高,而且不需增强,可作为一项常规检查序列。(3)MRI动态增强成像和扩散加权成像相结合对乳腺良恶性病变的正确诊断和鉴别诊断具有重要价值,能为临床乳腺疾病的术前明确诊断提供更有价值、更丰富的信息。
Breast lesions is the world's women frequently-occurring disease, common diseases. With the rapid economic development, people lifestyle changes, breast cancer incidence and mortality rates increase with years, and seriously endanger women's health, so early detection, early diagnosis and early treatment are key to reducing breast cancer mortality.
Recently, MRI technology in the detection and diagnosis of breast cancer showed great advantages, particularly in DCE-MRI and DWI applications, to further improve the early diagnosis of breast cancer. This study is the application of DCE-MRI and DWI to a group of breast lesion evaluation, designed to explore the DCE-MRI and DWI in the diagnosis of benign and malignant breast lesions and differential diagnosis of the value and progress.
All tumors were treated by dynamic contrast enhanced MRI (3D-FLASH sequence) and diffusion-weighted (EPI sequence) scan.
This group 21 female patients were collected, which were found in clinical palpation with unilateral or bilateral breast lumps and X ray mammography or b-mode ultrasonic suspected malignancy. There were 23 lesions, including 15 malignant lesions and 8 benign lesions. All cases underwent surgical resection or biopsy, and confirmed by pathology. Pathological findings as follows: malignant lesions have 12 infitrating ductal carcinoma cases, 2 infitrating lobular carcinoma cases; 1 Lymphoma case. Benign lesions included 5 Fibroadenoma cases, 1 intraductal papilloma case, 1 Plasma cell mastitis case, 1 Breast adenosis.
All lesions were accorded to morphological characteristics of lesions, strengthen means, early enhanced rate, time-signal intensity curve and the ADC values to determine the nature of the lesion. Regarded pathologic results as the gold standard, DCE-MRI and DWI differential diagnosis of the nature of breast lesions assessed.
Through this group analysis of 23 lesions obtained the following results: Based on the MRI scan, differentiating benign and malignant breast lesions after injection of contrast agent were meaningful, especially in filling annular enhancement, the higher specificity in the diagnosis of breast cancer; Increased rate of early DCE-MRI of breast differential diagnosis of benign and malignant lesions was no significant difference, p>0.05; TIC to reflect the number of the blood supply of tumors, it has some value for benign and malignant differentiation, but TIC in the characterization of breast disease and classification have significant overlap, it is not an independent diagnostic breast benign lesions, malignant; In the DWI, the ADC value by the sensitivity of benign and malignant lesions, specificity and accuracy are high. Thus summarized as follows: (1) DCE-MRI of the breast in the differential diagnosis of benign and malignant disease, irregular shape, edge blur, burr, the border is unclear, filling-type ring enhancement,Ⅲ-type curve is typical of imaging findings of breast cancer; The shape is round or oval, sharp edges, smooth, homogeneous enhancement or no enhancement,Ⅰ-type curve of benign breast lesions diagnosis. (2) DWI in breast diagnosis of benign and malignant lesions of the ADC threshold value was 1.20×10-3 mm2/s, ADC≤1.20×10-3 mm2/s was malignant lesions, ADC>1.20×10-3 mm2/s was benign lesions. ADC values of benign and malignant lesions of the sensitivity, specificity, and accuracy is high, and without enhancement, can be used as a routine examination sequence.⑶DCE-MRI and DWI combined benign and malignant lesions of breast diagnosis and differential diagnosis had great value, it provided more valuable and more abundant information for clinical breast for preoperative diagnosis of disease.
DCE-MRI scanning is a dynamic point of view from the blood of breast lesions of the nature of their disease imaging method. Lesions more clearly show the shape, scope and violations of the surrounding tissue, is substantially improved breast disease diagnosis and differential diagnosis accuracy. DWI is a functional imaging, easy to operate, check the time is short, without contrast agent, in patients with no pain, measurement of ADC values of evaluating the effect is a fast and easy to approach, ADC values of benign and malignant tumors have a clear identification of value, can become a routine examination. By MRI diffusion-weighted imaging and dynamic contrast-enhanced imaging in benign and malignant breast lesions on performance can improve the accuracy of diagnosis for the clinical basis.
引文
[1]方亚,施侣元.乳腺癌危险因素综合评价及趋势预测[J].中华流行病学杂志, 2003, 24(7): 611-614.
[2]鲍润贤主编,中华影像医学(乳腺卷),北京人民卫生出版社, 2002(1): 66-75.
[3] Boetes C, Mus RD, Holland R, et al. Breast Tumors: Comparative Accuracy of MR Imaging Relative to Mammography and US for Demonstrating Extent [J]. Radiology, 1995, 197(3): 743-747.
[4] Von Fournier D, Weber E, Hoeffken W, et al. Growth Rate of 147 Mammary Carcinomas [J]. Cancer, 1980, 45(8): 2198-2207.
[5] Seiko KS, Yoshifumi K, Katsuhiro N, et al. Detecting breast cancer with non-contrast MR imaging: combining diffusion-weighted and stir imaging [J]. Magn Reson Ned Sci, 2007, 6(1): 21-27.
[6] Sinha S, Lucas-Quesada FA, Sinha U, et al. In vivo diffusion-weighted MRI of the breast: potential for lesion characterization [J]. J Magn Reson Imaging, 2002, 15: 696-704.
[7] Sinha S, Sinha U. Functional Magnetic Resonance of Human Breast Tumors: Diffusion and Perfusion Imaging [J]. Ann NY Acad Sci, 2002, 980(1): 95-115.
[8] Guo Y, Cai YQ, Cai ZL, et al. Differentiation of Clinically Benign and Malignant Breast Lesions Using Diffusion-weighted Imaging [J]. J Magn Reson Imaging, 2002, 16(2): 172-178.
[9] Kuroki Y, Katsushiro N, Kuroki S, et al. Diffusion-weighted Imaging of Breast Cancer with the Sensitivity Encoding Technique: Analysis of Apparent Diffusion Coefficient Value[J]. Magn Reson Med Sci, 2004, 3(2): 79-85.
[10] Woodhams R, Matsunaga K, Iwabuchi K, et al. Diffusion-Weighted Imaging of Malignant Breast Tumors: the Usefulness of Apparent Diffusion Coefficient (ADC) Value and ADC Map for the Detection of Malignant Breast Tumors and Evaluation of Cancer Extension [J]. J Comput Assist Tomogr, 2005, 29(5): 644-649.
[11] Sickles E. Breast imaging: from 1965 to the present. Radiology, 2000, 215(l): l-16.
[12]吕大鹏,徐光炜,乳腺癌普查的国内外进展[J].中国实用外科杂志, 2006, 26(1): 68-70.
[13]苏瑄.钼靶X线、红外线及B超检查在乳腺肿块诊断中的应用价值[J].医学影像学杂志, 2004, 14(6): 448.
[14]何子元,火树尧,徐开野.早期乳腺癌的X线表现. [J].临床放射学杂志, 2001, 20(1): 11-13.
[15]潘芝梅,李强.乳腺癌的临床X线分析[J].实用放射学杂志2001, 17(3): 186-188.
[16]张宏艳,梁峰,刘端祺,等.临床查体、乳腺超声及X线检查诊断中国人乳腺癌的评价[J].解放军医学杂志, 2007, 32(11): 1167.
[17]宋烨,陈苏宁.乳腺浸润性导管癌的超声表现与钼靶X线摄影对比研究. [J].肿瘤, 2004, 24(3): 298.
[18] Skaane P, Young K, Skjennald A, et al. Population-based mammography screening: comparison of screen-film and full-field digital mammography with soft-copy reading-Oslo I study [J], Radiology, 2003, 229(3): 877.
[19]张明满,高根五,余永康,等.近红外光扫描与彩色多普勒超声对乳腺肿块诊断的临床评价[J].中国普外基础与临床杂志, 2001, 8(5): 326.
[20]刘景平,李春梅,夏天,等.近红外线扫描及彩色多普勒超声对乳腺癌的诊断价值比较[J].中国普外基础与临床杂志, 1998, 5(5): 303.
[21] Sardanelli F, Calabrese M, Zandrino F, et al. Dynamic helical CT of breast tumors. [J]. Comput Assist Tomogr, 1998, 22: 398.
[22]孙永光,王富起,董珂,等.乳腺癌术前CT检查的价值. [J].临床放射学杂志, 2001, 20: 21.
[23] Seiko KS, Yoshifumi K, Katsuhiro N, et al. Detecting breast cancer with non-contrast MR imaging: combining diffusion-weighted and stir imaging [J]. Magn Reson Ned Sci, 2007, 6(1): 21-27.
[24] Orel SG. MR imaging of the breast [J]. Radiol Clin North Am, 2000. 38(4): 899-913.
[25] Kuroki Y, Nasu K, Kuroki S, et al. Diffusion-weighted imaging of breast cancer with the sensitivity encoding technique: analysis of the apparent diffusion coefficient value. Magn Reson Med Sci, 2004, 3: 79-85.
[26] Mardor Y, Pfeffer R, Spiegelmann R, et al. Early detection of response to radiation therapy in patients with brain malignancies using standard and high b-value diffusion-weighted MRI. J Clin Oncol, 2003, 21: 1094-1100.
[27] Reddy JS, Mishra AM, Behari S, et al. The role of diffusion weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions [J]. Surg Neurol, 2006, 66 (3): 246-250.
[28]郭勇,蔡祖龙,蔡幼铨,等.动态增强MRI鉴别乳腺良恶性病变的前瞻性研究[J].中华放射学杂志, 2001, 35(2): 671-675.
[29]唐建华,严福华,周梅玲,等.扩散加权成像与MRI动态增强检测小乳腺癌的比较研究[J].中华放射学杂志, 2008, 42(2): 152-156.
[30] Francesco S, Gian MG, Pietro P, etal. Sensitivity of MRI Versus Mammography for Detecting Foci of Multifocal, Multicentric Breast Cancer in Fatty and Dense Breasts Using the Whole-Breast Pathologic Examination as a Gold Standard [J]. AJR, 2004, 183(4): 1149-1157.
[31]蔡丰,张涛,任小波,等.乳腺癌的影像学诊断和治疗进展[J].中华超声影像学, 2000, 9: 704-705.
[32]李洁,张晓鹏,曹崑,等.乳腺MR动态增强扫描联合扩散加权成像的临床应用评价[J].中国医学影像技术, 2005, 21(12): 1821-1825.
[33] Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview [J]. Cancer, 1997; 80(7):1273-83.
[34]陈蓉,龚水根,张伟国,等.乳腺肿瘤动态增强MRI对比剂空间分布及其与微血管密度的相关性研究[J].临床放射学杂志, 2004, 23(10): 857-861
[35]汪晓红,耿道影,顾雅佳等,乳腺恶性肿瘤的MRI表现及病理对照研究[J],中国医学计算机成像杂志, 2005, 11(2): 100-106.
[36] Kuh1 CK. MRI of breast tumors [J]. EurRadiol, 2000, 10: 46-58.
[37] 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.
[38]刘小娟,翟仁友,蒋涛,等. MR重T2WI首次通过灌注成像鉴别乳腺良恶性肿瘤的价值初探[J].中华放射学杂志, 244: 277.
[39]罗建东,叶泳松,张雪林,等. MRI三维动态增强减影技术鉴别乳腺良恶性病变的研究[J].实用放射学杂志, 2007, 23(5): 688-692
[40]孙泽民,王守安,才艳玲,等.增强MRI诊断乳腺良恶性病变的价值[J],中华放射学杂志, 1998, 32: 467.
[41] Sinha S, Lueas-Quesada FA, Sinha U,et al. In vivo diffusion-weighted MRI of the breast: potential for lesion characterization [J]. J Magn Reson Imaging, 2002, 15(6): 693.
[42] Guo Y,Cai YQ,Cai ZL, et al. Diferentiation of clinically benign and malignant breastlesions using diffusion-weighted imaging. J Magn Reson Imaging, 2002, 16: 172
[43] Sinha S, Lucas-Quesada FA, Sinha U, et al. In vivo diffusion weighted MRI of the breast: potential for lesion characterization. J Magn Reson Imaging, 2002, 15: 693
[44]赵斌,蔡世峰,高佩虹,等. MR扩散加权成像鉴别乳腺良恶性病变的研究.中华放射学杂志, 2005, 39: 497
[45] Kim CK, Park BK, Han JJ, et al. Diffusion-weighted imaging of the prostate at 3-T for differentiation of malignant and benign tissue in transition and peripheral zones: preliminary results. Journal of Comput Assist Tomogr, 2007, 31: 449
[46]赵斌,蔡世峰,于台飞,等. MR氢质子波谱在乳腺肿块应用中的价值及技术干扰因素分析.中华放射学杂志, 2006, 40(3): 251-254.
[47] Stanwell P, Gulch L, Clark D, et al. Specificity of choline metabolites for in vivo diagnosis of breast cancer using 1H-MRS at 1.5T [J]. Eur Radiol, 2005, 15(5): 1037-1043
[48]陈蓉,龚水根,张伟国,等.乳腺肿瘤动态增强MRI对比剂空间分布及其与微血管密度的相关性研究[J].临床放射学杂志, 2004, 23(10): 857-861.
[49] Stomper P C, Hermall S, Klippenstein D L, et al. Suspect breast lesions findings at dynamic gadolinium enhanced MR imaging correlated with mammographic and pathologic features Radiology, 1995, 197: 387-395.
[50]唐建华,严福华,周梅玲,等.扩散加权成像与MRI动态增强检测小乳腺癌的比较研究[J].中华放射学杂志, 2008, 42(2): 152-156.
