乳腺叶状肿瘤MRI形态及功能表现与病理对照分析
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摘要
目的探讨乳腺叶状肿瘤(BPTs) MRI形态和功能表现,及其与病理对照分析结果,以提高乳腺叶状肿瘤的诊断水平。方法回顾性分析13例BPTs患者的临床及MRI影像学资料,并与病理结果进行对照。结果 13例患者中,术前MRI诊断为BPTs 8例,纤维腺瘤4例,脂肪肉瘤1例,准确率为61. 5%(8/13)。BPTs的T1加权成像(T_1WI)表现为较低信号,2例良性、4例交界性及2例恶性BPTs瘤体内有不规则小片状、裂隙状更低信号区,其余均表现为均匀信号; T_2加权成像(T_2WI)表现为较高信号,除2例良性BPTs信号均匀外,其余BPTs瘤体内可见线样分隔呈稍低信号,瘤体内T1WI所见不规则小片状、裂隙状更低信号区在T_2WI表现为更高信号区。扩散加权成像(DWI)序列均表现为等或稍高信号,良性BPTs表观弥散系数(ADC)值为(1. 33～2. 59)×10-3mm~2/s,交界性BPTs ADC值为(1. 21～2. 83)×10~(-3)mm2/s,恶性BPTs ADC值为(0. 81～2. 41)×10~(-3)mm~2/s。2例良性、1例交界性BPTs的时间-信号曲线为Ⅰ型曲线,5例良性、2例交界性、1例恶性BPTs为Ⅱ型曲线,1例交界性、1例恶性BPTs部分为Ⅱ型、部分为Ⅲ型曲线。6例良性、2例交界性BPTs为边缘光滑型,其余为局部边缘不规则型。结论 MRI检查显示BPTs肿瘤边缘大部分光滑,仅交界性及恶性BPTs部分边缘不规则,T_2WI脂肪抑制序列呈高信号,其内见分隔,增强扫描时间-信号曲线以平台型及上升型为主,DWI序列大多未见扩散受限。
Objective To investigate the morphological and functional features of breast phyllodes tumors( BPTs) on MRI and their comparison with pathological findings,so as to improve the diagnostic level of BPTs.Methods The clinical and MRI image data of 13 patients with BPTs were retrospectively analyzed and compared with pathological findings. Results Of the 13 cases,8 were diagnosed with BPTs on preoperative MRI,4 with fibroadenoma and 1 with liposarcoma,with an accuracy rate of 61. 5%( 8/13). On T_1-weighted imaging( T_1 WI),BPTs were hypointense,2 benign,4 borderline,and 2 malignant BPTs cases appeared with irregular patchy and fissure-like hypointense areas inside,the remaining cases were characterized by hemogeneous signal; on T_2-weighted imaging( T_2 WI),BPTs were hyperintense,except 2 benign BPTs cases with hemogeneous signal,the remaining BPTs cases were hypointense with streaky septations inside,those featured by irregular patchy and fissure-like hypointense areas inside on T_1 WI presented hyperintense areas on T_2 WI. All diffusion-weighted imaging( DWI) sequences displayed isointense or slightly hyperintense signal,apparent diffusion coefficient values of benign,borderline,and malignant BPTs were( 1. 33-2. 59) × 10~(-3) mm~2/s,( 1.21-2.83) × 10~(-3) mm~2/s and( 0. 81-2. 41) × 10~(-3) mm~2/s,respectively. Two benign and 1 borderline BPTs cases reported type Ⅰ time-signal intensity curve( TIC),5 benign,2 borderline,and 1 malignant BPTs cases reported typeⅡ TIC,1 borderline and 1 malignant BPTs cases made their TIC appear partially of type Ⅱ and partially of type Ⅲ.Six benign and 2 borderline BPTs cases were defined as smooth-margin type,the remaining cases as local-irregularmargin type. Conclusion MRI examination reveals that BPTs have smooth tumor margin mostly,only borderline and malignant BPTs exhibit irregular margin partially,T_2 WI sequence presents high signal and internal septations for fat suppression,enhanced scan TICs appear mainly with plateau pattern and ascending pattern,and the majority of DWI sequences have no diffusion limitation.
Objective To investigate the morphological and functional features of breast phyllodes tumors( BPTs) on MRI and their comparison with pathological findings,so as to improve the diagnostic level of BPTs.Methods The clinical and MRI image data of 13 patients with BPTs were retrospectively analyzed and compared with pathological findings. Results Of the 13 cases,8 were diagnosed with BPTs on preoperative MRI,4 with fibroadenoma and 1 with liposarcoma,with an accuracy rate of 61. 5%( 8/13). On T_1-weighted imaging( T_1 WI),BPTs were hypointense,2 benign,4 borderline,and 2 malignant BPTs cases appeared with irregular patchy and fissure-like hypointense areas inside,the remaining cases were characterized by hemogeneous signal; on T_2-weighted imaging( T_2 WI),BPTs were hyperintense,except 2 benign BPTs cases with hemogeneous signal,the remaining BPTs cases were hypointense with streaky septations inside,those featured by irregular patchy and fissure-like hypointense areas inside on T_1 WI presented hyperintense areas on T_2 WI. All diffusion-weighted imaging( DWI) sequences displayed isointense or slightly hyperintense signal,apparent diffusion coefficient values of benign,borderline,and malignant BPTs were( 1. 33-2. 59) × 10~(-3) mm~2/s,( 1.21-2.83) × 10~(-3) mm~2/s and( 0. 81-2. 41) × 10~(-3) mm~2/s,respectively. Two benign and 1 borderline BPTs cases reported type Ⅰ time-signal intensity curve( TIC),5 benign,2 borderline,and 1 malignant BPTs cases reported typeⅡ TIC,1 borderline and 1 malignant BPTs cases made their TIC appear partially of type Ⅱ and partially of type Ⅲ.Six benign and 2 borderline BPTs cases were defined as smooth-margin type,the remaining cases as local-irregularmargin type. Conclusion MRI examination reveals that BPTs have smooth tumor margin mostly,only borderline and malignant BPTs exhibit irregular margin partially,T_2 WI sequence presents high signal and internal septations for fat suppression,enhanced scan TICs appear mainly with plateau pattern and ascending pattern,and the majority of DWI sequences have no diffusion limitation.
引文
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[9]张淑平,刘佩芳,鲍润贤.乳腺叶状肿瘤MRI表现特征分析[J].临床放射学杂志,2010,29(2):174-178.
[2] B9cker W. WHO classification of breast tumors and tumors of the female genital organs:pathology and genetics[J].Verh Dtsch Ges Pathol,2002,86:116-119.
[3] Confavreux C,Lurkin A,Mitton N,et al. Sarcomas and malignant phyllodes tumours of the breast--a retrospective study[J]. Eur J Cancer,2006,42(16):2 715-2 721.
[4] Kinoshita T,Fukutomi T,Kubochi K. Magnetic resonance imaging of benign phyllodes tumors of the breast[J].Breast J,2004,10(3):232-236.
[5] Balaji R,Ramachandran KN. Magnetic resonance imaging of a benign phyllodes tumor of the breast[J]. Breast Care(Basel),2009,4(3):189-191.
[6] Yabuuchi H,Soeda H,Matsuo Y,et al. Phyllodes tumor of the breast:correlation between MR findings and histologic grade[J]. Radiology,2006,241(3):702-709.
[7]史凤毅,叶海军,柴薇,等.乳腺叶状肿瘤治疗和预后研究[J].中华普通外科杂志,2003,18(10):612-615.
[8] Wurdinger S,Herzog AB,Fischer DR,et al. Differentiation of phyllodes breast tumors from fibroadenomas on MRI[J].AJR Am J Roentgenol,2005,185(5):1 317-1 321.
[9]张淑平,刘佩芳,鲍润贤.乳腺叶状肿瘤MRI表现特征分析[J].临床放射学杂志,2010,29(2):174-178.