多参数MRI检查BI-RADS分类对乳腺疾病鉴别诊断价值

目的建立一种新的与BI-RADS分类相对应的多参数乳腺MRI诊断模式,探讨多参数乳腺MRI检查对乳腺良恶性疾病的鉴别诊断价值。方法回顾分析290例乳腺疾病患者,共309个经病理证实的乳腺病灶,根据其多平面重组、ADC值测量和TIC测量曲线数据进行BI-RADS分类并与病理结果进行对照分析,分别计算癌前病变纳入良、恶性组的灵敏度和特异度。结果本组病例中多参数MRI联合BI-RADS分类对乳腺疾病鉴别诊断的敏感度和特异度分别为:1)将癌前病变纳入良性病灶、在MRI将4类归为良性组为86.6%和85.0%;2)将癌前病变纳入恶性病灶、在MRI将4类归为良性组为93.3%和66.9%,高于其它组合。病理诊断为癌前病变的治疗建议为手术切除或随访,BI-RADS1-3类对随访病灶的阳性预测值(PPV)为88.2%,BI-RADS 5类对可手术切除病灶的PPV为93.3%,而将癌前病变纳入恶性病灶后,BI-RADS 4类对恶性的PPV为48.0%。结论建立乳腺疾病MRI多参数诊断模型能更精确地判断乳腺病灶良性、癌前病变和恶性特征,对鉴别乳腺良恶性疾病有良好的应用价值。     

超声BI-RADS分类对乳腺结节良恶性鉴别中的应用价值

目的 探讨高频彩色多普勒超声BI-RADS分类在乳腺结节良恶性鉴别中的应用价值。方法 选取乳腺结节患者80例,均行高频彩色多普勒超声检查并经超声BI-RADS分类标准进行分析,以病理学为金标准,对比超声BI-RADS分类在乳腺结节良恶性鉴别诊断中的应用效能。结果 80例中共有结节80个,经病理学检测显示良性病变50例,恶性病变30例。经超声BI-RADS分类显示良性49例,恶性31例。超声BI-RADS分类3类、5～6类的诊断与病理结果一致,灵敏度、特异度以及准确度均为100%,4类诊断的灵敏度95.83%、特异度100%、准确度97.3%。结论 超声BIRADS分类标准进行乳腺结节良恶性鉴别诊断具有非常高的诊断准确度,4类分级结节的鉴别诊断准确度相对偏低。     

结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的处理体会

目的:评价结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的良恶性评估价值,探讨BI-RADS 4类肿块新的处理建议.方法:X线筛查为BI-RADS 4a类(105个)、4b类(42个)和4c类(19个)的151例共166个乳腺肿块,在活检前行MRI.动态增强结合扩散加权成像(DWI)进行MRI BI-RADS分类.结合X线与MRI分类提出新的良恶性评估法.统计X线与MRI诊断乳腺癌的敏感度、特异度及诊断符合率;绘制两者的ROC曲线,Z检验比较曲线下面积;统计结合MRI和X线的新的良恶性评估法发现乳腺癌的敏感性、诊断符合率和对良性病变检出率.结果:2名X线诊断医师和2名MRI诊断医师的BI-RADS分类的Kappa值分别为0.70和0.76,一致性较好.166个肿块,恶性41个,占24.7％.X线BI-RADS 4a类105个:恶性12个,MRI分类为4、5类12个;良性93个,MRI为2、3类81个.X线BI-RADS 4b类42个:恶性16个,MRI分类为4、5类15个;良性26个,MRI为2、3类16个.X线BI-RADS 4c类19个:恶性13个,MRI分类为4、5类12个;良性6个,MRI为3类2个.X线诊断敏感度、特异度为70.7％、74.4％,诊断符合率为73.5％.MRI诊断敏感度、特异性及诊断符合率为95.1％、79.2％和83.1％.X线及MRI诊断乳腺癌的ROC曲线下面积分别为0.749及0.927,两者差异有统计学意义(Z=2.282,P＜0.05).新的良恶性评估法发现乳腺癌的敏感度为100％,诊断符合率为77.7％,良性病变检出率为53.0％.结论:MRI对乳腺X线筛查为BI-RADS 4类肿块有较高的诊断价值.结合X线及MRI分类进行新的良恶性评估,能减少良性肿块不必要的活检.     

彩色多普勒血流显像与超声弹性成像联合诊断BI-RADS4类乳腺病变

目的 探讨彩色多普勒血流显像(CDFI)与超声弹性成像(UE)联合诊断乳腺影像报告和数据系统(BI-RADS)4类乳腺病变的价值.资料与方法 132例BIRADS4类乳腺病变,根据病变血流Adler半定量分级及弹性评分对BI-RADS分类进行调整,绘制ROC曲线,比较BI-RADS分类及校正BI-RADS分类.结果 132例病灶中,良性病灶75个,恶性病灶57个.CDFI诊断乳腺癌的敏感度为87.72％,特异度为48.00％,准确度为65.15％;UE诊断乳腺癌的敏感度为87.72％,特异度为61.33％,准确度为72.73％.校正BI-RADS分类诊断4类乳腺病变的ROC曲线下面积为0.845,明显高于BI-RADS分类的0.760 (Z=2.963,P＜0.01).结论 CDFI联合UE可以明显提高对BI-RADS 4类乳腺病变的诊断准确率,有效减少不必要的术前活检.     

自动乳腺全容积扫描联合磁共振成像检测对乳腺肿瘤的诊断价值

目的探讨自动乳腺全容积扫描(ABVS)联合磁共振成像(MRI)诊断乳腺良、恶性肿瘤的价值。方法选取2016年1月～2018年2月在我院治疗的乳腺肿块患者83例共计112个病灶,均采用ABVS联合MRI检查。结果病理结果证实良性病灶41个,恶性病灶71个;乳腺恶性病灶ABVS图像形态不规则、有分叶状、边缘模糊、内部回声不均匀、汇聚征、虫蚀征和钙化比例分别为63.38%、70.42%、87.32%、50.70%、47.89%、40.85%和43.66%,明显高于乳腺良性病灶(P0.05);乳腺恶性病灶MRI形态不规则、有分叶状、边缘粗糙和毛刺征比例分别为67.61%、78.87%、84.51%和67.61%,明显高于乳腺良性病灶(P0.05);联合检查诊断乳腺癌特异度为92.68%,明显高于ABVS、MRI单独检查(P0.05);ABVS、MRI和联合检查诊断乳腺癌灵敏度、阳性预测值、阴性预测值和准确性差异比较无统计学意义(P0.05)。结论 ABVS和MRI在乳腺良、恶性病灶诊断中有较好的应用价值,两者联合检查可助于提高诊断特异度。     

乳腺疾病磁共振扫描方案的优化选择

探讨磁共振多种扫描序列及方法诊断乳腺良、恶性疾病的应用价值,旨在为临床确定最优磁共振乳腺扫描方案。对42例乳腺疾病患者分别进行磁共振平扫和动态增强扫描及部分DWI、DWIBS检查,与手术病理结果对照,分析各种方法诊断价值及临床意义。多数病灶在磁共振平扫无特征性价值,联合动态增强各项标准诊断乳腺癌的敏感度为95.8%,特异度87.9%,准确度为91.2%;恶性组ADC值明显低于良性组,差异有统计学意义(P<0.05),以ROC曲线确定的诊断阈值为1.542×10-3mm2/s。以此值作为良、恶性判断界值,敏感度83.3%,特异度85.7%,诊断效果较好。5例DWIBS检查,观察到淋巴结转移及病灶远处转移灶,敏感性很高,适合乳腺多病变中心的观察及乳腺肿瘤的筛检和乳腺癌患者治疗前后的评估。时间-信号强度曲线、峰值时间及早期增强率,DWI在鉴别乳腺良、恶性病变方面具有较高的敏感性和特异性,DWIBS亦具有较高的敏感性,结合各种扫描方法的良恶性评判标准,对良、恶性病变的诊断及鉴别诊断有重要价值,且优化出临床最佳磁共振乳腺扫描方案。     

彩色多普勒能量图联合超微血管成像技术对乳腺肿块的诊断价值

目的评价彩色多普勒能量图(CDE)及超微血管成像技术(SMI)联合应用对BI-RADS+4类乳腺病灶的诊断价值。方法选取我院经病理证实的BI-RADS 4级及以上分类的乳腺良恶性病灶132例,其中良性病灶67个,恶性病灶65个。按照Adler分级标准,所有的病灶都采用CDE和SMI技术进行检测,观察同一病灶的血流分布情况,计算出两种检测技术检出血管条数的差值;CDE、SMI、CDE-SMI诊断恶性病灶的血管条数的阈值。结果两种检测方法对所有病灶血流的检测差异有统计学意义(P<0.05);对恶性病灶血流程度的检测有统计学意义(P<0.01);而对良性病灶血流程度检测无统计学意义(P>0.05)。CDE诊断恶性病灶的阈值为血管条数的≥2,敏感度90%,特异度58%;SMI诊断恶性病灶的阈值为血管条数≥3,敏感度95%,特异度71%;CDE-SMI诊断恶性病灶的阈值为≥3,敏感度97%,特异度81%。结论CDE与SMI技术都可检测乳腺恶性病灶的微血管,而SMI技术对潜在的超微血管更敏感,二者联合可为临床鉴别乳腺的良恶性病灶提供可靠的依据。     

~1H-MRS在乳腺BI-RADS 3病变的应用价值

目的探讨MRI氢质子波谱成像(1 H-MRS)在常规动态增强MRI检查诊断的乳腺BI-RADS 3病变中的应用价值。方法应用1.5T MRI对常规动态增强MRI检查诊断为BI-RADS 3乳腺病变的34例患者、39处病灶再次行(1 H-MRS)检查。以Cho峰信噪比(SNR)≥2作为阳性的诊断标准,Cho峰阳性病灶重新评级为BI-RADS 4,阴性患者维持BI-RADS 3不变。以穿刺活检或手术病理为金标准,分析1 H-MRS胆碱峰对乳腺癌与乳腺良性病变的诊断价值。结果6处病灶(累及5例患者)1 H-MRS检查Cho峰阳性从而被重新评估为BI-RADS 4,病理证实均为乳腺癌。另外33处病灶Cho峰阴性维持BI-RADS 3分级不变,病理证实均为良性病变。1 H-MRS检查胆碱峰在乳腺良、恶性病变中有显著统计学差异(P0.001)。结论 1 H-MRS对鉴别常规动态增强乳腺MRI诊断的BI-RADS 3病变中可能存在的恶性病变具有重要作用,可进一步提高BI-RADS分级的准确性。     

超声造影联合弹性成像对BI-RADS 4类乳腺肿块的诊断价值

目的探讨超声造影(CEUS)联合弹性成像(UE)对BI-RADS 4类乳腺病灶的诊断价值。方法回顾性分析经手术病理证实的190枚BI-RADS 4类病灶的UE及CEUS声像图特点,以手术病理结果为"金标准",采用受试者工作特征(ROC)曲线分别评估两者单独及联合应用调整BI-RADS分类的诊断效能。结果 190枚病灶,病理结果显示良性71枚,恶性119枚。CEUS各增强特点良恶性组间差异均有统计学意义。CEUS、UE及常规超声的受试者工作特征曲线下面积(AUROC)分别为0.848,0.767,0.818,均小于UE联合CEUS调整BI-RADS分类的方法(AUROC为0.935),诊断效能具有统计学意义(P0.01)。常规超声、UE、CEUS的敏感度、特异度、准确率分别为97.5%,67.6%,86.3%;68.1%,76.1%,71.1%;65.5%,91.5%,75.3%。CEUS联合UE调整BI-RADS分类后的敏感度98.3%,特异度88.7%,准确率94.7%。结论 CEUS在乳腺良恶性病灶的鉴别上有一定的应用价值,CEUS联合UE能进一步提高BI-RADS 4类乳腺病灶的良、恶性鉴别诊断。     

BI-RADS分类在全数字化乳腺摄影乳腺良恶性病变诊断中的应用

目的：探讨乳腺影像报告和数据系统（BI-RADS）在乳腺良恶性病变诊断中的应用价值。方法：586例患者行全数字化乳腺摄影（FFDM）检查,并根据第四版 BI-RADS 分类标准进行图像分析。将 BI-RADS 分类评估结果与病理结果进行比较。结果：586例患者的 FFDM 检查共发现601个病灶,其中良性病灶340个,恶性病灶261个。与病理结果比较,BI-RADS 分类评估对良、恶性乳腺病变的诊断符合率为82．9％,敏感度为92．0％,特异度75．9％,阳性预测值为74．5％,阴性预测值为92．5％;受试者工作特征曲线（ROC）下面积为0．871（P ＜0．001）,95％可信区间为0．842～0．900。结论：BI-RADS 分类标准对乳腺良恶性病变的诊断和鉴别诊断有重要作用,同时也有利于指导临床制定合适的治疗方案。     

Contrast-enhanced 3.0-T breast MRI for characterization of breast lesions: increased specificity by using vascular maps

Purpose: To assess the diagnostic accuracy of contrast-enhanced 3.0-T breast magnetic resonance imaging (MRI) for differentiating benign from malignant breast masses and subsequently to test if specificity could be further improved by scoring of the overall ipsilateral breast vascularity. Materials and methods: Fifty-four patients were prospectively enrolled in the study and underwent contrast-enhanced 3.0-T breast MRI. MR images were evaluated and classified according to the MRI BI-RADS lexicon criteria. Lesion size, number of lesions, and localization in the breast were systematically assessed. Maximum intensity projections (MIPS) were obtained by using high-resolution contrast-enhanced (0.1 mmol/kg gadobutrol) fat-saturated T1-weighted images. Breast vascularization was scored according to the methods from Sardanelli et al. by measuring the number, diameter, and length of the vessels on the MIPS. The score ranged from 0 (indicating absent or low breast vascularity) to 3 (indicating high breast vascularity). Results: Final analysis of 56 lesions revealed 25 (45%) malignant lesions and 31 (55%) benign lesions. Correlation with the MRI BI-RADS classification revealed cancer in none (0%) of the BI-RADS II lesions, in 1 (12%) of the BI-RADS III lesions, in 5 (83%) of the BI-RADS IV lesions, and in 19 (100%) of the BI-RADS V lesions. Based on morphologic and kinetic data analysis, the sensitivity and specificity of 3.0-T breast MRI was 100% (25/25) and 74% (23/31), respectively. After adjustment for the breast vascularity score, specificity significantly (p = 0.048) increased to 87% (27/31) without affecting sensitivity. Conclusion: Diagnostic accuracy of contrast-enhanced 3.0-T breast MRI increased significantly when the vascularity score was added to the standard morphologic and kinetic data analysis, resulting in a specificity of 87% without affecting sensitivity, which remained 100%.     

Gadolinium-enhanced MR angiography of the breast: Is breast cancer associated with ipsilateral higher vascularity?

The aim of this study was to assess a possible association between breast malignancy and ipsilateral higher vascularity on gadolinium-enhanced MR angiography. One hundred six patients were examined by dynamic gadolinium-enhanced 3D MR imaging. Magnetic resonance angiographic views were generated by image subtraction and maximum intensity projection. The study included 85 patients with unilateral malignant breast neoplasms and 21 with unilateral benign lesions. Three blinded readers independently reviewed the MR angiograms after masking the lesions and the corresponding contralateral sites. The readers were asked to determine whether vascularity was higher on the right side, higher on the left side, or equal on both sides. The results were analyzed by the Kappa statistic and Pearson's chi-square test. The blood vessels of the breasts were clearly seen in all cases. There was good agreement among the observers (kappa > 0.54 ) in assessing vascularity on both sides. Breasts harboring malignant neoplasms were found to have a higher vascularity than the contralateral breasts (p < 0.005). This sign of malignancy had a sensitivity of 76.5 %, a specificity of 57 %, and an accuracy of 72.6 %. Blood vessels of the breast can be depicted by MR angiography. Unilateral malignant neoplasms are associated with a higher ipsilateral vascularity. In conjunction with other indications of malignancy on gadolinium-enhanced MR images, a higher ipsilateral vascularity may serve as an additional sign of malignancy. Received: 4 April 2000 Revised: 14 August 2000 Accepted: 18 August 2000     

同一个体3.0T与1.5T乳腺MR扩散加权成像的图像质量比较

目的比较3.0 T与1.5 T MR正常乳腺组织扩散加权成像(DWI)的图像质量,从而评价3.0 T乳腺MRDWI的可行性。方法对44名女性乳腺受检者分别在3.0 T MR与1.5 T MR上行DWI。3.0 T DWI应用选择性水激励(Water excitation)技术行脂肪抑制,1.5 T DWI应用频率选择脂肪饱和(Fatsat)技术行脂肪抑制,b值均为0,1000 s/mm2,其他参数相同。比较3.0 T及1.5 T乳腺MR DWI图像的主观质量评分,测量并计算3.0 T及1.5 T乳腺MR DWI乳腺组织信噪比(SNR)及表观扩散系数(ADC)值,进行统计学分析。结果 3.0 T乳腺MR DWI的图像质量平均评分为(3.07±0.79),主观质量评分达到3分(可以诊断)及以上者为34名,占总检查例数的77.27%。1.5 T乳腺MR DWI的图像质量平均评分为(3.23±0.52),主观质量评分达到3分及以上者为42例,占总检查例数的95.45%。两者比较差异无统计学意义(P=0.1615,>0.05)。3.0 T乳腺MR DWI的乳腺组织SNR为(52.28±19.34),1.5 T乳腺MR DWI的乳腺组织SNR为(49.97±17.99)。3.0 T乳腺MR DWI图像乳腺组织平均SNR略高于1.5 T,但二者差异无统计学意义(P=0.5500,>0.05)。3.0 T MR DWI的平均ADC值为(1.80±0.44)×10-3mm2/s,1.5 T MR DWI的平均ADC值为(1.73±0.32)×10-3 mm2/s,两者比较差异无统计学意义(P=0.0652,>0.05)。结论 DWI可用于3.0 T MR乳腺成像,图像质量可以达到1.5 T MR DWI的效果,且ADC值与1.5 T的ADC值无明显差异。     

Magnetic resonance imaging of breast vascularity in medial versus lateral breast cancer

Objective

Breasts with malignant tumors can demonstrate a general increased vascularity compared to the contralateral breast and a prominent blood vessel adjacent to the tumor on magnetic resonance imaging (MRI). The aim of the study was to further characterize these alterations in blood supply by location of the tumor within the breast using MRI.

Materials and methods

The study group included 105 patients who underwent breast MRI for suspicion of a malignancy over a 2-year period. Fifty-one had pathologically verified malignant tumors (study group), 11 had pathologically verified benign lesions (control), and 43 had negative scans (control). The malignant lesions were distinguished by location, medial or lateral, within the breast. Origin of the vascular supply and vessel diameter was recorded in a blinded manner. When available, MRI scans performed 2 years after treatment were reviewed as well.

Results

Of the 24 medial malignant tumors, 21 (87%) had a predominantly medial vascular supply and 3 (13%), a predominantly lateral supply; of the 23 lateral tumors, 11 (48%) had a predominantly medial vascular supply and 8 (35%), a predominantly lateral supply (p = 0.03). In 4 cases, no dominant vessel was noted. Maximum vessel diameter was 3.6 ± 1.1 mm in the patients with malignancy and 2.6 ± 0.8 mm in the controls (p < 0.0005). General increased vascularity was demonstrated in 91% of the medial tumor subgroup and 83% of the lateral tumor subgroup, as opposed to 36-37% in the control groups (p < 0.0005). Follow-up MRI, performed in 8 patients in the malignant-tumor group after treatment, revealed a considerable decrease in the prominent vessels, to a size close to that of the controls.

Conclusion

Breasts with malignant tumors are characterized by an altered general vascular supply, a prominent feeding vessel, and increased regional vascularity. Both the presence and location of the tumor affect the vascular supply. The vascular change apparently diminishes after treatment, although this finding requires further investigation in a larger sample.     

Gadobenate dimeglumine-enhanced MR imaging breast vascular maps: association between invasive cancer and ipsilateral increased vascularity

PURPOSE: To retrospectively compare three different doses of gadobenate dimeglumine with a standard dose of gadopentetate dimeglumine for magnetic resonance (MR) imaging evaluation of breast vessels and to evaluate the accuracy of one-sided increased vascularity seen on gadobenate dimeglumine-enhanced MR images as an indicator of ipsilateral breast cancer. MATERIALS AND METHODS: The original study had local ethics committee approval; informed consent was obtained from all enrolled patients. Ninety-five patients known to have or suspected of having breast cancer were randomly assigned to four groups to receive gadobenate dimeglumine at a dose of 0.05, 0.10, or 0.20 mmol per kilogram of body weight or gadopentetate dimeglumine at a dose of 0.10 mmol/kg. T1-weighted gradient-echo MR images were acquired before and 2 minutes after intravenous contrast material injection. Subtracted images were used to obtain maximum intensity projections (MIPs). Two readers blinded to the type and dose of contrast agent administered scored the MIPs obtained in the dose groups for vessel number, length, and conspicuity from 0, which indicated absent or low breast vascularity, to 3, which indicated high breast vascularity. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of one-sided increased vascularity in association with ipsilateral malignancy for 69 histopathologically confirmed lesions (reference standard) were determined after gadobenate dimeglumine-enhanced MR imaging. RESULTS: The mean MIP scores assigned to the gadobenate dimeglumine groups were significantly higher than those assigned to the gadopentetate dimeglumine group (P < or = .044). Histopathologic analysis revealed malignant lesions in 52 of 69 patients examined with gadobenate dimeglumine MR imaging: invasive ductal carcinoma in 45, invasive lobular carcinoma in four, and invasive mixed ductal-lobular carcinoma in three patients. Seventeen patients had benign lesions. Two cases of bilateral invasive cancer with symmetric breast vascular maps were excluded. Thus, the overall sensitivity, specificity, accuracy, PPV, and NPV of one-sided increased vascularity as a finding associated with ipsilateral malignancy were 88% (44 of 50 patients), 82% (14 of 17 patients), 87% (58 of 67 patients), 94% (44 of 47 patients), and 70% (14 of 20 patients), respectively. CONCLUSION: Gadobenate dimeglumine is effective for MR imaging evaluation of breast vessels at doses as low as 0.05 mmol/kg. One-sided increased vascularity is an MR imaging finding frequently associated with ipsilateral invasive breast cancer.     

Preoperative breast MR Imaging in patients with primary breast cancer has the potential to decrease the rate of repeated surgeries

PurposeThe impact of preoperative MRI on re-excisions and mastectomy rate is discussed controversially in the literature. Aim of this study was to evaluate the effect of preoperative breast MRI on the surgical procedure and rate of repeated surgeries.Material and methodsA total of 991 consecutive patients in the years 2009 and 2010 with 1036 primary breast cancers were retrospectively analyzed. Sixty percent (599 patients with 626 cancers) received preoperative breast MRI. Planned surgical procedures before and after MRI and numbers of repeated surgeries in patients with (MR+ ) and without preoperative MRI (MR−) were compared.ResultsThe result of preoperative MRI changed the surgical procedure in 25% (157/626) of the cases. In 81% (127/157), MRI was beneficial for the patients, as otherwise occult carcinomas were removed (n = 122) or further biopsy could be prevented (n = 5). Mastectomy rates did not differ between MR+ and MR- group (39% vs. 39%). On multiple regression analysis, the MR+ group had a lower chance for repeated surgery (p < 0.05).ConclusionPreoperative MRI could lower the chance for repeated surgery in patients with primary breast cancer. The rate of mastectomy did not differ between patients undergoing preoperative MRI and those who did not.     

A wide variety of dynamic contrast-enhanced MR appearances of breast cancer: pathologic correlation study

PURPOSE: The aim of this study was to elucidate the characteristic magnetic resonance (MR) appearance of breast cancers, as well as, its variations and to investigate the pathology providing different patterns of dynamic-MR appearances. MATERIALS AND METHODS: Fifty-two women with cancer underwent mastectomy (52 tumors resected) and had MR imaging at our institution between April 2001 and March 2004. MR images of T1WI, T2WI, dynamic-MRI and contrast-enhanced T1WI were obtained and evaluated. Dynamic-MR images were correlated with pathological findings. RESULTS: Common MR appearance of breast cancer was a focal mass either with irregular or spiculated margins with similar signal intensity on T1WI as and similar to higher signal intensity on T2WI compared to the normal mammary gland. On static contrast-enhanced T1WI, apparent enhancement was typically observed. On dynamic MRI, tumor-rim-enhancement on an early phase image and washout enhancement pattern on dynamic images, both characteristic for breast cancer, were observed, however, the prevalence of them was relatively low, which could be explained by the variation of histopathology among breast cancer nodules. CONCLUSION: In diagnosing breast masses on MRI, as well as the common and characteristic findings of breast cancer, the variations of MR findings and their underlying histopathology should also be considered.     

MRI of the breast in patients with metastatic disease of unknown primary

The objective of this study was to assess the value of contrast-enhanced dynamic breast imaging in patients with carcinoma of unknown primary (CUP). Fourteen patients presenting with metastatic disease compatible with breast cancer (axillary lymph node metastasis: n = 6; supraclavicular lymph node metastasis: n = 1; bone metastasis: n = 3; liver metastasis: n = 3; lung metastasis: n = 1), who had no evidence of tumor in X-ray mammograms and ultrasound, underwent bilateral dynamic breast MR imaging. Suspicious lesions were localized preoperatively using a stereotactic device for MR-guided localization procedures. Magnetic resonance imaging revealed suspicious lesions in 9 of 14 patients. Histopathology revealed invasive carcinoma of the breast in 6 of these patients. Two enhancing lesions were fibroadenomas; one proved to be sclerosing adenosis. In 5 patients MR imaging showed no abnormality. Follow-ups performed up to 1 year after initial treatment revealed no breast cancers in these 5 patients. In patients with metastatic disease of unknown primary, MRI of the breast depicts the primary in a considerable number of cases with normal conventional evaluation. Received: 20 February 1998; Revision received: 2 June 1998; Accepted: 10 July 1998     

乳腺癌保乳术前的动态增强MRI和X线摄影联合评估

目的:探讨动态增强MRI和钼靶X线摄影在乳腺癌行保乳术(BCS)的术前评估价值。方法:分析106例经手术和病理证实的乳腺癌患者的术前动态增强MRI及钼靶X线摄影资料,观测动态增强MRI和钼靶X线摄影片上乳腺癌病灶的数目、位置、大小、形态、侵犯范围和淋巴结转移情况,按乳腺癌保乳术所需条件与术后大体解剖标本及镜下病理相对照,分析单独和联合运用动态增强MRI与钼靶X线摄影对乳腺癌保乳术前的评估准确性。结果:动态增强MRI判断40例(37.8%)可行BCS,判定准确性为96.2%;钼靶X线摄影判断37例(34.9%)可行BCS,判定准确性为89.6%;动态增强MRI与钼靶X线摄影联合运用,判断41例(38.7%)可行BCS,判定准确性为97.2%。结论:联合运用动态增强MRI和钼靶X线摄影能为乳腺癌患者筛选是否适合BCS提供较全面和准确的信息。