磁共振动态增强、扩散加权成像联合应用对乳腺病变的诊断价值

目的：探讨单一磁共振动态增强扫描诊断试验、扩散加权成像诊断试验及其联合应用对乳腺病变定性诊断的敏感性、特异性和阳性似然比、阴性似然比，比较其诊断效能。方法：对临床拟诊肿块的患者37例，同时进行动态增强扫描和扩散加权成像检查，均获得手术和病理证实，其中良性病灶18个，恶性病灶19个。对病变的边缘、形态特征、动态增强表现及时间一信号强度曲线采用评分法对病变性质分恶性、可疑恶性及良性三组进行判断。参照动态增强病变位置确定扩散图像病变所在，描记扩散图像上病变的感兴趣区，由软件计算获得表观扩散系数（ADC）值。对获取数据进行统计分析，采用t检验统计学方法进行良性和恶性ADC值比较。联合动态增强扫描和ADC值，采用评分法根据积分情况进行综合定性诊断。比较动态增强扫描、DWI ADC值及联合应用对乳腺病变定性诊断效能。结果：动态增强扫描（病灶边缘、形态学表现结合时间-信号强度曲线）诊断乳腺病变的敏感性、特异性和阳性似然比、阴性似然比分别为89．5％、72．2％和3．221、0．146。良性病变组ADC值1．474±0．441（×100^-3mm^2／s），恶性病变组ADC值1．082±0．160（×10^-3mm^2／s），两者间有显著统计学差异（P=0．002，〈0．05）。ADC值诊断敏感性、特异性和阳性似然比、阴性似然比分别为94．7％、66．7％和2．842、0．079。动态增强扫描和DWI-ADC值联合诊断的敏感性、特异性和阳性似然比、阴性似然比分别为94．7％、83．3％和5．684、0．063。结论：磁共振动态增强、扩散加权成像联合应用对乳腺病变的定性诊断敏感性、特异性、阳性似然比、阴性似然比均较单一动态增强扫描或扩散成像诊断效能强。

Diagnostic value of combining dynamic contrast-enhanced MR imaging, diffusion-weighted MR imaging for diagnosis of breast lesions

Objective：To analyze the sensitivity, specificity and positive likelihood rate, negative likelihood rate of dynamic contrast- enhanced imaging, diffusion-weighted imaging and combination of the two methods for the diagnosis of breast lesion, and to evaluate their diagnostic validity. Methods：Thirty-seven lesions from 37 patients were acquired with histopathologieal demonstration, of which 19 were malignant and 18 were benign. All lesions were examined with dynamic contrast-enhanced MRI and DWI. The images were reviewed by two radiologists at ADW 4.3 workstation and made consensus on the shape, contour and the type of time-signal intensity curve （TIC）. The lesions were classified as malignant, suspicions or benign according the seore summed up. Apparent diffusion coefficient （ADC） of the lesion was acquired using region of interest （ROI） technique eorrelated with the location of enhanced lesion by Funetool software on the workstation. T test statistical method used to compare ADC, and lesions were classified as benign and malignant. The validities of dynamic contrast-enhanced imaging, ADC, and combination of the two methods were evaluated. Results： The sensitivity, specificity and positive likelihood rate, negative likelihood rate of dynamic contrast-enhanced imaging were 89.5%, 72.2% and 3.221, 0. 146. The benign lesion group ADC was 1.474 ± 0.441 （ × 10^-3 mm^2/s）, and the malignant group was 1.082 ± 0.160 （ × 10^-3 mm^2/s）. To the total numbers had significant difference （ P = 0.002, 〈 0.05）. The sensitivity, specificity and positive likelihood rate, negative likelihood rate of ADC were 94.7%, 66.7% and 2. 842, 0. 079. The combination of dynamic contrast-enhanced MRI and DWI-ADC of breast lesions had a sensitivity, specificity and positive likelihood rate, negative likelihood rate of 94.7 %, 83.3 % and 5. 684, 0. 063. Conclusion： The combination of dynamic contrast-enhancod MRI and DWI was mere diagnostic validity than only the other diagnosis examination in sensitivity, sp