锥光束乳腺CT增强检查对致密类乳腺内病灶的诊断价值研究

背景与目的：乳腺纤维腺体组织的密度与乳腺癌的发生、发展有密切关系，该研究旨在比较乳腺X线摄影（mammography，MG）、锥光束乳腺CT（cone beam breast computed tomography，CBBCT）平扫及CBBCT增强检查对具有致密类乳腺的临床就诊者的乳腺恶性肿瘤的诊断效能，探讨CBBCT增强检查的临床价值。方法：回顾2012年5月—2014年8月同时接受MG、CBBCT平扫及增强检查的患者，共有来自80例患者的80侧乳腺符合条件入组。将80侧乳腺的MG、CBBCT平扫及增强诊断结果与其病理学检查结果相比较。测量CBBCT增强前后肿物的CT值变化（△CT），并对其强化程度及类型进行分类。结果：符合条件入组的80侧致密类乳腺，经手术或活检病理学证实，其中40侧为良性，40侧为恶性。将80侧乳腺的MG、CBBCT平扫及增强诊断结果与病理学检查结果比较，绘制受试者工作特征（receiver operating characteristic，ROC）曲线，三者的曲线下面积（area under curve，AUC）分别为0.934（95%CI：0.855~0.977）、0.971（95%CI：0.907~0.996）和0.975（95%CI：0.912~0.997），P<0.01。以BI-RADS 4b为截断点，三者诊断的灵敏度分别为72.5%、75%和92.5%。CBBCT增强检查可见恶性肿瘤多呈明显不均匀强化，而良性肿瘤强化方式呈多样性。恶性肿瘤强化程度明显高于良性肿瘤，良、恶性肿瘤增强前后的CT值变化（△CT）之间差异有统计学意义（t=-4.180，P<0.01）。结论：CBBCT增强检查有助于提高诊断的准确率及灵敏度，对提高具有致密类乳腺的临床就诊者乳腺肿瘤的诊断效能和良恶 性肿瘤的鉴别具有较高价值。

Diagnostic value of contrast-enhanced cone beam breast CT in dense breast lesions

Background and purpose: The density of fibrous gland tissue is closely related to the occurrence and development of breast cancer. This study aimed to compare the diagnostic value of mammography, cone beam breast CT (CBBCT) and contrast-enhanced CBBCT in dense breast lesions of clinical patients. Methods: The study included 80 patients who underwent mammography and CBBCT examinations from May 2012 to August 2014. The CBBCT and mammography diagnostic results of 80 breasts were reviewed and compared with pathological results. We measured the lesion CT values of CBBCT images before and after enhancement, and classified the degree and type of enhancement. Results: The area under the receiver operating characteristic (ROC) curves of mammography, CBBCT and contrast-enhanced CBBCT of the 80 breasts were 0.934(95%CI: 0.855-0.977),0.971(95%CI: 0.907-0.996) and 0.975 (95%CI: 0.912-0.997), respectively. With BI-RADS 4b as the critical value, the sensitivities of the three imaging techniques were 72.5%, 75.0% and 92.5% respectively. The P values were all<0.01. It was showed that most of the malignant tumors were obviously inhomogeneous, and the way of benign tumor enhancement was diversified. The enhanced degree of malignant tumor was obviously higher than that of benign tumor. There was significant difference in CT values between the benign and malignant tumors（t=-4.180, P<0.01）. Conclusion: In this study, the diagnosis of breast malignant tumors by contrastenhanced CBBCT showed higher sensitivity and accuracy. It has significant value in identifying the benign and malignant tumors in dense breast of clinical patients.