乳腺癌的MRI影像学特征与细胞分子表型之间的相关性研究

目的 探讨乳腺癌动态增强MRI的影像学征象与细胞分子表型之间的相关性.方法 回顾性分析85例经手术病理确诊的乳腺癌患者术前MRI资料,采用统计学方法分析MRI影像学征象与乳腺癌分子表型之间的相关性.免疫组织化学检测采用二步法观察癌组织中雌激素受体(ER)、孕激素受体(PR)和人类表皮生长因子受体2 (CerbB-2)的表达水平.结果 动态增强MRI诊断乳腺癌病理类型的敏感性和特异性分别为94.0％和80.0％,诊断其分化程度的敏感性和特异性分别94.8％和71.4％.肿瘤的形态和边缘与其病理类型和组织学分级相关(x2值分别为6.21和5.88,P均＜0.05),肿瘤形态和环形强化均与ER和PR的阴性表达相关(P＜0.05),环形强化和肿瘤内部坏死与CerbB-2的阳性表达相关(P＜0.05),而肿瘤边缘与ER、PR和CerbB-2的表达均无相关性(P＞0.05).肿瘤不规则形态可以预测ER的阴性表达,而环形强化是ER、PR阴性预测因子(P＜0.05),肿瘤内部坏死是CerbB-2阳性表达的预测因子(P＜0.05).结论 乳腺癌MRI的影像学特征对判断肿瘤类型和组织学分级具有一定的指导意义,可预测乳腺癌的分子表型表达情况,评估预后.     

乳腺癌MRI动态增强征象与免疫组化指标间的相关性分析

目的 探讨乳腺癌磁共振动态增强(DCE-MRI)征象与免疫组化各指标之间的相关性。方法 选取经病理证实肿块型乳腺癌(浸润性,非特殊型) 186例,所有病例术前行磁共振检查,根据乳腺影像报告和数据系统(BI-RADS)对肿块影像学征象进行分类,术后对病变组织行免疫组织化学染色,检测雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体(HER-2)、增殖细胞核抗原(Ki-67)表达情况,运用统计学方法分析病变磁共振特征与免疫组化各指标之间的相关性。结果 肿块的边缘不规则是ER表达阴性的预测因子(P=0.04);肿块内部环形强化是PR表达阴性的预测因子(P=0.03);肿块大小与HER-2表达呈正相关(P=0.02),边缘不规则是HER-2表达阳性的预测因子(P=0.03); Ki-67表达与肿块大小呈正相关(P=0.01),与肿块边缘及内部强化方式呈负相关(P=0.04、P=0.01)。结论 乳腺癌磁共振征象与免疫组化各指标之间具有一定的相关性,总结不同免疫组化指标表达的影像学表现,为从术前影像角度分析乳腺癌的生物学行为和预后提供理论基础。     

乳腺癌的MRI影像特征与ER、PR、HER-2表达的相关性研究

目的探讨乳腺癌的MRI影像特征与ER、PR、HER-2表达的相关性。方法收集经手术病理证实的女性单发乳腺癌50例,术前均行乳腺MRI常规及动态增强扫描。使用免疫组化染色测定所有病例的ER、PR、HER-2的表达情况;采用卡方检验,P0.05为差异有统计学意义。结果 50个乳腺癌灶中,癌肿不规则形态、毛刺状边缘与ER、PR阳性表达呈正相关,毛刺状边缘与HER-2阴性表达呈正相关,早期环形强化与ER、PR阴性表达呈正相关。结论乳腺癌的MRI增强表现与乳腺癌生物学指标存在一定相关性,可为患者的临床治疗及预后评估提供参考价值。     

乳腺癌MRI表现与免疫组化相关性的初步研究

目的:探讨乳腺癌的ER、PR、CerbB-2、VEGF表达与MRI征象之间的关联性。方法:对50个乳腺癌患者术前行乳腺MR扫描,分析乳腺癌的MRI影像学表现,术后标本行免疫组织化学染色测定肿瘤细胞ER、PR、CerbB-2、VEGF表达情况,并分析与相应病灶MRI表现的关系。结果:乳腺癌的MRI多表现为形态不规则、分叶状或类圆形结节,边缘毛刺,边界模糊,部分病灶内部见坏死;大部病灶在T1WI呈略低信号,在脂肪抑制T2WI呈不均匀高信号;Gd-DTPA增强扫描后,呈明显均匀或不均匀强化、斑驳样强化或边缘环形强化。乳腺癌病灶早期边缘强化与癌细胞VEGF阳性表达呈显著正相关(r=0.873;P0.01);毛刺状边缘与ER、PR、VEGF阳性表达呈正相关(r=0.702,0.764,0.497;P0.05);内部坏死与CerbB-2阳性表达呈显著正相关(r=0.718;P0.01);形态与癌细胞ER、PR、CerbB-2、VEGF表达情况无显著相关性(r=0.129,0.312,0.343,0.254;P0.05)。结论:乳腺癌MRI征象与免疫组化标记物之间存在一定的相关性,对我们从影像角度评估乳腺癌的生物学行为和预后有一定的参考价值。     

乳腺癌MRI形态学表现与病理、分子生物学相关性研究

目的　探讨乳腺癌MRI形态学表现与病理、分子生物学之间的相关性。方法　对 78例原发性乳腺癌患者术前行乳腺MR扫描 ,分析乳腺癌的MRI形态学表现。术后标本行免疫组织化学染色测定癌细胞雌激素受体 (ER)、孕激素受体 (PR)、C erbB 2和P5 3的表达情况及微血管密度 (MVD)分布情况 ,并分析与MRI表现之间的关系。结果　 80个乳腺癌中 ,癌肿毛刺状边缘与癌细胞ER阳性表达呈正相关 (P <0 0 1) ,肿瘤T分期与癌细胞ER阳性表达呈负相关 (P <0 0 5 ) ,肿瘤内部坏死与癌细胞C erbB 2、P5 3阳性表达呈正相关 (P <0 0 5 ) ,而肿瘤毛刺状边缘、边界模糊、内部坏死、T分期与癌细胞PR表达水平无显著相关性 (P >0 0 5 )。 4 1个乳腺癌中 ,癌肿动态增强MR对比剂空间分布与相应MVD之间存在高度正相关 (P <0 0 1)。结论　乳腺癌MRI形态学表现与病理、分子生物学之间存在一定相关性 ,可根据乳腺癌MRI表现对癌灶的生物学行为和预后进行评估。     

乳腺癌钼靶X线表现与ER、PR和P53表达的相关性探讨

目的 探讨乳腺癌的钼靶X线表现与乳腺癌癌细胞中雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)及P53蛋白表达的相关性.方法 收集乳腺癌患者60例术前行钼靶X线检查,术后标本行免疫组织化学染色测定 ER、PR及P53蛋白表达情况,分析钼靶X线征象与ER、PR及P53蛋白表达的相关性.结果 在60例乳腺癌中,有肿块组ER、PR及P53阳性表达率均高于无肿块组,2组PR表达有统计学差异(χ2=6.213,P=0.013);其中有毛刺组ER、PR阳性表达率高于无毛刺组,且有统计学意义(χ2=6.673、3.873,P<0.05);钙化组ER、PR及P53阳性表达率高于无钙化组,均有统计学差异(χ2=7.330、5.984、4.671,P<0.05);有淋巴结转移组PR阳性表达率低于无淋巴结转移组,P53阳性表达率明显高于无淋巴结转移组,有统计学意义(χ2=6.213、5.978,P<0.05).结论 乳腺癌钼靶X线征象在一定程度上反映了ER、PR及P53的表达状况.     

乳腺癌磁共振动态增强及DWI表现与生物学预后因子的相关性研究

目的:分析乳腺癌形态学特征、MRI动态增强扫描参数、ADC值与生物学预后因子的相关性,探讨MRI检查术前评估乳腺癌预后的可行性。方法:51例患者共52个病灶。观察病灶的形态学特征、时间-信号强度曲线、早期强化率、ADC值,采用Spearman等级相关法分析乳腺癌MRI表现与生物学预后因子的相关性。结果:乳腺癌MRI表现中的环形强化与Ki-67阳性表达程度呈正相关(r=0.276);TIC类型与PR阳性表达程度呈负相关(r=-0.295);早期强化率与C-erbB-2阳性表达程度呈正相关(r=0.273)。结论:动态增强扫描不仅在乳腺癌定性诊断中起重要作用,还可以间接预测乳腺癌的预后,为临床治疗方案的选择提供参考。     

乳腺癌超声征象与分子生物学表达的相关性研究

目的 :探讨乳腺癌超声征象与分子生物学表达的相关性,以提高超声对乳腺癌的诊断水平,为乳腺癌治疗及预后评估提供可靠的影像学信息。方法:随机抽取经手术病理证实为乳腺癌的患者50例,均行乳腺高频超声检查,重点观察肿块的形态、边缘、后方回声、微小钙化、内部血流及腋窝淋巴结;均采用免疫组化法检测ER、PR及Cerb B-2基因表达,并分析其与超声表现的关系。结果:12 cm乳腺癌微小钙化检出率最高,其次为边缘毛刺状;形态不规则在2 cm的肿瘤检出率较高。2肿块纵横比1患者的ER、PR阳性率为77.8%、61.1%,较纵横比≤1者高(P0.05);3边缘毛刺征患者的ER、PR阳性率分别为65.5%、55.2%,较无毛刺组高(P0.05);4周边高回声晕患者的ER和PR阳性率分别为73.3%、60.0%,均高于无高回声晕患者(P0.05);5内部无回声区患者的PR阳性率22.2%,低于未见无回声区患者(P0.05);6微小钙化患者的Cerb B-2阳性率83.3%,高于未见微钙化者(P0.05)。结论:乳腺癌超声表现与分子生物学指标的表达有一定的关系,肿瘤生物学特性影响乳腺癌的超声表现。超声检查可为乳腺癌的预后评估及临床治疗方式的选择提供影像学依据。     

乳腺癌超声表现与分子生物学指标的相关性研究

目的初步探讨乳腺癌超声表现与分子生物学指标雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体-2(CerbB-2)的相关性。资料与方法回顾性观察137例病理确诊为乳腺癌的超声图像与石蜡切片,分析超声征象与ER、PR、CerbB-2的关系。结果肿块纵横比>1与ER、PR阳性表达相关(χ2=11.551,P<0.05;χ2=5.973,P<0.05);边缘毛刺征与ER、PR阳性表达相关(χ2=7.883,P<0.05;χ2=5.600,P<0.05);高回声晕征与ER、PR阳性表达相关(χ2=8.108,P<0.05;χ2=4.957,P<0.05);肿块内部坏死与PR阴性表达相关(χ2=4.819,P<0.05);微钙化与CerbB-2阳性表达相关(χ2=4.661,P<0.05)。结论乳腺癌超声表现与分子生物学指标有一定的相关性,可根据乳腺癌超声表现预测其生物学行为,为临床治疗方案的选择与预后评估提供依据。     

乳腺癌钼靶X线征象与病理及激素受体表达的关系

目的 探讨乳腺癌的钼靶X线征象与激素受体ER和PR之间的相关性.方法 回顾性分析60例经乳腺钼靶X线摄影、手术及病理证实的乳腺癌的X线表现.术后标本应用免疫组织化学染色测定乳腺癌原发灶癌细胞ER和PR表达情况,并分析其与钼靶X线征象之间的关系.结果 60例乳腺癌中,乳腺癌X征象钙化与癌细胞ER阳性表达之间相关(P＜0.01);PR阳性表达水平与钙化和肿块边缘有毛刺征象的癌细胞之间有相关性(P＜0.0 1).结论 乳腺癌钼靶X表现与激素受体ER和PR之间存在一定的相关性.通过乳腺癌的钼靶X线表现可以预测ER和PR的表达,为临床内分泌治疗方案的选择提供客观依据.     

乳腺MR灌注时间-信号强度曲线表现及价值研究

目的探讨乳腺MRT2*WI首次通过灌注时间-信号强度曲线(TIC)表现及其在乳腺病变鉴别诊断中的价值。资料与方法对40例乳腺肿瘤患者行乳腺动态增强成像扫描,绘制T2*WI首次通过灌注TIC及T1WI动态增强TIC。采用Fisher’s确切概率法检验,判定良、恶性病灶T1WI动态增强及灌注TIC的差异。结果良、恶性病灶灌注TIC之间差异具有显著性统计学意义(P<0.05=0.000);良、恶性病灶T1WI动态增强TIC之间差异有显著性统计学意义(P<0.05=0.011),但在平台型曲线类型中良恶性病灶有较大重叠。结论乳腺MR灌注TIC在良、恶性病灶具有显著差别,恶性病灶灌注TIC主要表现为信号快速下降后缓慢回升(A型)与快速下降后不回升(B型);良性病灶灌注TIC主要表现为平直型(C型)及缓慢上升后平台型(D型)。灌注TIC与病灶形态学结合可大大提高乳腺疾病诊断的准确性。     

3T磁共振高分辨动态增强诊断小乳癌的应用研究

目的:探讨磁共振高分辨动态增强检查对小乳腺癌诊断的临床应用价值。方法:回顾性分析病理证实的20例(21个病灶)小乳腺癌(最大径≤2cm)的MRI高分辨动态增强检查的形态学及血流动力学特征。结果:小乳腺癌的特征性表现为形态不规则或分叶、边缘不规则或者毛刺、不均匀环形强化的肿块样病变以及局灶、不均匀或簇集样强化的非肿块病变,时间-信号强度曲线:平台型7例(33.3%),流出型14例(66.7%)。对侧对称部位正常乳腺为逐渐轻度强化,时间-信号强度曲线均为持续型。结果显示小乳腺癌灶与正常乳腺组织之间的血流动力学变化有显著差异。结论:3T磁共振高分辨动态增强检查能够提供清晰、丰富的形态学及血流动力学信息,对小乳腺癌的诊断和鉴别诊断具有重要价值。     

乳腺癌动态增强MRI与X线摄影的对比分析

目的:通过对乳腺癌动态增强MRI表现与X线摄影的对比分析,评价两者对乳腺癌的诊断价值。材料和方法:回顾性分析了50例乳腺癌的动态增强MRI与X线摄影,MRI分别采用自旋回波(FSE)序列加预饱和脂肪抑制技术(SPIR)、减影技术及快速三维动态增强扫描。X线摄影采用常规方法摄片。结果:乳腺MRI在显示肿块形态、边缘、内部结构、与周围组织关系、乳内淋巴结方面优于X线摄影;X线摄影在显示钙化方面占绝对优势,检出乳腺癌的敏感性分别为:MRI93%(47/50),X线摄影82%(41/50),两者比较差异有显著性(P<0.01);两种方法结合检查的敏感性为98%(49/50)。结论:NRI、X线摄影各有优势和限度,检查乳腺癌敏感性MRI较X线摄影高,而当两种方法联合应用时,可减少乳腺癌的漏诊率,从而提高病变诊断的准确性。     

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.     

彩色多普勒超声与MR诊断乳腺病变的临床价值分析

目的：比较彩色多普勒超声、磁共振动态增强对乳腺病变的临床诊断价值。方法收集经手术与病理证实的95例同时做过超声与M R的101个乳腺病灶,对其二维声像图及CDFI特点与磁共振动态增强影像学表现,对照病理结果进行回顾性分析。结果彩色多普勒与MR动态增强扫描对乳腺良恶性病变定性诊断准确率分别为：超声良性病变诊断正确率73．3％,恶性病灶诊断正确率87．3％;M R良性病变诊断正确率84．3％,恶性病灶诊断正确率92．7％。95个患者共检出101处病灶,其中乳腺癌67例,占66％;纤维瘤23例,占23％,炎性肉芽肿4例,占4％;分叶状肿瘤2例,占2％;囊腺瘤1例,占1％;乳头状瘤4例,占4％。结论超声检查诊断准确性高,适用于乳腺疾病的常规检查;MR空间分辨力及软组织分辨力高,适用于超声检查难以定性的病变及乳腺癌的术前评估。     

Invasive breast cancer: correlation of dynamic MR features with prognostic factors

The purpose of this exploratory study was to correlate kinetic and morphologic MR features with histologic prognostic factors in invasive breast cancer. Sixty-one women with invasive breast cancer underwent dynamic contrast-enhanced MR imaging at 1.5 T, using T1-weighted 3D fast low-angle shot technique. The MR characteristics were correlated with classical pathologic prognostic factors (tumor size, histologic type, grade and lymph node status) and immunohistochemically detected biomarkers [c-erbB-2, p53, Ki-67, and estrogen receptor (ER)]. Univariate and multivariate statistical analyses were performed. Presence of rim enhancement pattern, early maximal enhancement and washout phenomenon were independently associated with established predictors of poor prognosis (higher histologic grade, positive Ki-67, and negative ER status). Our results suggest that these MR signs are not only important in differentiating benign from malignant lesions, but may also be useful to noninvasively identify highly aggressive breast carcinomas.     

3D -FLASH序列动态MR增强扫描技术在乳腺疾病中的应用

目的 探讨3D-FLASH动态增强扫描在乳腺疾病检查中的应用价值. 方法 将108例经病理证实的乳腺疾病患者作为研究对象,均为女性,年龄35～76岁,平均47岁,使用Siemens 1.0T超导磁共振扫描仪和双环极阵列乳腺线圈.均先常规平扫,静脉注射造影剂Gd-DTPA(0.1 mmol/kg体重)后,三维-快速小角度激发(3D-FLASH)序列获得双侧乳腺轴位动态增强图像并进行减影. 结果 108例中,良性病变62例,乳腺癌46例,术前MRI诊断符合率81.5%. 结论 3D-FLASH序列动态增强是乳腺病变中最有价值的检查序列.     

A case of pleomorphic adenoma of the breast on dynamic contrast-enhanced MR imaging

Pleomorphic adenoma commonly develops in the salivary gland, but rarely in the breast. The dynamic contrast-enhanced MR imaging findings of pleomorphic adenoma of the breast have not been well described. We report a 43-year-old woman with pleomorphic adenoma of the left breast. The imaging findings, including those on dynamic contrast-enhanced MR imaging, included an oval mass with a smooth margin, which consisted of solid and cystic components. The solid component was hypo-intense on T1-weighted imaging, hyper-intense on short tau inversion recovery imaging, with no apparent restricted diffusion, and had heterogeneous enhancement with dark internal septation and a fast/plateau dynamic contrast enhancement pattern. The cystic component was slightly hyper-intense on T1-weighted imaging, slightly hypo-intense on short tau inversion recovery imaging and had no apparent restricted diffusion or contrast enhancement. Together with its rarity, the similarities of imaging findings and the pathologic findings of pleomorphic adenoma of the breast to those of other tumors make accurate preoperative diagnosis difficult. Therefore, through this case report, awareness of pleomorphic adenoma of the breast on dynamic contrast-enhanced MR imaging will facilitate appropriate surgery and postoperative observation based on an accurate diagnosis.     

Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral breast cancer or high-risk lesions

PURPOSE: To prospectively evaluate accuracy of gadobenate dimeglumine-enhanced magnetic resonance (MR) mammography for depiction of synchronous contralateral breast cancer in patients with newly diagnosed unilateral breast cancer or high-risk lesions, with histologic analysis or follow-up as reference. MATERIALS AND METHODS: The study had ethics committee approval; all patients provided written informed consent. One hundred eighteen consecutive women (mean age, 52 years) with unilateral breast cancer or high-risk lesions and negative findings in the contralateral breast at physical examination, ultrasonography, and conventional mammography underwent gadobenate dimeglumine-enhanced 1.5-T MR mammography. Transverse three-dimensional T1-weighted gradient-echo images were acquired before and at 0, 2, 4, 6, and 8 minutes after gadobenate dimeglumine administration (0.1 mmol per kilogram body weight). Breast Imaging Reporting and Data System (BI-RADS) was used to categorize breast density and the level of suspicion for malignant contralateral breast lesions. Results were compared with histologic findings. Sensitivity, specificity, accuracy, and positive and negative predictive values for contrast-enhanced MR mammography were evaluated. RESULTS: Contrast-enhanced MR mammography revealed contralateral lesions in 28 (24%) of 118 patients. Twenty-four lesions were detected in patients with dense breasts (BI-RADS breast density category III or IV). Lesions in eight (29%) of 28 patients were BI-RADS category 4; patients underwent biopsy. Lesions in 20 (71%) patients were BI-RADS category 5; patients underwent surgery. At histologic analysis, 22 lesions were confirmed as malignant; six lesions were fibroadenomas. No false-negative lesions were detected; none of the fibroadenomas were BI-RADS category 5. The sensitivity, specificity, accuracy, and positive and negative predictive values of contrast-enhanced MR mammography for depiction of malignant or high-risk contralateral lesions were 100%, 94%, 95%, 79%, and 100%, respectively. Follow-up findings (12-24 months) confirmed absence of contralateral lesions in 90 of 118 patients with negative contrast-enhanced MR mammographic findings in the contralateral breast. CONCLUSION: Contrast-enhanced MR mammography is accurate for detection of synchronous contralateral cancer or high-risk lesions in patients with newly diagnosed breast cancer or high-risk lesions.     

乳腺恶性肿瘤的MRI诊断

目的　评价MRI诊断乳腺恶性肿瘤的临床应用价值。方法　对37例乳腺恶性肿瘤进行MRI平扫和增强扫描,并对照X线、B超及手术病理结果,分析比较了增强前病变形状、边界、内部信号,以及增强后病变强化特征。结果　平扫及增强MRI对37例乳腺恶性肿瘤患者的诊断准确率分别为84.5%和94.6%。结论　平扫及增强MRI是诊断乳腺恶性肿瘤的有效影像学方法。