乳腺MRI检查与诊断流程的设计与优化

乳腺MRI已经广泛应用于乳腺癌的诊断和临床评估,高质量的乳腺MRI检查对充分发挥临床应用价值至关重要。笔者针对乳腺MRI检查流程中在预约、患者准备、序列设计、图像采集、阅片和报告等环节中与临床医疗质量相关的问题进行分析和讨论,结合当前国内外进展介绍技术优化的方法,旨在为我国乳腺MRI工作者的临床实践提供指导或借鉴。     

乳腺磁共振检查技术的应用与探讨

目的探讨乳腺磁共振(MRI)检查技术中成像序列、参数、扫描方位的选择及其应用价值。方法 回顾性分析32例乳腺MRI检查资料,对进行检查所选用的扫描方法、序列、参数做出总结分析。结果 32例研究对象乳腺MRI图像均显示良好,乳腺结构和周围组织清晰,未见有变形情况。结论 MRI检查中,采用恰当的扫描序列、参数及进行合理的扫描,可清晰显示乳腺结构,观察到乳腺肿瘤周边、内部情况及其与邻近组织的关系;动态增强扫描可清晰显示肿瘤形态及较小病灶,对乳腺肿瘤定性诊断极具价值。     

乳腺MRI技术操作规范探讨

目的：乳腺MRI具有良好的软组织分辨率、多平面成像和无辐射性,现已成为高危人群普查、乳腺癌早期诊断、判断疗效、评估预后等不可或缺的检查手段的重要方法。该文简要介绍乳腺MRI的适应证、常用技术的规范和图像影响因素,以期对乳腺MRI技术的临床应用提供参考。     

MRI成像优化组合序列在乳腺病变诊断中的对比分析

目的 探讨快速优化的乳腺MRI成像组合序列,提高对乳腺病变诊断的准确率.方法 回顾性分析20例乳腺癌患者的MRI检查资料.按患者入院手术先后次序,平均分成A、B、C、D 4组,各5例;应用横轴位FSE T2WI脂肪抑制序列及动态增强扫描技术(VBRENT+C)作为每组的固定序列;每组再分别选择3种不同序列作为非固定序列进行组合,对各组中非固定序列的总扫描时间、病灶显示满意度进行比较、分析与评估;筛选出总扫描时间与总满意度之和的最高得分组合序列,作为乳腺MRI成像的常规组合序列.结果 A组时间级别S4,满意度M1;B组时间级别S2,满意度M1;C组时间级别S1,满意度M2;D组时间级别S3,满意度M3;D组(S3M3)为最佳优化组合序列,差异有统计学意义(P<0.05).结论 在乳腺MRI成像技术的多组合序列比较中,D组是乳腺MRI成像的最佳常规组合序列.     

多参数MRI在乳腺癌诊疗中的应用及进展

多参数核磁共振成像（MRI）在乳腺癌诊疗过程中具有重要作用。随着乳腺MRI的不断发展,越来越多的功能学参数提供了更多定量指标,为乳腺癌筛查、诊断、疗效评估及预后提供更多信息。本文从乳腺MRI检查设备、检查序列、临床检查适应证及MRI的新技术、新进展等方面介绍多参数MRI在乳腺癌诊疗过程中的应用及进展。     

数字化乳腺摄影与MRI联合应用对提升乳腺癌诊断准确率的实效性探究

目的探讨数字化乳腺摄影与磁共振成像技术(MRI技术)联合使用对临床上乳腺癌诊断准确性的提升以及其实效性。方法对2013年9月至2014年5月43例乳腺癌患者在进行手术前使用数字化乳腺摄影检查和磁共振技术(MRI技术)检查。将43例患者的数字化乳腺摄影的图像作为数字组;所有的磁共振成像技术的图像作为MRI像组;所有的数字化乳腺摄影图像与MRI图像作为合并组。由3名医师对三组图像进行独立判断图片是否为乳腺癌,并对医师的判断结果用软件进行配对、检验。结果 3名医师通过数字组对乳腺癌的判断的平均例数是25例,准确率为58.1%(25/43);通过MRI像组对乳腺癌的判断的平均例数是33例,准确率为76.7%(33/43);通过数字化摄影图像与MRI图像共同观察的合并组的判断的平均例数为40例,准确率为93.0%(40/43)。三组间比较差异有统计学意义(P0.05)。结论数字化乳腺摄影与MRI技术联合使用对乳腺癌的判断的准确率很高,应在临床上广泛地推广使用。     

不同MRI序列显示乳腺病变的比较

目的比较不同MRI序列显示乳腺病变的价值.方法对79例乳腺癌和68例乳腺良性疾病患者采用自旋回波(SE)序列、快速自旋回波(TSE)序列、脂肪抑制(FS)成像、快速小角度激发(FLASH)序列、静态或动态增强扫描,比较不同MRI序列对乳腺病变的显示检出情况.结果脂肪抑制成像序列对乳腺病变的检出率高于SE序列,SE序列有利于病灶病理解剖关系的显示,MR增强扫描可检出所有乳腺病灶且有助于明确病灶的内部结构、浸润范围及其血供情况.结论 SE、TSE应为乳腺MR检查的常规序列,脂肪抑制成像序列必不可少,MR增强扫描对病灶的定性诊断很有价值,尤其是FLASH动态增强扫描.     

乳腺1H磁共振波谱

对比增强MRI已经成为重要的乳腺成像手段,但是该手段并不总能提供确切的病理.在动态增强MRI基础上增加活体MRS的初步研究显示的结果很具前景,越来越多的研究小组将MRS加入乳腺MR检查序列.本文阐明了进行MRS检查的预期检查结果,并列举了其中的一些缺陷.     

MRI随访在乳腺癌诊断和疗效评估中的价值

乳腺MRI是检出、诊断乳腺癌以及监测乳腺癌治疗效果的重要影像检查手段,本文通过对近10年来国内外相关经典文献的回顾性分析,分别对MRI随访在乳腺癌前病变及乳腺癌早期诊断、在不同类别乳腺癌的诊断、在复发性乳腺癌的诊断等方面的应用价值进行详细阐述。同时以大量数据将MRI随访与乳腺X线摄影、乳腺超声等常规随访手段的价值进行比较。MRI随访在乳腺癌新辅助化疗疗效中的应用价值在文中也有较准确的论述。最后本文以实际工作中的具体病例MR图像对MRI随访的上述应用进行例证。同时附注乳腺MRI检查的相关技术要求及注意事项。     

乳腺X线检查联合磁共振成像在乳腺癌早期诊断中的应用价值

目的 分析乳腺X线机联合磁共振成像在乳腺癌早期诊断中的应用价值。方法 选取2017年3月至2019年1月濮阳市妇幼保健院经手术病理确诊的乳腺癌患者47例为观察组,并选取同期本院经手术病理确诊的乳腺良性病变患者56例为对照组。所有患者均进行乳腺X线检查与MRI检查,分析乳腺X线检查联合MRI检查结果,并分析两种方法诊断乳腺癌的T分期结果,分析MRI影像学图像。结果 钼靶X线用于乳腺癌诊断的灵敏度为80. 85%(38/47)、特异度为89. 29%(50/56)、准确度为85. 44%(88/103),乳腺X线+MRI检查诊断乳腺癌灵敏度为93. 62%(44/47)、特异度为94. 64%(53/56)、准确度为94. 17%(97/103)。乳腺X线检查T分期符合率为76. 60%(36/47),乳腺X线联合MRI检查T分期符合率为91. 49%(43/47)。结论 联合X线以及MRI检查对乳腺癌进行诊断可提升诊断的准确度以及TNM分期符合率,在乳腺癌早期诊断中具有较高的应用价值。     

Screening for breast cancer with MRI

Breast MRI has emerged as an extremely powerful tool in breast imaging. The use of breast MRI for cancer detection has the potential to change our current algorithms in the detection of breast cancer. By being able to detect cancer that is occult on conventional imaging, such as mammography and sonography, MRI can detect early breast cancer that was previously unseen by conventional imaging. This article reviews the experience of screening breast MRI in the high-risk population. It also reviews the limitations associated with its use. Before breast MRI can be used in the clinical setting, an ability to localize or biopsy MRI detected lesions that are occult on mammography and ultrasound is needed and must be available for these patients. Although the robustness of this technique has generated considerable enthusiasm, our perspective should be tempered by the fact that many questions remain unanswered regarding the use of breast MRI for screening in the nonhigh risk population as well as integration of breast MRI into clinical practice.     

高频超声联合磁共振可提高对乳腺癌早期诊断的价值

目的分析高频超声联合MRI在乳腺癌早期诊断的价值。方法回顾2018年1月~2019年11月因乳腺肿块于我院诊治的85例患者,所有患者均接受高频超声和MRI检查,以病理结果为标准,观察高频超声、MRI检查以及二者联合检测的阳性检出率,比较高频超声、MRI检查以及二者联合诊断乳腺癌及其分期的价值。结果85例乳腺肿块患者进行病理学检查,共发现病灶107个,其中良性59个,恶性48个;高频超声检查显示,40个病灶诊断为乳腺癌,其中8个病灶漏诊;45个病灶诊断为良性肿块,其中14个病灶误诊;MRI检查显示,46个病灶诊断为乳腺癌,其中2个病灶漏诊;53个病灶诊断为良性肿块,其中6个病灶误诊;高频超声联合MRI检查显示,47个病灶诊断为乳腺癌,其中1个病灶漏诊;56个病灶诊断为良性肿块,其中3个病灶误诊;高频超声联合MRI诊断乳腺癌的准确性、敏感度、特异度、阳性预测值以及阴性预测值高于高频超声（P < 0.05）,MRI诊断乳腺癌的准确性高于高频超声（P < 0.05）,敏感度、特异度、阳性预测值以及阴性预测值与MRI比较,差异无统计学意义（P>0.05）;高频超声联合MRI诊断不同分期乳腺癌优于高频超声和MRI,但差异无统计学意义（P>0.05）。结论高频超声和MRI均可有效诊断乳腺癌,二者联合应用可提高对乳腺癌早期诊断及分期的诊断价值,为临床治疗提供有效帮助。      

乳腺叶状肿瘤误诊为纤维腺瘤MRI影像分析:1例报告并文献复习

目的探讨乳腺叶状肿瘤与纤维腺瘤的MRI影像差异。方法通过1例乳腺叶状肿瘤在MRI上误诊为纤维腺瘤的病例,分析二者在MRI上的差异及误诊原因。结果乳腺叶状肿瘤的MRI表现与纤维腺瘤类似,极易混淆,乳腺叶状肿瘤中可见裂隙状T2WI更高信号区,乳腺纤维腺瘤的特征性表现则是内部不强化的T1WI、T2WI低信号的间隔,另外ADC值也有助于区分乳腺纤维腺瘤和乳腺叶状肿瘤,本病例为乳腺良性叶状肿瘤,MRI影像上未出现典型的裂隙状T2WI更高信号区,总体的影像表现为良性肿瘤,诊断医师首先考虑诊断为临床上更常见的乳腺纤维腺瘤,导致误诊。结论乳腺叶状肿瘤与乳腺纤维腺瘤的MRI影像表现存在一定的差异,但二者的MRI影像表现较为相近时,需密切结合临床病史以提高诊断准确性。      

Ethical issues in contrast-enhanced magnetic resonance imaging screening for breast cancer

Breast magnetic resonance imaging (MRI) screening has been shown to detect early breast cancer. The main challenge ahead for breast MRI screening is to prove its effectiveness in reducing breast cancer mortality. While this challenge is commonly viewed as a scientific, technological, and clinical one, it also carries ethical components. This article is concerned with the risks and benefits of MRI screening that should be explained to screening participants and discusses the evidence needed by policy makers who ultimately will determine a just allocation of health care resources to MRI breast cancer screening.     

Magnetic resonance imaging--guided breast interventions

The use of breast magnetic resonance imaging (MRI) for screening, diagnosis, staging, and management of breast cancer is rapidly increasing. MRI is highly sensitive for the detection of benign and malignant abnormalities that are occult to physical examination, ultrasound, and mammography. However, the specificity of MRI is moderate. These attributes necessitate methods for MR-guided tissue sampling to determine the histology of MRI detected lesions. This article will review appropriate peer-reviewed data and currently accepted methods for MR-guided tissue sampling. A detailed step-by-step technique for vacuum-assisted MR-guided breast biopsy is included. We also review emerging data for percutaneous and transcutaneous MR-guided breast interventions such as tissue ablation for benign and malignant disease.     

High-resolution MR imaging of the breast

Investigation into the use of MRI as a breast imaging tool is ongoing. Several studies have shown that MRI is a very accurate imaging method for the identification of implant failure in the symptomatic patient with augmented breasts. In this clinical setting, MRI may be the study of choice. Imaging techniques, and the MRI appearance of normal and abnormal implants, are described. The use of MRI for the detection of breast cancer is not as straightforward. Preliminary results suggest that this technique can be used as an adjunct to mammography for the detection and diagnosis of breast cancer. However, it is premature to draw firm conclusions regarding the role that MRI should play in the management of women with breast disease because of the wide variability of imaging techniques, protocols, and patient populations in the studies reported to date. In this overview, the current state of MR imaging of the breast is discussed. Technical requirements are described, and potential clinical applications—including the differentiation of benign from malignant lesions, breast cancer staging, detection of recurrence after breast conservation therapy, and detection of cancer in patients presenting with positive axillary lymph nodes with an unknown primary—are reviewed. Many of these potential clinical applications will require an accurate MR-guided biopsy system, and the implementation of such a system as well as its inherent limitations are discussed.     

乳腺癌MRI诊断进展

MR已成为临床和影像医师评估乳腺疾病的一项强有力的工具。DWI和动态对比增强MRI（DCE-MRI）是目前临床MR检查的首选。近年来,MRI新技术的发展,如钠磁共振成像、化学能量饱和转移（CEST）和BOLD MRI有望为诊断乳腺疾病提供更有价值的参数,而乳腺放射组学和放射基因组学也已成为乳腺成像的热门话题。本文对MRI新技术在乳腺癌中的应用进展进行综述。     

Diagnostic Performance of Automated Breast Ultrasound as a Replacement for a Hand-Held Second-Look Ultrasound for Breast Lesions Detected Initially on Magnetic Resonance Imaging

To evaluate the diagnostic performance of automated breast ultrasound (ABUS) after breast magnetic resonance imaging (MRI) as a replacement for hand-held second-look ultrasound (HH-SLUS), we evaluated 58 consecutive patients with breast cancer who had additional suspicious lesions on breast MRI. All patients underwent HH-SLUS and ABUS. Three breast radiologists evaluated the detectability, location, characteristics and conspicuity of lesions on ABUS. We also evaluated inter-observer variability and compared the results with HH-SLUS results. Eighty additional suspicious lesions were identified on breast MRI. Fifteen of the 80 lesions (19%) were not detected on HH-SLUS. Eight of the 15 lesions (53%) were detected on ABUS, whereas the remaining 7 were not detected on ABUS. Among the 65 lesions detected on HH-SLUS, only 3 lesions were not detected on ABUS. The intra-class correlation coefficients for lesion location and size all exceeded 0.70, indicating high reliability. Moderate to fair agreement was found for mass shape, orientation, margin and Breast Imaging Reporting and Data System (BI-RADS) final assessment. Therefore, ABUS can reliably detect additional suspicious lesions identified on breast MRI and may help in the decision on biopsy guidance method (US vs. MRI) as a replacement tool for HH-SLUS.     

A review of current evidence-based clinical applications for breast magnetic resonance imaging

Magnetic resonance imaging (MRI) is an important new tool for imaging of the breast. MRI has now been demonstrated to be the most sensitive imaging method for detecting breast carcinoma, allowing depiction of cancers that are occult on mammography, ultrasound, and clinical breast examination. This is tempered by imperfect specificity due to overlap in the features of benign and malignant lesions, and by higher examination cost and more limited availability compared to other breast imaging tests. This article describes the current evidence-based clinical indications for use of breast MRI. Specifically, MRI has been shown to be advantageous for cancer assessment for screening patients at high risk, evaluating patients with a new breast cancer diagnosis, monitoring patients undergoing neoadjuvant chemotherapy, and evaluating patients with metastatic axillary adenocarcinoma and unknown primary site. This tool has also been shown to be useful for the evaluation of silicone breast implant integrity. Employment of breast MRI as a problem solving technique for equivocal mammographic or clinical findings is controversial. For each of these clinical applications, the evidence regarding the diagnostic accuracy of breast MRI will be reviewed. An understanding of the current evidence will facilitate the most appropriate utilization of this important medical resource.     

动态增强磁共振成像在乳腺癌诊断及疗效监测中的应用进展(英文)

经过20余年的相关研究,MRI现已成为临床公认的用于检出和诊断乳腺疾病的影像检查手段之一。笔者简要阐述了乳腺动态增强(DCE)磁共振成像技术及其临床应用。详细介绍了动态增强中有关药代动力学的测量方法、各种相关参数的定性分析、以及Ktrans和kep等反应药代动力学特征参数的定量分析。笔者不但就当前"是否有必要对每位患者进行动脉输入函数进行测量"等有争议的话题进行了讨论,还在对当前广泛应用的各种动态增强MRI后处理软件进行了较详尽的描述之后,进一步对动态增强MRI在乳腺癌的诊断及疗效监测等方面的临床应用情况进行了详尽的回顾。作者认为:总体来讲,对于乳腺癌的诊断,关键在于关注病灶中最具侵袭性部分的MRI特征。而对于乳腺癌疗效的监测,则应该对整个病灶进行分析。最后,笔者就乳腺MRI对乳腺癌高危人群的筛查以及风险的处理等问题进行了讨论。笔者预测乳腺MRI在女性乳腺疾病尤其是乳腺癌的筛查、诊断、治疗及疗效监测等一系列问题上将继续发挥不可替代的重要作用。