MRI、CT与乳腺X线摄影诊断乳腺疾病临床价值分析

目的探讨MRI、CT及诊断X线摄影等三种检查方法在乳腺疾病诊断中的应用价值。方法对收治的乳腺疾病患者分别采用MRI、CT及乳腺X线摄影进行检查,比较三种检查方法在乳腺疾病诊断中的应用价值。结果乳腺X线摄影、CT和MRI检查出的病灶直径与病理检查结果比较无明显差异。本文98例患者经病理检查发现112枚病灶,其中确诊良性68枚,恶性44枚。乳腺X线摄影诊断良、恶性乳腺病变的敏感性、特异性及准确性分别为68.18%、69.12%、68.75%;MRI诊断良、恶性乳腺病变的敏感性、特异性及准确性分别为88.64%、91.18%、90.18%;CT诊断良、恶性乳腺病变的敏感性、特异性及准确性分别为80.00%、88.06%、84.82%;经统计学分析发现MRI诊断良、恶性乳腺病变的敏感性、特异性及准确性均明显高于乳腺钼靶X线和CT,且差异具有统计学意义。结论乳腺X线摄影有利于早期发现乳腺疾病,MRI、CT增强可提高乳腺疾病诊断特异性和检出率,三者相结合缺点互补大大提高乳腺癌的诊断准确率。     

钼靶与磁共振检查对乳腺疾病诊断的对比研究

目的:比较全数字化X线钼靶摄影检查、磁共振动态增强序列及扩散加权序列诊断乳腺疾病的敏感性和特异性,探讨三者对乳腺疾病诊断的价值与局限性。方法:对50例乳腺疾病患者,分别行X线钼靶摄影检查、磁共振动态增强序列及扩散加权序列处理。病理证实恶性病变29例,34个病灶;良性病变21例,29个病灶。统计分析X线钼靶摄影、MR动态增强检查和病灶ADC值对全部病变诊断的准确率、敏感性、特异性。结果:X线钼靶摄影与MRI动态增强曲线诊断符合度比较(χ2=6.612,P=0.0092<0.01),X线钼靶摄影与MRI的DWI诊断符合度比较(χ2=4.375,P=0.0395<0.05),有统计学意义,MRI的TIC与ADC的诊断符合度比较(χ2=0.259,P=0.610>0.05),无统计学意义。结论:X线钼靶摄影对乳腺疾病检出的敏感性较高,特异性较差。乳腺MR动态增强序列及扩散加权序列诊断乳腺疾病的敏感性及特异性均高于X线钼靶摄影。两种MR扫描序列对乳腺疾病影像学诊断具有重要价值。     

乳腺导管癌的乳腺钼靶与磁共振增强扫描的对比研究

目的比较全数字化乳腺摄影(full-field digital mammography,FFDM)、磁共振(MRI)增强扫描对乳腺导管癌的诊断价值。方法回顾性分析经手术病理证实的30例乳腺导管癌,所有病例均行FFDM、MRI增强检查。观察X线特征,根据美国放射学会乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)进行分级,3级及以下的级别考虑为良性,4A级及以上的为恶性;MRI根据病灶增强表现,绘制时间-信号强度曲线诊断病灶的良、恶性。影像诊断与病理结果对照,比较二者对导管癌的检出情况及诊断准确率。结果 30例乳腺导管癌中,FFDM检出13例肿瘤呈单纯结节或肿块,肿块伴有的钙化12例,5例病灶表现为单纯簇状钙化,同侧腋下淋巴结肿大7例。FFDM诊断4A以上病例26例,3级及以下的病例4例;MRI增强扫描检出肿块或结节27例,发现钙化5例,同侧腋下淋巴结肿大10例。时间-信号强度曲线8例呈Ⅱ型曲线,22例呈Ⅲ型曲线。FFDM正确诊断乳腺导管癌24例,MRI增强扫描正确诊断为26例,二者结合正确诊断27例。FFDM、增强MRI及FFDM+增强MRI对导管癌的诊断符合率分别为80%、86.7%、90%。结论 FFDM操作简单,对导管癌的簇状钙化检出率高于增强MRI,诊断敏感性较高,是筛查乳腺导管癌,尤其导管原位癌的首选,增强MRI对乳腺导管癌肿块及同侧腋下淋巴结检出情况高于FFDM,在乳腺导管癌定性方面有重要作用,是乳腺导管癌进行术前评价的有效方法。二者结合应用可以提高乳腺导管癌的诊断正确率。     

数字乳腺断层摄影在乳腺筛查中的应用进展

目前全数字化乳腺摄影（full-field digital mammography, FFDM）仍是乳腺癌早期发现、早期诊断的首选检查方法。而数字乳腺断层摄影技术能够克服常规FFDM中重叠纤维腺体组织干扰诊断这一主要局限性,增强对乳腺病变的可见性,显著提高诊断的敏感性和特异性,有效地降低了召回率。本文重点对于DBT在乳腺筛查中的优势及局限性进行综述。     

数字乳腺断层成像与磁共振成像对乳腺肿瘤的诊断价值

【摘要】目的：通过对比全数字化乳腺摄影（FFDM）、数字乳腺三维成像（DBT）与MRI对乳腺肿瘤的鉴别诊断能力,评价不同影像检查方法对乳腺癌的诊断价值。方法：回顾性分析253例临床经病理证实为乳腺病变的女性患者的病例资料,均采用FFDM、DBT及MRI检查。观察肿瘤大小、形态、边缘、有无钙化等,强化方式、早期强化率（EER）、时间-信号强度曲线（TIC）及表观扩散系数（ADC）,根据乳腺影像报告数据系统（BI-RADS）进行分类,以病理结果为金标准,采用受试者操作特性曲线（ROC）分析不同检查方法对乳腺癌的诊断效能,评价单纯的FFDM、DBT、MRI对乳腺癌的诊断准确性。结果：253例乳腺病变患者中良性病灶112例,恶性病灶141例。FFDM、DBT及MRI诊断乳腺癌的ROC 曲线下面积分别是0.826、0.897、0.884;诊断其敏感度分别为84.2%、92.3%、95.6%;特异度分别为82.5%、85.5%、84.5%。DBT及MRI 诊断乳腺癌的曲线下面积大于FFDM,差异有统计学意义（P<0.001）,DBT与MRI诊断乳腺癌的曲线下面积差异无统计学意义（P>0.05）。结论：DBT及MRI较FFDM检查能够提高乳腺癌的诊断效能,DBT和MRI 对乳腺病灶的检出及诊断效能相近,但DBT更为经济适用,且禁忌证相对较少。     

全数字化乳腺摄影与乳腺计算机X线摄影的临床应用对比分析

目的: 比较全数字化乳腺摄影(FFDM)系统与计算机X线摄影(computed radiography,CR)系统在诊断乳腺疾病中的临床应用价值.材料和方法: 回顾2006-01～2007-06 CR检查300例和2007-07～12 FFDM检查300例的临床及影像资料,分析图像质量,统计受检者的照射剂量,比较技术操作、图像质量控制与后处理技术、工作效率等方面的优势.结果: CR和FFDM同时清楚显示皮肤、皮下组织、血管及腺体和导管等结构分别为45.5%(300例)和99.2%(300例);检查时间(包括图像采集及后处理时间),FFDM为5～10min/人,CR为15～20min/人;摄影条件,FFDM为26～30kV,26～60mAs,CR为30～45kV,36～100mAs;FFDM照射剂量(乳房压迫厚度5cm,有滤线栅)为0.5～2.0mGy,CR照射剂量(乳房压迫厚度5cm,有滤线栅)1.0～2.5mGy.FFDM对乳腺癌的诊断敏感性、特异性和准确性分别为83.3%、75%、80%,与CR差异非常显著(P＜0.05).结论: FFDM的图像质量、后处理功能、工作流程能力、患者吸收剂量及FFDM对乳腺癌的诊断敏感性、特异性和准确性均明显优于CR,更有利于乳腺检查.     

动态增强MRI与乳腺X线摄影检查乳腺病变的临床应用对比

目的探讨动态增强MRI与乳腺X线摄影在诊断乳腺病变中的应用价值。方法乳腺病变患者应用动态增强MRI与乳腺X线摄影进行检查,两种检查方法在发现病变及良恶性肿块鉴别方面的诊断能力进行对比研究。结果以病理确诊结果为金标准,计算乳腺X线摄影诊断良、恶性乳腺病变的敏感性为65.63%,特异性为70.64%,准确性为68.79%;DCE-MRI诊断良、恶性乳腺病变的敏感性为87.50%,特异性为90.83%,准确性为89.60%;经统计学分析发现DCE-MRI诊断良、恶性乳腺病变的敏感性、特异性及准确性均明显高于乳腺X线摄影,且差异具有统计学意义。结论动态增强MRI对乳腺病变的鉴别诊断效能要优于乳腺X线摄影,两种技术联合使用可以发挥优势互补的作用。     

钼靶X线摄影与1.5T MRI对乳腺良恶性肿块的诊断价值

目的 探讨钼靶X线摄影与MRI对乳腺良恶性肿块的诊断价值.方法 收集临床资料完整,经手术病理结果证实并于术前1～2周进行过临床触诊、钼靶X线摄影乳腺肿块138例,对48例X线表现不典型病例行MRI平扫及动态增强检查,并与手术病理结果做对照分析. 结果本组中恶性病变71例,良性病变67例.钼靶X线摄影的敏感性、特异性及准确性分别为81.69%、76.12%及78.99%.MRI结合平扫、DCE-MRI早期强化率及时间-密度曲线诊断,MRI检查的敏感性、特异性及准确性分别为87.50%、83.33%及85.42%. 48例患者MRI与钼靶X线摄影对病变的符合情况准确性比较具有统计学意义(χ2=4.063,P0.05).结论 钼靶X线摄影与1.5T MRI二者结合可明显提高乳腺良恶性肿块的诊断准确率.     

全野数字乳腺摄影系统在乳腺检查中的应用价值研究

目的:探讨全野数字乳腺摄影系统在乳腺检查中的应用价值。方法:收集我院进行乳腺检查患者321例进行研究评价,其中,CR乳腺摄影148例,全野数字乳腺摄影173例,分析评价检查时间、图像质量、诊断阳性率,乳腺癌的诊断敏感性、特异性、准确性。结果:CR乳腺摄影平均检查时间13.6min/人,甲级片率91%、诊断阳性率83.1%,其敏感性、特异性、准确性分别为86.8%、89.4%、88.6%。全野数字乳腺摄影系统平均检查时间5.7min/人,甲级片率97%,诊断阳性率92.5%,其诊断敏感性、特异性、准确性分别为91.8%、93.7%、93.1%。结论:全野数字乳腺摄影成像技术优于CR钼靶成像技术,且曝光剂量大大减少,提高了图像质量和乳腺疾病的诊断阳性率,减少了检查时间,乳腺癌的诊断敏感性、特异性、准确性都有提高。     

高频超声与全数字化乳腺摄影联合诊断乳腺导管癌的临床应用

目的:探讨乳腺导管癌的高频超声表现,并评价高频超声联合全数字化乳腺摄影检查对乳腺导管癌的诊断价值。方法:分析46例经病理证实的乳腺导管癌的超声表现,与相应病理结果进行对比分析。46例患者均行高频超声和全数字乳腺摄影检查。结果:高频超声探及到肿块46例,诊断乳腺癌45例,诊断率达98%。全数字化乳腺摄影诊断乳腺癌46例,诊断率达100%。高频超声和全数字化摄影对乳腺导管癌检出率无差别且无统计学意义(P>0.05)。结论:高频超声与全数字化乳腺摄影联合应用,可提高乳腺癌诊断的敏感性和准确性。     

全数字化乳腺摄影与MRI对乳腺恶性病变诊断的对比分析

目的 探讨乳腺癌全数字化乳腺摄影(full-field digital mammography,FFDM)与乳腺MRI的影像学表现,评价其对乳腺癌的诊断价值.方法 收集68例经穿刺或手术病理证实的乳腺癌病例,对比分析其X线摄影及MRI表现.全数字化乳腺摄影采用常规方法摄片,MRI采用自旋回波T1WI,T2WI序列及动态增强扫描等.结果 68例乳腺恶性肿瘤中,浸润性导管癌57例,浸润性小叶癌3例,叶状囊肉瘤1例,血管肉瘤1例,导管内癌2例,炎性乳癌2例,印戒细胞癌1例,Paget's病1例.乳腺X线摄影诊断正确61例,诊断准确率89.7％.MRI诊断正确66例,诊断准确率97.1％.结论 乳腺X线摄影是乳腺恶性病变的首选检查方法,MRI能更多的显示乳腺病灶的内部特征,二者联合应用对乳腺癌的临床诊断具有重要意义.     

钼靶及MRI纹理分析技术在乳腺良恶性病灶的诊断价值

目的:探讨综合乳腺MRI多个序列、钼靶联合MRI纹理分析对乳腺良、恶性病灶的诊断价值.方法:搜集本院2014年6月-2019年12月116例乳腺钼靶图像(恶性57例,良性59例)及96例乳腺MRI(恶性45例,良性51例)的横轴面T2 WI脂肪抑制序列、DWI及增强后的第2、3期(C2、C3)图像进行回顾性纹理分析,其...     

Computer-aided detection in direct digital full-field mammography: initial results

For the first time, full-field digital mammography (FFDM) allows computer-aided detection (CAD) analysis of directly acquired digital image data. The purpose of this study was to evaluate a CAD system in patients with histologically correlated breast cancer depicted with FFDM. Sixty-three cases of histologically proven breast cancer detected with FFDM (Senographe 2000D, GE Medical Systems, Buc, France) were analyzed using a CAD system (Image Checker V2.3, R2 Technology, Los Altos, Calif.). Fourteen of these malignancies were characterized as microcalcifications, 37 as masses, and 12 as both. The mammographic findings were categorized as BI-RADS 3 (n=5), BI-RADS 4 (n=17) and BI-RADS 5 (n=40). The sensitivity for malignant lesions and the rate of false-positive marks per image were calculated. The sensitivity and its 95% confidence interval (CI) were estimated. The sensitivity of the CAD R2 system in breast cancer seen on FFDM was 89% for microcalcifications [CI_95%=(70%; 98%)] and 81% for masses [CI_95%=(67%; 91%)]. As expected, the detection rate was higher in lesions categorized as BI-RADS 5 (37 of 40) compared with lesions categorized as BI-RADS 4 (11 of 17). In the group categorized as BI-RADS 3 the detection rate was 4 of 5 lesions; however, this group was very small. The rate of false-positive marks was 0.35 microcalcification marks/image and 0.26 mass marks/image. The overall rate of false-positive marks was 0.61 per image. CAD based on FFDM provides an optimized work flow. Results are equivalent to the results reported for CAD analysis of secondarily digitized image data. Sensitivity for microcalcifications is acceptable and for masses is low. The number of false-positive marks per image should be reduced. Electronic Publication     

Image quality, lesion detection, and diagnostic efficacy in digital mammography: full-field digital mammography versus computed radiography-based mammography using digital storage phosphor plates

OBJECTIVE: To compare image quality, the lesion detection, and the diagnostic efficacy of full-field digital mammography (FFDM) and computed radiography-based mammography using digital storage phosphor plates (DSPM) in the evaluation of breast lesions. MATERIALS AND METHODS: In this prospective study, 150 patients with suspicious breast lesions underwent FFDM and DSPM. Nine aspects of image quality (brightness, contrast, sharpness, noise, artifacts, and the detection of anatomic structures, i.e., skin, retromamillary space, glandular tissue, and calcifications) were evaluated by five radiologists. In addition, the detection of breast lesions and the diagnostic efficacy, based on the BI-RADS classification, were evaluated with histologic and follow-up correlation. RESULTS: For contrast, sharpness, and the detection of all anatomic structures, FFDM was rated significantly better (p<0.05). Mass lesions were equally detected, whereas FFDM detected more lesions consisting of calcifications (85 versus 75). DSPM yielded two false-negative results. Both lesions were rated BI-RADS 4 with FFDM, but BI-RADS 2 with DSPM. Both were invasive carcinoma at histology. The sensitivity, specificity, PPV, NPV, and accuracy of FFDM were 1.0, 0.397, 0.636, 1.0, and 0.707, compared to 0.974, 0.397, 0.630, 0.935, and 0.693 of DSPM. CONCLUSION: Based on image quality parameters, FFDM is, in part, significantly better than DSPM. Furthermore, the detection of breast lesions with calcifications is favorable with FFDM. However, the diagnostic efficacy of FFDM and DSPM was equal. The interpretation of the false-negative results suggests that the perception and characterization of breast lesions is not defined solely by the digital mammography system but is strongly influenced by the radiologist, who is one of the determinants in the interpretation of breast imaging.     

全数字化乳腺摄影诊断同时性双侧原发性乳腺癌的价值

目的:评价全数字化乳腺摄影诊断同时性双侧原发性乳腺癌的价值.材料和方法:回顾性分析2005-11～2008-12同时性双侧原发性乳腺癌21例,使用GE公司全数字化平板乳腺X线机,经临床及病理证实,符合同时性双侧乳腺癌的诊断标准.结果:第一原发癌以Ⅱa期为主,浸润性导管癌12例,导管原位癌5例,浸润性小叶癌2例,浸润性筛状癌1例,混合细胞癌1例;5例以微钙化为主要表现,13例肿块,局部密度增浓1例,2例未见异常;第二原发癌以0期为主,浸润性导管癌7例,导管原位癌12例,浸润性小叶癌1例,混合细胞癌1例;11例以微钙化为主要表现,肿块3例,结构不良4例,局部密度增浓1例,2例未见异常.结论:FFDM检查和仔细的外科查体相结合是对已经确诊一侧乳腺癌的患者随访的一种有效方法.     

Comparative study in patients with microcalcifications: full-field digital mammography vs screen-film mammography

The goal of this prospective study was to compare a full-field digital mammography system (FFDM) to a conventional screen-film mammography system (SFM) for the detection and characterization of microcalcifications. Fifty-five patients with 57 isolated microcalcification clusters were examined using a FFDM system (Senographe 2000D, GE Medical Systems, Milwaukee, Wis.) and a SFM system (Senographe DMR, GE Medical Systems, Milwaukee, Wis.). A conventional screen-film mammogram and a digital contact mammogram were obtained of each cluster. The image quality and the number of calcification particles were evaluated, and a characterization (BI-RADS 1–5) of microcalcifications was given by four experienced readers. Histopathology revealed 16 benign lesions (sclerosing adenosis, dysplasia, hamartoma, radial scar) in 15 patients and 21 malignant tumors (in situ carcinoma, invasive carcinoma) in 20 patients. Twenty patients had benign changes verified by long-term follow-up. Image quality of FFDM was assessed as superior to SFM in more than 50% of the cases. The FFDM showed more calcifications in 41% of all cases. Sensitivity and specificity for FFDM vs SFM were 95.2 vs 91.9% and 41.4 vs 39.3%, respectively. Moreover, FFDM demonstrated a higher diagnostic accuracy (deviation: 0.86 BI-RADS steps) compared with FSM (deviation 0.93 BI-RADS steps). The FFDM system with a 100-μm pixel size provides better image quality than SFM in patients with mammographic microcalcifications. The FFDM has a higher sensitivity and a higher reliability in characterizing microcalcifications. Electronic Publication     

The added benefit of digital breast tomosynthesis in second breast cancer detection among treated breast cancer patients

Objectives

We aimed to compare the recall rate (RR) and the cancer detection rate (CDR) of combined full field digital mammography and digital breast tomosynthesis (FFDM?+?DBT) to those of full field digital mammography (FFDM) alone in breast cancer survivors.

全数字化乳腺摄影在乳腺病变中的临床应用价值

目的探讨全数字化乳腺摄影(FFDM)在乳腺病变中的临床应用价值。资料与方法搜集经手术病理证实有完整临床资料的乳腺病变共102例,所有患者均行FFDM,结合病理进行影像学分析。结果 102例乳腺病变中乳腺癌31例,乳腺良性病变71例。临床触及肿块者63例,未触及肿块者39例。影像表现为肿块80例,单纯成簇微小钙化4例,结构紊乱并粗长毛刺2例,结构紊乱并微小钙化1例,局部片状致密影14例,无明显影像表现1例。FFDM对乳腺癌诊断敏感性为90.3%,特异性为94.4%,准确性为93.1%。结论 FFDM能清晰显示乳腺病变的X线征象,尤其能够显示乳腺癌的主要X线征象,为临床早期诊断乳腺病变创造了条件,尤其对临床未触及肿块的早期乳腺癌具有重要的临床价值。     

全数字化乳腺摄影对妇女致密型乳腺病变的诊断价值

目的探讨全数字化乳腺摄影（FFDM）对妇女致密型乳腺病变的诊断价值。方法搜集2003年4月至2004年9月门诊及体检者行FFDM的3500余例中致密型乳腺的66例乳腺癌及6例癌前病变，12例囊性增生症，58例纤维腺瘤，1例结核，4例囊肿，11例乳腺腺病作为研究对象。全部病例采用美国GE公司的平板2000D全数字化乳腺摄影机检查，并经病理证实。检查体位常规采用头足位（CC）、内外斜位（MLO），必要时加摄侧位及局部点片。对临床未触及肿块的乳腺癌，均行术前定位。结果72例乳腺癌及癌前病变中，临床触及肿块者57例，未触及肿块者15例。影像表现为肿块23例；肿块并微小钙化18例；片状弥漫微小钙化伴局部结构紊乱11例；结构紊乱并粗长毛刺12例；簇状微小钙化2例；片簇状微小钙化1例；结构紊乱1例；小星状结构1例；长毛刺星状结构1例；平片无明显影像表现2例，其中1例仅导管造影显示僵硬、中断。共发现假阳性10例，假阴性5例，得出FFDM对乳腺癌诊断的敏感性、特异性、准确性分别为93．06％、88．37％、90．51％。良性病变中，58例纤维腺瘤，表现为肿块38例，肿块伴钙化20例；12例囊性增生症，表现为肿块10例，肿块伴点状钙化2例；11例乳腺腺病，表现为肿块9例，肿块伴点状钙化2例。4例囊肿和1例结核，均表现为肿块。结论FFDM能清晰显示乳腺癌的直接及间接征象，尤其能够显示致密乳腺的结构紊乱、粗长毛刺及微小钙化，对临床未触及肿块的乳腺癌及癌前病变具有重要的诊断价值。