全数字化乳腺摄影对乳腺癌的诊断价值

目的探讨全数字化乳腺摄影对乳腺癌,尤其未扪及肿块的乳癌的诊断价值。方法搜集2005年3月至9月门诊、住院及体检作全数字化乳腺摄影检查1290例,从中发现并经手术、病理证实乳腺癌50例,其中,临床扪及肿块42例,未扪及肿块8例。所有病例常规摄双侧乳腺CC位(头尾位)、MLO位(内外斜位),必要时局部点压摄片。对未扪及肿块者,行术前定位。使用医生工作站高分辨竖屏显示器观察图像。结果42例临床扪及肿块的乳癌中,主要X线表现有单纯肿块22例,肿块伴钙化18例,结构紊乱2例;病理类型为浸润性导管癌30例,髓样癌6例,黏液腺癌4例,浸润性小叶癌2例。8例未扪及肿块的乳癌中,分别表现为单纯钙化5例,小结节影伴钙化2例,局部结构紊乱1例;病理类型为导管原位癌3例,导管浸润癌3例,小叶原位癌2例。结论全数字化乳腺摄影能较清晰显示乳腺癌的直接及间接X线征象,对乳腺癌尤其是未扪及肿块的乳癌具有重要的诊断价值。     

微焦点点压摄影对乳腺可疑病灶的诊断价值

目的:探讨乳腺微焦点点压放大摄影对常规摄影中可疑病灶的辅助诊断价值。方法:选取60例经常规MLO及CC位摄影见可疑病灶的患者,片中见:①不对称的致密影;②难以确定的团状致密影;③致密影区或远处见模糊钙化灶的病例。对可疑病变区域行微焦点点压放大摄影。结果:无确切异常病灶的21例(35%),考虑良性病变可能(无确定形态及边界)19例(32%),考虑为良性病变(边缘光滑)6例(10%),考虑恶性病变可能的14例(23%)。结论:微焦点点压放大摄影可作为常规乳腺摄影的辅助诊断方法。     

点压放大摄影对乳腺疾病的诊断价值

目的探讨点压放大摄影在乳腺肿瘤早期诊断中的价值。方法对仿真乳腺体模及30例乳腺有致密片团影的患者行常规摄片和点压放大摄片,对照研究了病灶的形状、边界、钙化、条索等显示情况。结果30例乳腺病灶的良、恶性诊断准确率近90％,明显高于常规平片对乳腺致密区检查的准确性。结论点压放大片有助于早期发现乳腺肿瘤,提高乳腺肿瘤的检出率和准确率。     

放大摄影在乳腺疾病诊断中的价值

目的 :评价放大摄影在乳腺良、恶性病变中的诊断价值。材料和方法 :对 115例临床扪及结节或肿块患者 ,行常规摄影和加摄局部放大摄影 ,于术后分别与病理对照 ,研究两种摄影方法对病灶的边界、形态、钙化等显示情况及诊断正确率。结果 :显示肿块边界 ,放大组 3 3 .9% ,常规组 14 .8% ;肿块边缘毛刺显示率 ,放大组 2 4.3 % ,常规组 13 .0 % ;对良性病变的诊断正确率 ,放大组 94.6% ,常规组 60 .8% ;对恶性病变诊断正确率 ,放大组 87.8% ,常规组 63 .4%。结论 :放大摄影可以明显提高乳腺疾病检出率和诊断正确性。     

乳腺导管原位癌的钼靶X线诊断(附20例报告)

目的 探讨乳腺导管原位癌的钼靶X线征象.方法 分析20例经手术及病理证实的乳腺导管原位癌的钼靶X线表现.常规摄影双侧乳腺轴位(CC位)及侧斜位(MLO位)摄片.结果 20例中,16例钙化,3例单纯肿块,1例为小灶致密影.结论 导管原位癌(DCIS)X线表现以钙化为主,还应重视肿块、小灶致密影等征象.     

乳腺导管原位癌的全数字化钼靶X线诊断

目的探讨乳腺导管原位癌（BDCIS）的全数字化乳腺钼靶X线征象。方法回顾分析30例经手术及病理检查证实为BDCIS的全数字化乳腺钼靶X线表现。常规摄影双侧乳腺轴位（CC位）及侧斜位（MLO位）摄片。结果 30例中26例有病灶内钙化,其中单纯钙化18例,肿块伴钙化3例,结构扭曲伴钙化5例;3例为单纯肿块,其中,边缘光滑、密度均匀的圆形肿块2例,边缘有毛刺、密度不均匀的类圆型肿块1例;1例为单纯结构扭曲。结论 BDCIS全数字化乳腺钼靶X线表现以钙化为主,还应重视肿块、结构扭曲以及局部非对称致密影等征象。     

超声检查和乳腺X线摄影及数字乳腺断层摄影对乳腺肿块的应用

目的探讨超声检查、乳腺X线摄影和数字乳腺断层摄影对致密型乳腺无钙化肿块的诊断价值。方法收集100例致密型乳腺无钙化肿块患者的临床资料,以病理组织检查结果为金标准,进行乳腺影像报告和数据系统(BI-RADS)评价常规超声、乳腺X线摄影和数字乳腺断层摄影对疾病的检出率和符合率。结果 100例患者中,良性病变41例(41.00%),平均肿块直径(2.14±0.68)cm;恶性病变59例(59.00%),平均肿块直径(2.32±0.71)cm。良性病变与恶性病变患者肿块直径的比较,并无明显差异(P0.05)。超声对良性致密型乳腺无钙化肿块的检出率和符合率均明显高于乳腺X线摄影、数字乳腺断层摄影(P0.05),乳腺X线摄影与数字乳腺断层摄影对良性病变的检出率和符合率的比较,均无明显差异(P0.05)。三种影像学方法对恶性致密型乳腺无钙化肿块的检出率和符合率的比较,均无明显差异(P0.05)。超声对乳腺肿块良性病变的BI-RADS分类结果与乳腺X线摄影比较,存在明显差异(P0.05);超声与数字乳腺断层摄影、乳腺X线摄影与数字乳腺断层摄影对乳腺肿块良性病变的BI-RADS分类结果比较,并无明显差异(P0.05);三种影像学方法对乳腺肿块恶性病变的BI-RADS分类结果比较,并无明显差异(P0.05)。结论对致密型乳腺无钙化肿块数字乳腺断层摄影、超声的诊断价值相当,二者的检出率和诊断符合率均高于乳腺X线摄影。     

选择性局部点压联合触诊在致密型乳腺疾病中的诊断价值

目的探讨钼靶局部点压摄影联合触诊对致密型乳腺疾病的诊断价值.资料与方法纳入常规乳腺 X 线摄影表现为致密腺体且影像未见明显异常者133例,分别进行双乳细致触诊,并结合常规体位影像表现,对触诊异常部位进行局部点压摄影,对所获得图像进行再次分析诊断.结果133例局部点压后影像中,69例清楚显示病灶,阳性检出率为51.9%(69/133),其中乳腺内肿块43例,腋下肿块9例,成簇微细钙化2例,局限性致密浸润15例;术后病理提示良性病变59例,恶性病变10例.结论钼靶局部点压摄影联合触诊可提高致密型乳腺中病灶的检出率,减少漏诊.     

对比增强乳腺X线摄影灰度值定量测量鉴别诊断乳腺钙化良性与恶性的研究

目的探讨对比增强乳腺X线摄影(CESM)中减影图像灰度值(GV)测量对乳腺钙化病变良性与恶性的鉴别诊断价值。方法该研究为回顾性研究。收集2017年3月至2021年7月北京大学肿瘤医院因乳腺X线摄影检出以钙化为唯一可疑征象而接受CESM检查的连续性病例95例, 均为女性, 年龄34～76(48±7)岁。患者均接受头尾(CC)位及内外斜(MLO)位CESM。2名医师根据目标钙化剪影图像上有无强化作出良、恶性主观判断。另由2名医师在减影图像上分别测量MLO及CC位的钙化病变区GV, 并以乳腺腺体、胸大肌、皮下脂肪等区域作为背景实质测量GV, 计算病灶/背景灰度差值(DGV)及病灶/背景灰度差值比(DRGV)。以变异系数评价GV稳定性, 以Kappa检验分析2名医师测量的一致性;以独立样本t检验或Mann-WhitneyU检验比较良性与恶性钙化不同区域GV值的差异;以受试者操作特征曲线(ROC)分析GV鉴别钙化良性与恶性效能。诊断效能间的比较采用χ2检验。结果纳入的95例患者中共97个钙化, 其中良性62个, 恶性35个。2名医师测量MLO及CC位钙化病变区GV值的一致性和稳定性均较高。恶性钙...     

基于X线摄影影像组学特征鉴别乳腺良恶性肿块的价值

目的探讨X线摄影影像组学对乳腺肿块良、恶性鉴别诊断的价值。方法选取乳腺肿块136例患者的相关X线摄影及病理资料,采用人工智能Mask R-CNN算法对乳腺肿块的精确分割,应用回归算法建立模型并验证,利用ROC曲线及决策曲线评价模型,并使用Delong检验比较不同模型的效能,同时将Shap方法应用于模型的解释。结果筛选后最终纳入乳腺侧斜位(MLO)视角21个特征,头尾位(CC)视角20个特征,两个融合视角38个特征进行建模。三个模型在测试集中对乳腺肿块良恶性判别的AUC值分别为0.842、0.843、0.955。且MLO视角的组学特征建模模型和CC视角的组学特征建模模型效能差异无统计学意义(P=0.9454),两个单视角模型与融合视角模型ROC曲线下面积差异有统计学意义(P=0.0012和P=0.0059)。结论基于乳腺X线摄影多视角融合模型对良、恶性肿块的鉴别具有较大的应用价值。     

DIMA enlargement mammography in microcalcifications: a prospective study with ROC analysis

The purpose of this study was to investigate whether the four-fold magnification mammography (direct magnification, DIMA) technique would perform better than conventional 1.5-fold magnification mammography in the differentiation of breast microcalcifications into benign and malignant. Fifty patients with non-palpable microcalcifications detected by mammography were examined immediately prior to surgical biopsy using both a conventional (1.5-fold) and the DIMA (fourfold) magnification mammography techniques. The microcalcifications were classified by five experienced radiologists using morphological criteria. A receiver operating characteristics curve (ROC) analysis of the sensitivity and specificity of both techniques in assessing malignancy was then carried out. The DIMA mammography technique was slightly but non-significantly superior to the conventional method in detecting malignancy (p > 0.05). Coarse granular and pleomorphic calcifications were detected more frequently with the DIMA technique. Coarse calcifications were significantly more frequently associated with histologically benign findings, whereas fine granular calcifications were significantly more likely to be malignant lesions. Assessment of malignancy associated with microcalcifications using morphological criteria is not significantly improved by mammography techniques with higher magnification.     

数字化X线钼靶检查对女性乳腺疾病诊断的价值

目的：研究乳腺良、恶性病变的钼靶影像学特征,评价钼靶影像学对乳腺良、恶性病变诊断的临床价值及早期发现乳腺癌的意义。方法对2010年2月至2011年3月100例经病理证实乳腺良恶性病变病例,进行回顾性钼靶影像学分析研究。结果乳腺良性病变64例,术前钼靶检查诊断符合51例,正确率为80％;乳腺恶性病变36例,术前钼靶检查诊断符合31例,正确率为86％。结论数字化钼靶摄影对乳腺良、恶性病变鉴别诊断优越于超声检查,诊断早期乳腺癌有其独特优势。     

3.0 TMR联合乳腺X线摄影对乳腺良恶性病变的诊断价值

目的：探讨乳腺 X线摄影、3.0T MR检查及两者联合应用对乳腺良恶性病变的诊断价值。方法收集乳腺 X线摄影、MR检查的女性患者61例,良性14例,恶性47例。所有病例均经手术病理证实。观察病变时间-信号强度曲线(TIC)、表观扩散系数(ADC)值、磁共振波谱(MRS)有无胆碱(Cho)峰。分析单独运用乳腺X线摄影、MR及2种技术联合应用在乳腺良恶性病变的价值。采用 SPSS 17.0统计软件包进行分析,计数资料进行卡方检验,P<0.05认为差异有统计学意义。结果单独使用乳腺 X线摄影及 MR诊断乳腺良恶性疾病的诊断符合率分别是45.9%、62.3%;两者联合运用诊断乳腺良恶性疾病的符合率为80.3%,均高于单独使用某一种检查(χ2=4.08,P<0.05)。结论 MR检查对乳腺良恶性病变的诊断价值高于乳腺 X线摄影。乳腺 X线摄影联合 MR检查明显提高乳腺良恶性病变术前诊断的准确率,为早期诊断及预后提供理论依据。     

乳腺X线摄影与MRI对致密型乳腺内病变的诊断

目的:比较乳腺X线摄影与MRI对致密型乳腺病变的诊断价值.方法:搜集同时行乳腺X线摄影及MRI检查的致密型乳腺患者185例,所有病例均经病理证实,分别分析两种方法的影像学表现,并与病理对照.结果:185例患者中组织病理学为恶性者80例,良性105例.乳腺X线摄影诊断致密型乳腺恶性病变的敏感度、特异度、阳性预测值及阴性预...     

数字钼靶X线摄影与彩色多普勒超声对乳腺肿块的诊断价值

目的：评价数字钼靶X线摄影、彩色多普勒超声成像及二者联合应用在乳腺肿块性病变中的定性诊断价值。方法：73例乳腺肿块性病变,其中良性24例,恶性49例。所有病例均行数字钼靶X线摄影和彩色多普勒超声检查,两者单独及联合诊断并与病理结果对照。结果：数字钼靶X线摄影诊断乳腺癌的敏感度、特异度及准确度分别为89．80％、75．00％及84．93％,彩色多普勒超声为85．71％、83．33％及84．93％,二者联合检查为95．92％、91．67％及94．52％。彩色多普勒超声在诊断Ⅰ型及Ⅳ型乳腺病变上较钼靶具有明显的优势（P〈0．05）,钼靶在诊断Ⅱ、Ⅲ型的乳腺病变时准确度（62．50％）高于彩色多普勒超声（45．00％）,但两者差异无统计学意义（P〉0．05）。结论：联合应用乳腺数字钼靶X线摄影检查和彩色多普勒超声成像可提高乳腺肿块性病变的定性诊断符合率。     

全数字化乳腺X线摄影对乳腺肿块的良恶性鉴别价值

目的:探讨全数字化乳腺X线摄影图像特点对乳腺肿块定性诊断的价值。方法:收集185例经病理证实以肿块为主的乳腺病患者的临床和影像资料,对222个病灶的形态、边缘、密度、大小及周围结构改变的发生率分别进行统计分析。结果:肿块的形态、边缘、密度及周围结构扭曲、伴随病理结构在良恶性病变间差异有统计学意义(P0.05),特别是肿块边缘征象及周围结构改变对肿块良恶性具有鉴别诊断价值。边缘清晰、周围结构正常在良性病变中明显高于恶性病变;边缘模糊、毛刺及周围结构扭曲、紊乱,伴随病理结构在恶性病变中明显高于良性病变,差异有统计学意义(P0.05)。以2cm为界,肿块大小对病变定性差异无统计学意义(P=0.235)。结论:乳腺X线摄影对良恶性肿块具有重要鉴别诊断价值。     

Characterization of breast lesions with CE-MR multimodal morphological and kinetic analysis: comparison with conventional mammography and high-resolution ultrasound

Objective

Evaluation of the diagnostic value of magnetic resonance mammography and comparison with conventional mammography and ultrasonography in cases of women with suspicious breast lesions.

Subjects and methods

Sixty-nine women (age range 39–68 years) with 78 focal breast lesions were examined with mammography, ultrasonography and dynamic magnetic resonance mammography. The lesions were classified according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon of the American College of Radiology for each diagnostic method. Histological reports were available after biopsy or surgical excision of the lesions.

Results

Pathological examination confirmed that 53 lesions were malignant and 25 benign. Conventional mammography estimated a total of 59/78 lesions as malignant with 44 true positive lesions, ultrasonography estimated a total of 50/78 lesions as malignant with 44 true positive lesions and magnetic resonance mammography estimated a total of 66/78 lesions as malignant with 52 true positive lesions. Sensitivity and specificity of magnetic resonance mammography in the diagnosis of malignancy was 98.1% and 44%, of conventional mammography 83% and 40% and of ultrasonography 83% and 76%. Negative predictive value for magnetic resonance mammography was 91.7%, for ultrasonography 67.9% and for mammography 52.6% for malignancies.

Conclusion

Magnetic resonance mammography has the highest negative predictive value compared with mammography and ultrasound in cases of suspicious breast lesions. The combination of morphologic and enhancement criteria can improve the diagnostic capability of magnetic resonance mammography (MRM) in breast lesion characterization.     

Computed tomographic mammography (CTM).

Breasts of 724 patients were studied by physical examination, mammography, and computed tomographic mammography (CTM) using a scanner designed for evaluation of the breast. Among cases in which CTM was not accompanied by use of contrast material, there were 60 malignant lesions, of which 10% were missed by mammography, 32% by CTM, and 8% by both. Among cases where CTM was supplemented by a 50 ml injection of 75% contrast material, there were 63 malignant lesions, of which 14% were missed by mammography, 16% by CTM, and 3% by both. Among cases where CTM was supplemented by a 300 ml infusion of 30% contrast material, there were 41 malignant lesions, of which 7% were missed by mammography and 5% by CTM, but none by both. Clinically, 22% of the malignant lesions in the infusion series were occult. There were 44 benign lesions in patients studied with the infusion technique. With mammography 68% were suspicious for malignancy, and with CTM, 56%.