乳腺叶状肿瘤的MRI表现及临床病理学分析

目的:分析乳腺叶状肿瘤(phyllodes tumors,PTs)的MRI表现,以提高MRI的诊断价值。方法:回顾性分析8例PTs患者的临床及影像资料,包括肿瘤在T1WI、STIR序列上的信号强度,肿瘤大小、形状、边缘、内部强化方式、早期强化率、时间-信号强度曲线(time-signal intensity curve,TIC)类型及ADC值;比较PTs与正常腺体ADC值的差异。结果:8例乳腺PTs中,3例良性,4例交界性,1例恶性。MRI平扫T1WI呈等及较低信号,STIR呈高信号,3例肿瘤内见低信号未强化分隔,6例见裂隙状高信号;最大径线2.4~7.5cm;2例呈圆形、类圆形,6例呈分叶状;8例边缘均较清晰;增强扫描病灶均呈不均匀强化;7例PTs早期强化率大于100%,1例50%且100%;TIC类型1例为流入型,5例为平台型,2例为廓清型。DWI病灶均呈高信号,且ADC值低于正常腺体,PTs平均ADC值为(1.30±0.25)×10-3 mm2/s,正常腺体ADC值为(1.64±0.12)×10-3 mm2/s,二者差异有统计学意义(t=3.375,P0.05)。结论:乳腺PTs的MRI征象具有一定的特征性,结合其临床特点综合分析,可提高其术前诊断准确率。

MRI findings and clinical pathology analysis in breast phyllodes tumors

Objective:To evaluate the MRI findings of breast phyllodes tumors for improving the level of diagnosis.Methods:MRI findings were retrospectively reviewed in 8women with PTs confirmed by pathology.Analyzed MRI findings included tumor signal intensity(SI)on T1-weighted images and STIR,and tumor size,shape,margin,internal enhancement,initial contrast-enhanced rate,the type of time-signal intensity curve(TIC)and ADC value.The ADC values for phyllodes tumors and normal breast tissue were compared using paired t-test.Results:The histologic findings of 8PTs including 3benign,4borderline and 1malignant.All tumors were equal or low signal on T1 WI and hyperintense on STIR.Internal non-enhanced septations which appeared low signal intensity in 3tumors and hyperintense slit-like spaces in 6tumors on STIR were seen.The maximal diameter was 2.4~7.5cm.2were round or oval and 6were lobular in shape and the margins were well-defined in all cases.Dynamic contrast enhancement(DCE)showed heterogeneous internal enhancement;initial enhancement rate more than100%in 7cases,between 50%and 100%in 1case,with 1persistent,5plateau and 2washout type of TIC.All cases showed hyperintense on DWI,the mean PTs ADC value were(1.30±0.25)×10-3 mm2/s,the normal breast tissue were(1.64±0.12)×10-3 mm2/s,and PTs ADC value was significantly lower than the normal tissue(t=3.375,P<0.05).Conclusion:The combination of the MRI characteristic finding and clinical features of PTs can increase the accuracy of preoperation diagnosis.