DCE-MRI结合1H-MRS对乳腺良恶性肿瘤的诊断价值

目的:探讨磁共振动态增强曲线(DCE-MRI)、波谱成像(1H-MRS)及其联合应用对乳腺病变的定性诊断价值。方法:32例乳腺疾病患者,全部行动态增强扫描及1H-MRS成像,分别判断时间-信号强度(TIC)曲线类型、波谱曲线有无异常增高胆碱峰(Cho);以病理结果为标准,比较DCE-MRI及1H-MRS诊断乳腺疾病的敏感性、特异性和诊断符合率。结果:病理结果证实乳腺癌20例,良性肿瘤12例。20例乳腺癌患者中,1例呈缓慢上升型(Ⅰ型),5例呈上升平台型(Ⅱ型),14例呈上升下降型(Ⅲ型);16例MRS检出胆碱峰。12例良性肿瘤中,7例呈Ⅰ型,4例呈Ⅱ型,1例呈Ⅲ型,MRS检查2例出现胆碱峰且TIC曲线均为Ⅰ型。TIC曲线诊断乳腺癌的敏感性95.00%,特异性58.30%,诊断符合率81.25%;胆碱峰诊断的敏感性80.00%、特异性83.30%、诊断符合率71.87%;两者联合诊断的敏感性95.00%、特异性100.00%、诊断符合率96.90%。结论:DCE-MRI对乳腺恶性病变的检出有较高的敏感性,1H-MRS可以弥补DCE-MRI特异性低的不足,因此,二者联合应用可以提高乳腺良恶性病变诊断的敏感性、特异性及诊断符合率。

Diagnosis value of dynamic enhanced magnetic resonance imaging combined with magnetic resonance spectroscopy in benign and malignant breast tumor

Objective:To investigate the value of Dynamic Enhanced Magnetic Resonance(DCE-MRI) and 1H-Magnetic Resonance Spectroscopy(1H-MRS) in differential diagnosis between benign and malignant breast tumor.Methods:Breast DCE-MRI and MRS were performed in 32 patients with breast tumors.The early enhancement rate,time-intensity curves(TIC) and high choline peak in all lesions were calculated,and compare the sensibility,specificity and diagnose accordance rate of DCE-MRI and MRS with pathology result as standardization.Results:20 cases were pathologically cancer and 12 were pathologically benign of 32 patients with breast tumors.In 20 breast cancers there were 1 showing type Ⅰ curve,5 showing type Ⅱ curve,14 showing type Ⅲ curve,16 demonstrating increased choline peak.In 12 benign tumors there were 7 showing type Ⅰ curve,4 showing type Ⅱ curve,1 showing type Ⅲ curve,only 2 demonstrating increased choline peak.The sensibility,specificity and diagnose accordance rate in diagnosing breast cancer were 95.00%,58.30%,71.87% respectively.The sensibility,specificity and accuracy by using choline peak were 80.00%,83.30%,65.65% respectively.The sensibility,specificity and accuracy of the combination criteria were 95.00%,100%,96.90%.Conclusion:Diagnosis of breast cancer by using DCE-MRI only has high sensibility.The combination of choline peak and pattern of time-signal intensives curve can improve the sensitivity and accuracy of diagnosing breast cancer.