MR动态增强特征对乳腺癌诊断的价值

目的探讨乳腺癌动态增强扫描相关参数在乳腺癌诊断中的价值。方法对93例患者行MR平扫、动态增强扫描。分析形态学、增强曲线类型及最大斜率对乳腺癌的诊断价值。结果 (1)形态学表现及病理结果:105个肿块的强化形式可分为五型:①无强化9个(囊肿);②均匀强化31个(纤维腺瘤9个,乳腺癌11个,增生10个,叶状瘤1个);③不均匀强化42个(纤维腺瘤5个,增生3个,乳腺癌33个,叶状瘤1个);④边缘强化17个(乳腺癌15个,纤维腺瘤及炎症各1个);⑤网状强化2例(乳腺炎,巨乳症各1例)。⑥导管状强化4个(增生1个,导管癌3个)。(2)曲线类型及病理结果:I型曲线20个,II型曲线42个,III曲线型43个。六种表现形式①曲线信号强度基本无增加9个(囊肿);②曲线信号强度缓慢持续增加6个(增生2个,纤维腺瘤2个,慢性炎症1个,导管内癌1个);③曲线号强度早期迅速增加后仍持续缓慢增加5个(增生4个,炎性乳腺癌1个);④曲线早期信号强度迅速增加之后基本停止而形成中晚期的平台42个(增生9个,纤维腺瘤8个,叶状瘤1个,乳腺癌24个);⑤曲线早期信号强度迅速增加到达峰值,之后信号强度逐渐下降40个(增生1个,纤维腺瘤5个,叶状瘤1个,乳腺癌33个);⑥曲线早期信号强度迅速增加到达峰值,呈平台期后又迅速上升3个(均为乳腺癌)。(3)增强斜率及病理结果:62个恶性病灶的平均最大斜率为19.19±8.13,43个良性病灶平均最大斜率为9.46±6.64,二者差异有非常显著性意义(P<0.01)。以14.85为临界值,敏感性为67%,特异性为83%;以17.10为临界值,特异性为100%。结论增强形态学特征、最大斜率在良、恶性病变,尤其是II型曲线的鉴别诊断中具有重要价值。

The application of DCE-MRI in diagnosis of breast cancer

Objective To further explore breast dynamic contrast enhancement diagnostic value and to improve breast cancer diagnosis specificity.Methods 93 patients with 105 breast masses were performed with routine MR scan and dynamic contrast enhancement scan.Results(1) Morphological manifestations and pathologic findings: 105 masses of enhance forms can be divided into five type: ① No strengthening(9 breast cysts);② The heterogeneous enhancement in 31(9 of fiber adenoma,11 of breast cancer,10 of mammary gland hyperplasia,1 of leafy tumor);③ The unheterogeneous enhancement in 42(fiber adenoma in 5,the hyperplasia in 3,breast cancer in 33,leafy tumor in 1);④ Ring enhancement in 17(breast cancer in 15,fiber adenoma in 1 and inflammation in 1);⑤ Reticular enhancement in 2 cases(gigantic breast in 1,inflammation in 1);⑥ duct shape enhancement in 4 cases(hyperplasia in 1,duct carcinoma in 3).(2) Enhancement slope and pathology result: The maximum slope in 62 malignant masses was equally 19.19±8.13,maximum slopes in 43 benign masses was equally 9.46±6.64,the difference had a very significance(P<0.01).In 42 II type curves,the maximum slope of 24 malignant focuses were 17.52±6.39,18,while 18 benign focuses were 8.33±5.47,the difference had a very significance(P<0.01).By use of a test-receiver to work curve(ROC curve) progress analysis,with 14.85 for critical point,sensibility for was 67%,specificity for was 83%;With 17.10 for critical value,the specificity was 100%.(3) Curve type and pathological results: according to general type standard,type I of single-phase curve was 20,type II of platform type curve 42 and III type curve type of washout 43.A group of six kinds of forms: ① Basic no increase signalstrength curve was found in 9(cyst);② The curve signal strength slowly increased in 6(hyperplasia in 2,fiber adenoma in 2,chronic inflammation in 1,duct carcinoma in 1);③ The intensity of curve after rapid increased early,continued to increase slowly in 5(hyperplasia in 4,inflammatory breast cancer in 1);④ Curve early signal strength increasing rapidly formed the basic stop after middle-late platform(platform type) in 42(hyperplasia in 9,fiber adenoma in 8,leafy tumor in 1,breast cancer in 24);⑤ Early signal strength rapid increase arrived the peak then rapid declined(outflow type) in 40(hyperplasia 1,fiber adenoma in 5,leafy tumor in 1,breast in 33);⑥ Early signal strength increase quickly reached a peak,after platform period,then rising quickly again,all of 3 were breast cancer.Conclusion Enhancement morphological characteristics of breast cancer such as duct or ring enhancement had diagnostic value.Maximum slope in benign or malignant lesions,particularly in the differential diagnosis of type II curve played an important role.Formation mechanism of type II curve might be vascular tumor emboli or tumor compression by blood vessels and obstacle blood backflow.