体素内不相干运动扩散加权成像对乳腺肿块样病变的诊断价值

目的 乳腺肿块样病变的诊断及鉴别对于临床治疗方案的制定及预后判断具有重要意义.本研究旨在探索体素内不相关运动(intravoxel incoherent motion,IVIM)扩散加权成像(diffusion weighted imaging,DWI)在乳腺肿块样病变中的诊断价值.方法 选取云南省肿瘤医院2015-07-01-2015-12-30乳腺肿块患者127例,共135个病灶,其中乳腺癌75例(75个病灶)、良性肿瘤27例(32个病灶)、囊肿10例(13个病灶)、炎性病变15例(15个病灶).所有患者行常规DWI及IVIM-DWI、动态增强(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)检查.根据病理结果将病灶分为乳腺癌组、良性肿瘤组、囊肿组、炎性病变组,并以对侧正常腺体作为对照组.比较不同病变及正常腺体各组间ADC、D、D*和f值有无差异,评价上述各参数对乳腺肿块样良恶性病变的诊断效能.结果 在IVIM-DWI上,随b值增大,囊肿信号呈单指数线性衰减,正常腺体组织、炎性病变、良性肿瘤及乳腺癌信号呈双指数非线性衰减.单因素方差分析显示,各组ADC(F=119.35,P＜0.001)、D(F=58.31,P＜0.001)、f(F=50.961,P＜0.001)和D*值(F=2.732,P=0.032)比较差异有统计学意义;进一步两两比较,ADC值除对照组和良性肿瘤组外其余各组间差异均有统计学意义(P＜0.05),囊肿组ADC值最高,乳腺癌组最低;D值各组间两两比较差异均有统计学意义(P＜0.05);f值除炎性组和乳腺癌组、腺体组和良性肿瘤组外,其余各组间比较差异有统计学意义,P＜0.05;D*值仅囊肿组与其他4组比较差异有统计学意义,P＜0.05.各组D与ADC值比较,除囊肿组D值和ADC值差异无统计学意义外,余各组ADC值均高于D值,P＜0.001.D、ADC和f值诊断乳腺肿块样病变良恶性实验得到的曲线下面积(area under roc curve,AUC)分别为0.930、0.898和0.768,D值诊断效果最好,三者鉴别诊断乳腺肿块样良恶性病变的最佳临界值分别为0.89×10-3mm2/s、1.08×10-3 mm2/s和5.54％,相对应的诊断敏感性依次为95.7％、89.3％和79.2％,特异性依次为92.9％、87.5％和71.4％.结论 IVIM-DWI对于乳腺肿块样病变具有较高的诊断及鉴别诊断的价值,D值诊断效能较常规ADC值更好.

Diagnostic value of intravoxel incoherent motion diffusion weighted imaging of breast mass-like lesions

OBJECTIVE Diagnosis and differentiation of mass-like lesions of breast are of great significance for clinical treatment and prognosis.The aim of this study was to investigate the value of diffusion weighted imaging (DWI) which based on the intravoxel incoherent motion(IVIM) of the different mass-like lesions of breast.METHODS From July 1,2015 to December 30,2015,DWI,IVIM-DWI and DCE of Magnetic resonance imaging (MRI) were obtained from patients with breast mass from Tumor Hospital of Yunnan Province.A total of 127 patients(135 lesions) were studied,including 75 cases(75 lesions) of breast cancers,27 cases(32 lesions) of benign tumors,10 cases(13 lesions) of cysts,15 cases(15 lesions)of inflammatory lesions.According to the pathological results,the lesions were divided into breast cancer group,benign tumor group,cyst group,inflammatory lesion group and group taken contralateral gland as the gland.The differential diagnosibility of ADC,D,D* and f value between of each group was analyzed and compared.The optimal diagnostic cut-off value and corresponding sensitivity as well as specificity were confirmed.RESULTS Along with the increase of b value,cyst took on single-exponential linear attenuation;gland tissues,inflammatory lesions,benign tumors and breast cancer took on double-exponential non-linear attenuation.One-way analysis of variance showed that the differences of conventional DWI parameters,ADC value(F=119.35,P＜0.001),D value(F=58.31,P＜0.001),F value(F=50.961,P＜0.001) and D* value(F=2.732,P=0.032)among breast cancers,benign tumors,inflammatory lesions,cysts and normal gland tissues were all with statistical significance.ADC values in the five groups,excluded normal gland tissues and benign tumors,were with statistical difference (P＜0.05).Cysts had the highest ADC value and breast cancers the lowest.There were statistical differences of D values in any two of all five groups (P＜0.05).There were no of f values between inflammatory lesions and breast cancers and between normal gland tissues,while other pairs with statistical difference (P＜0.05).Malignant group had the highest f value and cyst group the lowest.As for D* value,only comparison between cyst group and other four groups was with statistical difference (P＜0.05).Comparing D value and ADC value of different lesions and normal gland,there were statistical difference between the two parameters in malignant group,benign tumor group,inflammatory group and normal gland (P＜0.001),with ADC value higher than D value.Area under the curve obtained from diagnostic experiment of D,ADC and f values was with statistical difference with their AUC respectively being 0.930,0.898 and 0.768.D value had the best diagnostic effect.The optimal cut-off value of the three diagnosing breast gland's benign and malicious lesions was respectively 0.89 × 10-3 mm2/s,1.08 × 10-3 mm2/s and 5.54 ％.The sensitivities of breast gland' s benign and malicious lesions diagnosed by this threshold value were respectively 95.7％,89.3％ and 79.2％.The specificities were 92.9％,87.5％ and 71.4％ respectively.CONCLUSIONS IVIM-DWI has a high value for diagnosis of breast mass-like lesions.D value of IVIM-DWI can obtain better diagnostic performance than the ADC value of conversional DWI.