3.0T超导型MRI灌注加权成像联合动态增强扫描技术在乳腺早期良恶性病变鉴定中的研究

目的探讨3.0 T超导型MRI灌注加权成像(PWI)联合动态增强扫描(DCE)在乳腺早期良恶性病变鉴定中的价值。方法选择术后经病理确诊为良恶性的乳腺早期病变女性患者61例,年龄24~65岁,平均年龄30.12岁。所有患者均经3.0 T超导型MRI PWI常规T2加权成像(T2WI)和T1加权成像(T1WI)平扫后行三维(3D)动态增强扫描技术,并根据病理结果分为恶性病变和良性病变,对比病变形态学变化、时间-信号强度曲线(TIC)及表观弥散系数(ADC)值,并分析PWI联合DCE对乳腺早期良恶性病变鉴别诊断价值。结果病理结果为恶性病变27例,良性病变34例;DCE-MRI扫描结果为恶性病变患者20例,良性病变患者26例,病变检出率75.41%;PWI扫描结果为恶性病变患者21例,良性病变患者27例,病变检出率78.69%。乳腺早期良性病变形态以类圆形(76.5%)、边缘以光滑(70.6%)为主,乳腺早期恶性病变形态以分叶形(63.0%)、边缘以毛刺征(59.3%)为主;乳腺早期良恶性病变DCE-MRI扫描形态学特征对比,差异有显著统计学意义(χ^2=43.557、37.459,P=0.000、0.000)。乳腺早期良性病变TIC形态以Ⅰ型(61.8%)为主,乳腺早期恶性病变TIC形态以Ⅲ型(77.8%)为主,两者比较,差异有显著统计学意义(χ^2=121.852,P=0.000);22例(81.5%)恶性病变患者ADC值≤1.195×10-3 mm2/s,28例(82.4%)良性病变患者ADC值>1.195×10-3 mm2/s,两者差异有显著统计学意义(χ2=26.148,P=0.000)。二者联合鉴别诊断乳腺早期良恶性病变的灵敏度、特异度及准确度与DCE-MRI、PWI单一诊断更高(P<0.05)。结论 3.0 T超导型MRI PWI联合DCE在乳腺早期良恶性病变鉴定中具有较高的临床价值。

3.0T MR perfusion-weighted imaging combined with dynamic contrast-enhanced technique for identification of early benign and malignant breast lesions

Objective To explore the value of 3.0 T superconducting MR perfusion-weighted imaging(PWI)combined with dynamic contrast-enhanced(DCE)for identification of benign and malignant lesions in patients with early breast lesion.Methods A total of 61 female patients,pathologically diagnosed with benign and malignant breast lesions were enrolled,which aged 24-65 years old with mean age of 30.12 years old.All of them performed 3D DCE after underwent 3.0 T superconducting MR PWI conventional T2-weighted imaging(T2WI)and T1-weighted imaging(T1WI)plain scan.According to pathological results,they were divided into malignant lesion and benign lesion,the morphological changes,time-signal intensity curve(TIC)and apparent diffusion coefficient(ADC)value were further compared.The value of PWI combined with DCE in differential diagnosis for early benign and malignant breast lesions were analyzed.Results The pathological results indicated 27 cases of malignant lesion and 34 of benign lesion.DCE-MRI scan were 20 with malignant lesion and 26 with benign lesion.The detection rate was 75.41%.PWI scan were 21 with malignant lesion and 27 with benign lesion.The detection rate was 78.69%.The morphology of benign breast lesions were mainly round(76.5%)and smooth(70.6%).The malignant lesion were mainly lobulated(63.0%)and burr(59.3%).The morphological features of DCE-MRI scan of benign and malignant breast lesions were significantly different(χ^2=43.557,37.459,P=0.000,0.000).The morphology of TIC curve in early benign breast lesion was mainly typeⅠ(61.8%),in early malignant breast lesion was mainly typeⅢ(77.8%),and the difference was statistically significant(χ^2=121.852,P=0.000);The ADC value of 22 cases(81.5%)with malignant lesion was≤1.195×10-3mm2/s,28(82.4%)with benign lesion was>1.195×10-3mm2/s,the difference was statistically significant(χ^2=26.148,P=0.000).The sensitivity,specificity and accuracy of combined diagnosis of benign and malignant breast lesions were higher than those of DCE-MRI or PWI(P<0.05).Conclusion It is demonstrated that 3.0 T superconducting MR PWI combined with DCE technique shows high clinical value for identification of benign and malignant lesions in early breast disease.