MRI在乳腺叶状肿瘤与纤维腺瘤鉴别诊断中的应用价值

目的：探讨MRI对叶状肿瘤与纤维腺瘤鉴别诊断中的应用价值。材料与方法回顾性分析经手术或穿刺病理证实的23例乳腺叶状肿瘤（24个病灶）和59例乳腺纤维腺瘤（62个病灶）患者的MRI表现，采用χ2检验（Fisher精确概率法）和t检验进行统计学分析。结果叶状肿瘤的平均最大径大于纤维腺瘤，两者有统计学差异（P=0.004）。叶状肿瘤和纤维腺瘤的形状和边缘表现有统计学差异（P＆lt;0.05）；叶状肿瘤以分叶状形态多见（12/24，50.00%），也可出现不规则形态（2/24，8.33%）；纤维腺瘤以类圆形（29/62，46.77％）和分叶状（27/62，43.55％）多见，无不规则形态出现。纤维腺瘤边缘多表现为光滑（58/62，93.55％），边缘不规则少见；叶状肿瘤边缘不规则更多见：7个（29.17％）边缘不规则，1个出现毛刺。11例（11/24，45.83%）叶状肿瘤T1WI出现斑片状高信号（提示有出血），纤维腺瘤无T1WI斑片状高信号表现。叶状肿瘤T2WI脂肪抑制上以高信号为主（21/24，87.5%），无等或低信号出现；纤维腺瘤T2WI抑脂上等、低、高、混杂信号都有，以高信号为主（43/62，69.35％）；两者表现有统计学差异（P=0.025）。8例（8/24，33.33%）叶状肿瘤可见囊变区，纤维腺瘤无一例囊变表现。在强化方式和未强化的低信号分隔方面两者无明显统计学差异。在曲线类型上，叶状肿瘤以Ⅱ型多见，纤维腺瘤以Ⅰ型多见；Ⅲ型曲线更多见于叶状肿瘤，两者表现有统计学差异（P=0.008）。在平均ADC值方面，叶状肿瘤与纤维腺瘤无明显统计学差异（P=0.068）。结论叶状肿瘤与纤维腺瘤在MRI表现上存在差异，应用动态增强MR检查能够提高叶状肿瘤与纤维腺瘤的鉴别诊断。

Differentiation of phyllodes breast tumors from ifbroadenomas using MRI

Objective：To evaluate the MRI appearance of phyllodes breast tumors and to differentiate them from ifbroadenomas. Materials and Methods：MR images were obtained on GE medical system 3.0-T imager. MR images of 23 patients with 24 phyllodes breast tumors proved by surgery or biopsy pathology were retrospectively analyzed. The results were compared with the MRI appearance of 62 ifbroadenomas of 59 patients by using Chi-square test Fisher’s Exact test and t test. Results：There is statistical difference （P=0.004） in average maximum diameter between phyllodes breast tumor and ifbroadenomas. Still, there is another statistical difference （P＆lt;0.05） in tumor shape and edge between the both. Phyllodes tumors show as lobulated shape commonly （12/24, 50.00%） or irregular shape sometimes （2/24, 8.33%）, while ifbroadenomas show as quasi-circular shape （29/62, 46.77%） or lobulated shape （27/62, 43.55%） commonly and no irregular shape seen. In the aspects of tumor edge, most ifbroadenomas show smoothly （58/62, 93.55%） and less irregular edge. On the contrary, phyllodes tumors have more irregular edges （7 tumors with irregular edges （29.17%） and 1 tumor with spiculation）. Meanwhile, 11 （11/24, 45.83%） phyllodes tumors show patchy hyperintense （bleeding tip） on T1WI compared with ifbroadenomas, which has no this kind of signal. On T2WI fat saturation, it shows statistical difference （P=0.025） that phyllodes tumors have hyperintense mostly （21/24, 87.5%） with no isointense or hypointense and fibroadenomas have isointense, hypointense and mixed signal as well as hyperintense （43/62, 69.35%）. Furthermore, cystic change area is to be seen in 8 （8/24, 33.33%） phyllodes tumors and no this kind of area in ifbroadenomas. In terms of enhanced low signal lace and no-enhanced one, both tumors have not evidently statistical difference. Regarding of curve characteristic, the statistical difference （P=0.008） has showed that II type and III type is mostly seen in phyllode