1.5T乳腺专用磁共振诊断乳腺导管内乳头状瘤的应用价值

目的:探讨乳腺专用磁共振诊断导管内乳头状瘤的应用价值.方法:收集我院经手术病理证实的31例乳腺导管内孤立/多发乳头状瘤病例进行回顾性分析.所有病人术前均行乳腺X线、超声检查及AURORA乳腺专用磁共振平扫及动态增强扫描.参照乳腺影像报告和数据系统(BI-RADS),评价其病灶的形态学(包括病灶大小、形状、部位、边缘、多形性及与导管的关系)、动态增强扫描的强化模式及其他相关的特征,并与X线、超声检查相对照.结果:31例病人孤立导管内乳头状瘤23例,多发导管乳头状瘤8例.MRI共检出30个病灶,其中2例导管内乳头状瘤MRI为阴性,1例双侧多发导管乳头状瘤MRI检出双侧病灶.其MRI形态学表现最多见是沿导管分布多发小结节样或环形强化(38.7％),其次为乳晕后区孤立或多发结节样强化(22.6％)及乳晕后方导管样、线状、分支样强化(12.9％),伴或不伴导管扩张,MRI增强信号-时间曲线以平台型和流出型为主,具有一定的特征性.部分(4例)表现为类似恶性肿瘤的MRI征象(12.9％),难以与恶性肿瘤区分.结论:乳腺专用MRI检查对检出导管内乳头状瘤(病)具有较大的优势,能为临床手术治疗提供准确定位,具有较好的应用价值.

Value of a dedicated breast MRI (DBMRI) on diagnosis of breast intraductal papillomas

Objective To evaluated the value of a dedicated breast MRI(DBMRI) on diagnosis of breast intraductal papillomas.Methods A retrospective review of the breast MRI images of 31 cases of solitary/multiple intraductal papilloma with pathological diagnosis was performed.All the cases underwent breast DBMRI screening,as well as mammography and breast ultrasonography.The morphological analysis of papillomas included the size,shape,location,margin of the lesions,multiplicity and ductal relation,the pattern of enhancement and associated findings were evaluated.The MRI findings were categorized according to breast imaging reporting and data system(BI-RADS) lexicon.The MRI findings with mammography and breast ultrasonography was compared.Results Thirty lesions were found on MRI images in 31 cases.Among them,23 patients had solitary intraductal papilloma and 8 patients had multiple intraductal papillomas.There were 2 cases of solitary intraductal papilloma with no positive finding on MRI appearance,and bilateral breast multiple intraductal papilloma reviewed in 1 case.Dynamic enhanced images showed frequently multiple small nodulars or ring-like enhancement distributing along the ducts of the breast(38.7%),followed by solitary/ multiple nodular(22.6%) or ductal(12.9%) enhancement with or without ductal ectasia in the retroareolar region.Most cases had a plateau and wash-out type curve on MRI time-intensity curve.There were 4 cases(12.9%) mimicked invasive breast cancer on MRI appearance which was difficult to distinguished from malignancy.Conclusions The DBMRI shows great advantage on finding of breast papillomas compared with mammography and breast ultrosonography,which plays a valuable role in the preoperative diagnosis and localization.