MRI动态增强联合扩散加权成像可提高对乳腺良恶性病变的诊断效能

目的  分析乳腺癌MRI动态增强（DCE）与扩散加权成像（DWI）的影像学特点及联合诊断的效能。方法  回顾性收集2018年6月~2022年8月我院收治的230例乳腺癌患者作为恶性组，选取同期在我院接受检查和治疗的252例乳腺良性病变患者作为良性组，所有患者均经手术治疗或病理穿刺活检确诊。统计乳腺良恶性病变患者DCE-MRI、DWI的影像学特点，统计DCE-MRI、DWI单独及联合对乳腺良恶性病变患者诊断结果  ，采用ROC曲线分析DCE-MRI、DWI单独及联合对乳腺癌的诊断效能。结果恶性组病灶形状为分叶状、不规则形（43.04%、45.65%），边缘毛刺（48.70%），内部不均匀强化、簇集状强化、分支强化（20.87%、38.70%、36.09%），时间-信号强度曲线类型Ⅲ型（43.04%）患者占比高于良性组（33.33%、15.48%、12.70%、8.33%、14.29%、19.05%、3.57%，P < 0.05）。DCE-MRI、DWI单独及联合诊断乳腺良性和恶性病变分别187例、215例、239例和166例、193例、218例，检出率分别为74.21%、85.32%、94.84%和72.17%、83.91%、94.78%，DWI单独及DCE-MRI、DWI联合诊断乳腺良性和恶性病变检出率高于DCE-MRI单独诊断，DCE-MRI、DWI联合诊断高于DWI单独诊断（P < 0.05）。DWI单独及DCE-MRI、DWI联合诊断乳腺良性和恶性病变的敏感度（83.91%、94.78%）、特异性（85.32%、94.84%）、曲线下面积（0.846、0.948）均高于DCE-MRI单独诊断（72.17%、74.21%、0.732），DCE-MRI、DWI联合诊断高于DWI单独诊断（P < 0.05）。结论  DCE-MRI、DWI诊断乳腺良恶性病变具有特异的影像学特点，两者联合可有效提高对乳腺良恶性病变的诊断效能，具有较好的应用价值。

Dynamic contrast-enhanced MRI and diffusion-weighted MRI can improve diagnostic efficacy of benign and malignant breast lesions

Objective To analyze the imaging characteristics of dynamic contrast-enhanced MRI (DCE- MRI) and diffusion-weighted imaging (DWI) of breast cancer and the efficacy of combined diagnosis. Methods The clinical data of 230 patients with breast cancer admitted to our hospital from June 2018 to August 2022 were retrospectively collected as the malignant group, and the clinical data of 252 patients with benign breast lesions who were examined and treated in our hospital during the same period were selected as the benign group. All patients were diagnosed by surgery or pathological puncture biopsy. The imaging characteristics of DCE-MRI and DWI in patients with benign and malignant breast lesions were counted, and the diagnostic results of DCE- MRI and DWI alone and in combination were counted. ROC curve was used to analyze the diagnostic efficacy of DCE- MRI and DWI alone and in combination for breast cancer. Results In the malignant group, the lesions were lobulated and irregular (43.04%, 45.65%), with marginal burrs (48.70%), internal heterogeneous enhancement, cluster enhancement and branching enhancement (20.87%, 38.70%, 36.09%), and the proportion of patients with TIC type Ⅲ (43.04%) was higher than that in benign group (33.33%, 15.48%, 12.70%, 8.33%, 14.29%, 19.05%, 3.57%, P < 0.05). DCE-MRI and DWI alone and jointly diagnosed benign and malignant breast lesions in 187 cases, 215 cases, 239 cases, 166 cases, 193 cases and 218 cases respectively, and the detection rates were 74.21%, 85.32%, 94.84% and 72.17%, 83.91%, 94.78%, respectively. The detection rate of benign and malignant breast lesions diagnosed by DWI alone and DCE-MRI combined with DWI was higher than that by DCE- MRI alone, and that by DCE- MRI combined with DWI was higher than that by DWI alone (P < 0.05).The sensitivity (83.91%, 94.78%), specificity (85.32%, 94.84%) and area under the curve (0.846, 0.948) of DWI alone and DCE-MRI combined with DWI in diagnosing benign and malignant breast lesions were higher than those of DCE- MRI alone (72.17%, 74.21%, 0.732), the combined diagnosis of DCE-MRI and DWI was higher than that of DWI alone (P < 0.05). Conclusion DCE-MRI and DWI have specific imaging characteristics in the diagnosis of benign and malignant breast lesions. The combination of DCE-MRI and DWI can effectively improve the diagnostic efficiency of benign and malignant breast lesions and had good application value.