乳腺腺病与乳腺导管癌的MRI鉴别诊断及病理对照研究

目的探讨乳腺腺病与乳腺导管癌的动态增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)、扩散加权成像(diffusion weight imaging,DWI)鉴别诊断特征,及其与病理表现相关性。材料与方法回顾性收集分析经病理证实的105例乳腺腺病、78例乳腺导管癌患者的MRI资料。所有患者术前均行乳腺DWI、DCE-MRI扫描。分析两组患者的MRI表现特点及其与病理表现的相关性,采用χ~2检验比较两组的临床资料、病灶位置、大小、形态、时间-信号强度曲线(time-signal intensity curve,TIC)及强化方式等特征;采用单因素方差分析比较两组患者的表观扩散系数(apparent diffusion coefficient,ADC)值。结果 105例乳腺腺病呈肿块样强化(mass-like enhancement,MLE)50例,非肿块样强化(nonmass-like enhancement,NMLE)55例;78例乳腺导管癌中MLE52例,NMLE26例。腺病组MLE病变形态大多形态规则(37/50,74%)、边缘清晰(35/50,70%),两组MLE病变的强化方式、TIC类型的差异均有统计学意义(χ~2值分别为14.169和13.955,P均0.01);两组MLE病变的ADC值分别为(131.63±21.8)×10~(-3) mm~2/s、(104.21±18.54)×10~(-3) mm~2/s,两者的差异有明显统计学意义(F=52.167,P0.01);两组NMLE病变强化方式多样,其差异有统计学意义(χ~2值分别为4.478,P均0.05)。两组NMLE病变的ADC值分别为(136.23±14.8)×10~(-3) mm~2/s、(102.51±16.44)×10~(-3) mm~2/s,两者的差异有明显统计学意义(F=49.167,P0.01)。结论乳腺腺病的MRI表现具有一定的特征性,MLE病变多呈良性病变特点,NMLE病变形态与恶性病变相似,动态增强结合DWI有助于其与乳腺导管癌的鉴别诊断;乳腺腺病的间质纤维化可能是造成恶性征象出现的原因。

MRI differential diagnosis of breast adenosis and breast ductal carcinomawithpathologicalcorrelation

Objective: To investigate the radiological features of breast adenosis and breast ductal carcinoma by dynamic contrast enhanced MRI (DCE-MRI), DWI and to correlate them to different pathological types. Materials and Methods:105 cases of breast adenosis and 78 cases of breast ductal carcinoma confirmed by surgical histopathology or biopsy were retrospectively analyzed in the study. All of the patients were examined preoperatively by DWI and DCE-MRI (Vibrant). MRI features of breast adenosis and breast ductal carcinoma with pathological correlation were analyzed. Clinical data, lesion location, size, pattern and enhancement pattern in the groups between different pathological types of breast adenosis and breast ductal carcinoma were evaluated and analyzed by using statistics test by using χ2 test. One-way ANOVA was employed to compare the ADC values. Results: In 105 cases of breast adenosis, DCE MR images showed mass-like lesions (50 patients) and nonmass-like lesions (55 patients), In 78 cases of breast ductal carcinoma, DCE MR images showed mass-like lesions (52 patients) and nonmass-like lesions (26 patients). Most of MLE lesions of adenosis group have morphological rules (37/50, 74%) and clear edge (35/50, 70%). There were statistical significance between MLE lesions of breast adenosis and breast ductal carcinoma in enhancement pattern and TIC pattern (χ2=14.169 and 13.955, respectively, all P<0.01). The ADC values of MLE lesions of breast adenosis and ductal carcinoma were (131.63±21.8) ×10-3 mm2/s, (104.21±18.54) ×10-3 mm2/s, respectively. There were significant differences in the groups (F=52.167, P<0.01). NMLE lesions of breast adenosis and breast ductal carcinoma enhancement patterns were diverse. There were statistical significance between NMLE lesions in pattern and TIC pattern (χ2=and 4.478, respectively, all P<0.05). The ADC values of MLE lesions of breast adenosis and ductal carcinoma were (136.23±14.8) ×10-3 mm2/s, (102.51±16.44) ×10-3 mm2/s, respectively. There were significant differences between the groups (F=49.167, P<0.01). Conclusion: The characteristic of radiological findings can be found in breast adenosis using advanced MR imaging techniques, most of MLE lesions of breast adenosis are benignity-looking lesions, and NMLE lesions of breast adenosis in morphology are similar to malignant lesions, DCE-MRI combined with DWI are helpful in the differential diagnosis of breast ductal carcinoma. It shows these suspicious features could be misleading in the MRI interpretation in a group of patients with stromal fibrosis.