多模态MRI技术在乳腺非肿块性强化病变良恶性鉴别中的临床研究

目的:探讨多模态3.0T MRI技术在乳腺非肿块性强化病变(NMLE)良恶性鉴别诊断中的效能与临床应用价值。方法:回顾性分析在本院经手术和病理学证实且均行3.0T MRI检查的90例乳腺NMLE患者资料,其中良性病变31例(良性组),恶性病变59例(恶性组),均为女性,平均年龄(46.3±9.1)岁。分析比较两组NMLE分布类型及在DCE-MRI上的强化特点与时间-信号强度曲线,在DWI上检测与确定ADC最佳阈值及诊断敏感度与特异度。结果:①分布类型:导管型、节段型、区域型和弥漫型,其中节段型分布两组间差异有统计学意义(P<0.05),其余者差异无统计学意义(P>0.05);②强化病变特点:均匀、不均匀、集丛样强化、簇样环形强化,其中集丛样强化在两组间差异具有统计学意义(P<0.05),其余差异无统计学意义(P>0.05);③时间-信号强度曲线类型在两组间差异不具有统计学意义(P>0.05)。④ADC值:两组平均ADC值分别为(1.11±0.32)×10-3mm2/s、(1.47±0.37)×10-3mm2/s,差异有统计学意义(P<0.05),ADC值≤1.3×10-3mm2/s诊断NMLE为恶性病变的敏感度与特异度为71.8%、78.8%。结论:应用DCE-MRI与ADC值测量提供的形态学与功能学信息有助于提高乳腺NMLE良恶性病变的诊断效能。

Clinical study of multi-mode MRI in differentiating benign and malignant breast non-mass-like enhancement lesions

Objective: To explore the efficacy and clinical value of multi-mode 3.0 T MRI in the differential diagnosis of benign and malignant breast non-mass-like enhancement(NMLE) lesions. Methods: The data of 90 cases of breast NMLE lesions confirmed by operation and pathology and examined by 3.0 T MRI were analyzed retrospectively. Among them, 31 cases were benign lesions(benign group) and 59 cases were malignant lesions(malignant group), all of them were female. Average age was 46.3±9.1. The distribution types, enhancement characteristics and time-intensity curve(TIC) on DCE-MRI were analyzed and compared between the two groups. The optimal threshold, diagnostic sensitivity and specificity of ADC were detected and determined on DWI. Results: ①Distribution type: dutcal type, segmental type, regional type and diffusive type, among which,the difference of segmental type distribution between the two groups was statistically significant(P<0.05), while the difference of the rest was not statistically significant(P>0.05);②Characteristic of enhanced lesions: the homogeneous, the heterogeneous, the clumped and the clustered ring. The clumped enhancement in the two groups had statistical significance(P<0.05), and the remaining variances were not statistically significant(P>0.05);③The types of TIC in the two groups were not statistically significant(P>0.05);④ADC value: The average ADC values of the two groups were(1.11±0.32)×10-3mm2/s,(1.47±0.37)×10-3mm2/s,and the difference was statistically significant(P<0.05), When the ADC value was less than or equal to 1.3 ×10-3mm2/s, the sensitivity and specificity of diagnosing NMLE lesions as malignant lesions was 71.8% and 78.8% respectively. Conclusion:The application of DCE-MRI and ADC value measurement provides morphological and functional information that is helpful to distinguish benign and malignant breast NMLE lesions.