动态增强MRI鉴别诊断不典型乳腺癌与纤维腺瘤

目的 探讨动态增强MRI（DCE-MRI）定量参数对不典型乳腺癌和纤维腺瘤的鉴别诊断价值。方法 收集经病理证实的不典型乳腺癌30例（不典型乳腺癌组）和纤维腺瘤32例（纤维腺瘤组）患者。对所有患者均进行DCE-MR检查，获取血流动力学参数容量转移常数（K_trans）、速率常数（K_ep）、血管外细胞外间隙容积分数（V_e）、血浆分数（V_p），比较两组各参数的统计学差异，并评价其诊断效能。结果 不典型乳腺癌组K_trans、K_ep、V_e、V_p分别为（1.49±0.55）min^-1、（0.70±0.02）min^-1、0.78±0.19、0.26±0.13，纤维腺瘤组K_trans、K_ep、V_e、V_p分别为（0.64±0.23）min^-1、（0.30±0.23）min^-1、0.63±0.25、0.33±0.14；两组间K_trans、V_e、K_ep差异有统计学意义（P均<0.01），V_p差异无统计学意义（P=0.05）。K_trans、K_ep、V_e诊断不典型乳腺癌和纤维腺瘤的曲线下面积分别为0.94、0.88、0.68，敏感度为86.7%、86.7%、83.3%，特异度为93.7%、81.2%、46.9%。结论 DCE-MRI可准确评估病变的微循环，对纤维腺瘤和不典型乳腺癌的诊断及鉴别诊断具有较高的临床应用价值。

Dynamic contrast enhanced MR in differential diagnosis of atypical breast cancer and fibroadenoma

Objective To evaluate the value of quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the differential diagnosis of atypical breast cancer and fibroadenoma. Methods Totally 62 patients underwent DCE-MRI examination including 30 atypical breast cancer patients (atypical breast cancer group) and 32 breast fibroadenoma patients (breast fibroadenoma group) which were confirmed by pathology after operation. Quantitation of the hemodynamics parameters was measured including volume transfer constant (K_trans), rate constant (K_ep), extravascular extracellular volume fraction (V_e) and plasma fraction (V_p). The parameters of K_trans, K_ep, V_e and V_p were compared statistically and the differential diagnostic value in atypical breast cancer and fibroadenoma were evaluated. Results The mean K_trans, K_ep, Ve and V_p of the atypical breast cancer group were (1.49±0.55)min^-1, (0.70±0.02)min^-1, 0.78±0.19, 0.26±0.13, and that of the breast fibroadenoma group were (0.64±0.23)min^-1, (0.30±0.23)min^-1, 0.63±0.25, 0.33±0.14, respectively. There were significant differences between both groups in K_trans, K_ep, V_e (all P<0.01). There were no significant differences between the two groups in V_p (P=0.05). The areas under curve of K_trans, K_ep, V_e were 0.94, 0.88, 0.68. The diagnostic sensitivity of K_trans, K_ep, V_e were 86.7%, 86.7%, 83.3%, and the specificity were 93.7%, 81.2%, 46.9%. Conclusion The quantitative parameters of DCE-MRI can be used to evaluate the microcirculation of the lesions and have clinical value in differential diagnosis of atypical breast cancer and breast fibroadenoma.