浆细胞性乳腺炎的MRI表现及手术对照研究

目的探讨浆细胞性乳腺炎的MRI表现及其在临床诊疗中的应用价值。方法经手术病理证实的浆细胞性乳腺炎患者32例,术前均行双乳MRI平扫及增强检查,对照手术所见分析其MRI表现。结果 32例浆细胞性乳腺炎患者,均为女性,年龄23~42岁,平均(32±5)岁。其中30例累及单侧乳腺、2例累及双侧乳腺,共34个患乳。MRI显示7个(20.6%)患乳内病灶局限于乳晕周围及后方、4个(11.8%)累及单个象限及乳晕区、23个(67.6%)累及多个象限及乳晕区,并有21个(61.8%)累及乳后间隙。3个(8.8%)患乳病灶呈非肿块样,31个(91.2%)呈肿块样病灶。1个(2.9%)呈单发均匀强化结节,5个(14.7%)呈单发不均匀强化结节,23个(67.6%)呈多发不均匀强化结节,2个(5.9%)呈多发不均匀强化结节伴均匀强化结节,并见16个(47.1%)多发不均匀强化结节间相通。15个(44.1%)患乳乳晕皮肤增厚伴乳头凹陷,13个(38.2%)伴邻近皮肤增厚,8个(23.5%)伴皮下脓肿形成,均与手术所见一致。术中见12个(35.3%)患乳局部皮肤瘘管形成,MRI仅显示9个(26.5%);术中见6个(17.6%)患乳脓肿间瘘管形成,MRI仅显示3个(8.8%);术中见9个(26.5%)患乳脓肿与乳头孔间有管道相通,MRI仅显示7个(20.6%);术中见25个(73.5%)患乳乳导管扩张,MRI仅显示19个(55.9%)。结论浆细胞性乳腺炎的MRI表现具有一定特征性,并与手术所见具有较高的一致性。MRI能清晰显示病变的位置、累及范围及深度、皮下及病灶间的瘘管,并显示病灶与乳头相通的管道,对指导临床手术方案的制订有重要作用。

MRI performance of plasma cell mastitis and comparison with operation findings

Objective To evaluate MRI features of plasma cell mastitis（PCM） and the application values in clinical diagnosis and treatment. Methods Thirty-two patients with pathologically proved PCM had taken plain and enhanced bilateral breast MRI scanning before operation. The MRI appearance was analyzed, comparing with operation findings. Results The patients aged from 23 to 42,32 ± 5 in average. There were 30 cases with unilateral breast involvement, 2 cases with bilateral breasts involvement, and 34 suffering breasts in total. MRI showed that 7 breast lesions （ 20.6% ） were restricted to the areola region, 4 lesions （ 11.8% ） were located in single quadrant and the areola region, and 23 breasts （ 67.6% ） were located in mul- tiple quadrants and the areola region. Of the 34 breast lesions,21 （ 61.8% ） involved retro-mammary space. MRI showed that there were 3 with non-mass like lesions （ 8.8% ） , 31 with mass like lesions （ 91.2% ） , 1 with single homogeneously enhanced nodule （ 2.9% ） ,5 with single inhomogeneously enhanced nodule （ 14.7% ） , 23 with multiple inhomogeneously enhanced nodules （ 67.6% ） , and 2 with multiple homogeneously and inhomogeneously enhanced nodules （ 5.9% ） ）. In 16 breast lesions （ 47.1% ） ,the inhomogeneously enhanced nodules were communicated with each other. 15 lesions （ 44.1% ） had areola skin thickening with nipple retraction, 13 lesions （ 38.2% ） had thickening of the skin adjacent to lesion, and 8 lesions （ 23.5% ） had subcutaneous abscess. All of these were consistent with operation findings. During operation, skin fistula was present in 12 lesions （ 35.3% ） while the MRI demonstrated 9 （ 26.5% ） ;fistula between abscesses in 6 lesions （ 17.6% ） while MRI demonstrated 3 （ 8.8% ） ; duct between abscess and nipple in 9 lesions （ 26.5% ） while MRI demonstrated 7 （ 20.6% ） ; and duct ectasia in 25 breasts（73.5%） while MRI demonstrated 19 （55.9%）. Conclusion PCM representation on MRI is characteristic, and consistent with operation findings. MRI can clearly demonstrate the lesion＇s location, including scope and depth, subcutaneous fistula and fistula between lesions, and the duct between lesion and nipple. It is of great importance in formulating the operation plan.