磁共振扩散加权成像技术对可疑乳腺癌的鉴别诊断价值

目的探讨乳腺磁共振扩散加权成像中表观扩散系数(apparent diffusion coefficient,ADC)值、指数表观扩散系数(exponential apparent diffusion coefficient,eADC)值和相对表观扩散系数(relative apparent diffusion coefficient,rADC)值,结合MRI平扫对可疑乳腺癌的诊断和鉴别价值。材料与方法收集41例患者均行扩散加权磁共振成像(diffusion weighted imaging,DWI)成像检查并行BI-RADS分级为Ⅳ级,且经手术病理证实。在病变感兴趣区测量ADC值、eADC值和rADC值;采取组间两两比较采用t检验,P<0.05其良、恶性差异有统计学意义。同时,按ADC值大小进行良、恶性分布情况统计,均以手术病理结果为金标准,进行统计学分析。结果在两两比较中,恶性病变ADC、rADC值低于良性病变,eADC值高于良性病变,其差异具有统计学意义(P<0.05)。以病理诊断结果为金标准,以1.440×10^-3 mm^2/s为鉴别乳腺良、恶性病变的临界值,敏感性为85.7%,特异度为55.0%,准确度为70.7%。以DWI中ADC值<1.440×10^-3 mm^2/s作为恶性的评判标准,Kappa=0.712,与病理诊断一致性好。结论扩散加权成像技术(ADC值、eADC值和rADC值)是磁共振检查鉴别可疑性乳腺癌可靠的指标;结合MRI平扫对BI-RADS分类Ⅳ级病变良恶性鉴别更具有重要的价值,对临床治疗具有指导意义。

Differential diagnosis value of magnetic resonance diffusionweighted imaging for suspicious breast cancer

Objective:To investigate the value of ADC,eADC and rADC in breast magnetic resonance diffusion-weighted imaging(DWI),combined with MRI plain scan for the diagnosis and differential value of suspected breast cancer.Materials and Methods:Fortyone patients underwent DWI imaging and were enrolled in the BI-RADS gradeⅣ,and confirmed by surgery and pathology.The ADC value,eADC value and rADC value were measured in the lesion area of interest.The t test was used to compare the two groups.The difference between the good and the malignant was statistically significant at P<0.05.At the same time,according to the size of the ADC value,the distribution of benign and malignant statistics was performed,and the surgical pathological results were used as the gold standard for statistical analysis.Results:In the pairwise comparison,the ADC and rADC values of malignant lesions were lower than those of benign lesions,and the eADC value was higher than that of benign lesions,and the difference was statistically significant(P<0.05);The pathological diagnosis was the gold standard,and the critical value of benign and malignant breast lesions was identified by 1.440×10^-3 mm^2/s.The sensitivity was 85.7%,the specificity was 55.0%,and the accuracy was 70.7%.The ADC value<1.440×10^-3 mm^2/s in DWI was used as the criterion for malignancy,Kappa=0.712,which was in good agreement with pathological diagnosis.Conclusions:DWI techniques(ADC values,eADC values,and rADC values)are reliable indicators for identifying differential breast cancer by magnetic resonance imaging;combined with MRI plain scan is more important for the differential diagnosis of benign and malignant BIRADS classification and gradeⅣlesions,and has guiding significance for clinical treatment.