乳腺肿块磁共振动态增强与病理相关性初步研究

摘要] 目的 探讨乳腺肿块样病变MR动态增强扫描显示的形态、边缘特点、强化模式与其组织病理学改变的相关性。方法 对乳腺肿块样病变行MR平扫和动态增强扫描，所得病例样本再行组织病理学检查，二者对比研究。 结果 良性结节样病变MR表现边缘光滑，呈多种模式强化。病理显示当细胞增生活跃时，MR增强扫描可呈明显强化。囊性病变呈（不）规则环形强化。脓肿的MR显示病灶内不规则间隔，与病理显示病灶内小叶结构破坏，坏死腔形成相关。瘢痕组织无强化。在恶性肿块样病变中，浸润性导管癌MR主要表现为由边缘向中央强化，病灶周围可见毛刺影。病理显示癌巢呈出芽状生长，向周围组织浸润生长形成毛刺。浸润性小叶癌表现为不均匀边缘强化，中央轻度强化。病理显示瘤巢中央见大量粉染无结构物质。导管原位癌MR检查呈分支状强化，病理显示导管上皮明显不典型性增生。 结论 肿块样病变MR检查呈形态规则、边缘光滑，无明显强化及轻度强化（病灶间隔不强化）者强烈提示病变为良性。MR增强扫描肿块呈毛刺状边缘强化或不规则强化者高度提示恶性病变。MR动态增强扫描显示的病变强化特征对于乳腺肿块样病变的定性诊断具有显著意义。 关键词] 乳腺肿块 增强磁共振 结构特征 组织病理学

The relationship between the architectural features on the histopathology and the findings of enhancement model on MRI from breast masses

Abstract] Subject: To determine the relationship between the architectural features on the histopathology and the findings of enhancement model on MRI from breast masses. Methods: In all patients, precontrast and dynamic enhanced MRI were performed. The histopathological diagnosis was double blindly made by two pathologists. The of the breast lesions and the correlations with histopathology. Result: Benign bumps manifest clear margins, light homogeneous enhancement ,nonenhancement .These can always appear with nonenhancing septation. All these signs connect with a great deal of fibrous tissues, as the hyperplasia flourishes, the enhancement is marked. Cystic lesions are always irregular rim enhancement. The abscess company with irregular septation that is according to the extensive damage of lobular structure in microscope. One scar had no enhancement. And, for invasive ductal cancer, first appears marginal enforcement, then central, and the enhancement is homogeneous, peripheral radioated spur-shaped, which is related to the phenomena that the body of cancer grows buddingly in microscope. One ductal carcinoma in situ had irregular enhancement with atypic hyperplasia of ductal epithelium. Conclusion: The speculated and lobulared irregular enhancement suggest the lesion is malignant; And the smooth margin, with regular homogeneous enhancement ,nonenhancing lesions and nonenhancing internal septation suggest the benign lesion. It's difficult to differentiate the hyperplasia and the malignant masses with atypic pattern of enhancement .We need to enlarge our sample. There are obvious value to diagnose the breast masses with the contrast-enhanced MRI.