乳腺叶状肿瘤MRI诊断价值

目的：分析乳腺叶状肿瘤的MRI特征,提高对本病MRI诊断及良恶性的鉴别水平.资料与方法：回顾性分析9例经手术病理证实的乳腺叶状肿瘤的MRI表现,包括形态学、平扫信号、动态增强TIC形态、DWI信号及ADC值特点.结果：9例乳腺叶状肿瘤中良性6例、交界性1例、恶性2例.6例良性病灶5例表现为分叶状,1例表现为卵圆形,MRI平扫T1WI均呈低信号,T2WI示4例呈不均匀高信号,2例呈均匀高信号,TIC Ⅰ型4例、Ⅱ型1例、Ⅲ型1例;1例交界性病灶为分叶状,T1WI及T2WI呈混杂信号,TIC呈Ⅲ型;2例恶性病灶为分叶状,T1WI呈低信号,T2WI呈不均匀高信号,1例TIC呈Ⅱ型,1例呈Ⅲ型.9例乳腺叶状肿瘤于DWI上均为高信号,5例ADC值低于鉴别乳腺良恶性病变的ADC界值.结论：MRI检查有助于乳腺叶状肿瘤的诊断,当病灶较大,其内出现裂隙、囊变或分隔,曲线呈Ⅱ型或Ⅲ型,ADC值明显低于正常腺体时,应考虑到交界性或恶性可能,但确诊仍需依靠组织病理学检查.

The value of MRI in diagnosis of phyllode tumors of the breast

Objective： To analyze the MRI features of phyllode tumors of the breast（PTB）, and to improve the diagnosis and differential diagnosis of this disease by MRI. Materials and Methods： We retrospectively reviewed MRI features of 9 cases of PTB confirmed by pathology, including morphology, signal intensity, the type of TIC, signal on DWI and ADC value. Results： Six lesions were benign, 1 lesion was borderline, and 2 lesions were malignant. In the 6 benign lesions, 5 were lobulated and 1 was oval. All lesions were hypointensity on T1WI. Four lesions were inhomogeneous and 2 were homogeneous hyperintensity on T2WI. 4, 1, and 1 lesions showed TICs of type I, type Ⅱ and type Ⅲ, respectively. One borderline lesion was lobulated, and showed mixed signals on TIWI and T2WI, with TIC of type Ⅲ. Two malignant lesions were lobulated, and showed hypointensity on TIWI and inhomogeneous hyperintensity on T2WI, with TICs of type Ⅱ and type Ⅲ, respectively. All 9 tumors showed high signal on DWI, and ADC values of 5 cases were lower than the boundary value for differential diagnosis between benign and malignant breast lesions. Conclusion： MRI is helpful to the diagnosis of PTB. Large lesion with fissure, cystic degeneration or septation, TIC of type Ⅱ or Ⅲ and low ADC value should be considered as borderline or malignant lesion, but biopsy is still needed to confirm.