乳腺导管原位癌的MRI表现及其与组织学核级别的相关性分析

目的探讨乳腺导管原位癌(DCIS)的MRI形态学及动态增强特点,进一步分析MRI表现与组织学核级别间是否具有相关性。资料与方法回顾性分析30例经病理证实为DCIS患者的MRI表现,研究其MRI形态学特点、动态增强模式,并分析MRI特点与组织学核级别间的相关性。结果 (1)30例患者中,29例病灶出现强化,强化病灶直径3～57 mm(平均25.20 mm,中位数23 mm);1例未出现强化。(2)29例强化病灶中,非肿块样强化20例(段样强化12例,其内部均表现为成簇小囊状或轨道样强化;导管样强化3例;线样强化2例;区域样强化1例;多中心性强化2例),肿块6例,小点状强化(直径<5 mm)3例。(3)动态增强模式:曲线类型包括Ⅰ型曲线8例(包含未强化灶)、Ⅱ型曲线15例、Ⅲ型曲线7例;早期强化率包括早期缓慢强化8例(包含未强化灶),早期中度强化7例,早期快速强化15例。(4)动态增强曲线类型、早期强化率及病灶大小与组织学核级别间显著相关,P值分别为0.031、0.017、0.02;形态学表现与组织学核级别间无相关性(P=0.324)。结论乳腺DCIS的MRI形态学表现具有相对特异性,结合动态增强模式,可全面评价DCIS组织学核级别程度,对临床及患者预后具有较重要的指导意义。

MRI Features of Ductal Carcinoma in Situ with Different Nuclear Grade

Objective To discuss the MR dynamic enhanced and morphologic characteristics of ductal carcinoma in situ(DCIS) and its relations with nuclear grade.Materials and Methods The MR features of 30 cases with histologically proved DCIS were retrospectively reviewed.Results(1)Of the 30 DCIS lesions,29 were enhanced with diameters between 3 mm and 57 mm(mean value: 25.20 mm;media value: 23 mm).(2)20 lesions had non mass-like enhancement,6 showed masses and 3 showed foci.Among the non mass-like lesions,12 lesions were segmental distribution,3 were ductal distribution,1 was regional distribution,and 2 were multiple distribution.(3)Of the 30 lesions,15(25%) exhibited enhancement plateau curves and 7(23%) exhibited washout curves.7(23%) lesions exhibited moderate enhancement and 15(50%) exhibited fast enhancement.(4)There was significant relations between enhancement curves(P=0.017),early enhancement ratio(P=0.017),size(P=0.02)and the nuclear grades.Conclusion Breast DCIS have some MRI features,MR features combined with dynamic enhanced curves can be used to evaluate nuclear grade of DCIS.