乳腺DCE-MRI与ADC值及ADC差值的临床应用价值

目的 探讨动态增强磁共振成像(DCE-MRI)、扩散加权成像(DWI)对鉴别乳腺良恶性病变的临床应用价值.方法 对临床拟诊乳腺病变的60例患者行MR检查,将病灶形态学、早期增强率、时间-信号曲线(TIC)、表观扩散系数(ADC)值、病灶周围组织与病灶ADC的差值诊断结果进行比较分析.结果 早期增强率、TIC、ADC值、ADC差值受试者工作特征(ROC)曲线的曲线下面积(AUC)分别为0.741、0.808、0.882、0.959,早期增强率、ADC值、ADC差值最佳诊断阈值分别为163％、1.30×10-3mm2/s、0.47×10-3 mm2/s.形态学、早期增强率、Ⅲ型曲线、Ⅱ型及Ⅲ型曲线、ADC值、ADC差值鉴别诊断乳腺良恶性病变的敏感性分别为53.1％、59.4％、43.8％、90.6％、93.8％、96.9％,特异性分别为85.7％、82.1％、89.3％、57.1％、75.0％、82.1％,阳性预测值分别为81.0％、79.2％、82.4％、70.7％、81.1％、86.1％,阴性预测值分别为61.5％、63.9％、58.1％、84.2％、91.3％、95.8％,准确率分别为68.3％、70.0％、65.0％、75.0％、85.0％、90.0％.结论 DCE MRI与DWl对乳腺良恶性病变的鉴别诊断有重要作用,其中ADC差值诊断效能最高,需多种方法综合诊断互补不足,以提高诊断准确性.

Clinical application value of breast dynamic contrast-enhanced MRI and the ADC value as well as ADC difference value

Objective To probe into the clinical application value of dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion weighted imaging (DWI) in identifying benign and malignant breast lesions.Methods 60 patients with clinically suspected breast lesions underwent MR examination.Morphologic features,early enhancement rate,time-signal intensity curve (TIC),apparent diffusion coefficient (ADC) value,as well as the differences between ADC values of the surrounding normal tissues and these of the lesions were compared and analyzed.Results The areas under the receiver operating characteristic curves (AUC) of the early enhancement rate,TIC,ADC value,ADC difference value were 0.741,0.808,0.882 and 0.959,respectively;the best diagnostic thresholds for the early enhancement rate,ADC value,and ADC difference value were 163％,1.30× 10-3 mm2/s and 0.47× 10-3 mm-2/s,respectively.The sensitivity of morphologic features,early enhancement rate,type Ⅲ curve,type Ⅱ and type Ⅲ curve,ADC value and ADC difference value in differentiating benign and malignant breast lesions was 53.1％,59.4％,43.8％,90.6％,93.8％ and 96.9％,respectively;the specificity was 85.7％,82.1％,89.3％,57.1％,75.0％ and 82.1％,respectively;the positive predictive values were 81.0％,79.2％,82.4％,70.7％,81.1％ and 86.1％,respectively;the negative predictive values were 61.5％,63.9％,58.1％,84.2％,91.3％ and 95.8％,respectively;and the accuracy was 68.3％,70.0％,65.0％,75.0％,85.0％,90.0％,respectively.Conclusion DCDMRI and DWI play important roles in differential diagnosis of benign and malignant breast lesions,among which ADC difference value is associated with the highest diagnostic capability.Combination of multiple imaging diagnostic methods is necessary to improve the diagnostic accuracy of breast lesions.