MRI 鉴别诊断慢性乳腺炎与乳腺癌的价值

目的：比较慢性乳腺炎与乳腺癌的 MRI 表现,探讨 MRI 鉴别诊断两者的价值。方法回顾性分析20例经穿刺活检或手术病理证实为慢性乳腺炎的 MRI 检查资料,同时期经病理证实的30例乳腺癌作为对照。评估两者的形态学征象与动态增强表现并作统计学分析。形态学征象包括：病灶形状、毛刺征、环形强化、病灶周围水肿、皮肤增厚、乳头受累、腋窝淋巴结肿大。动态增强表现(DCE)包括计算早期强化率,绘制时间-信号强度曲线(TIC)。结果乳腺炎与乳腺癌形状、环形强化、灶周水肿等征象存在统计学差异,毛刺征、皮肤增厚、乳头受累、腋窝淋巴结肿大等征象无统计学差异。乳腺炎早期强化率1.156±0.635,乳腺癌1.253±0.499,两者无统计学差异(t=0.604,P =0.548)。乳腺炎Ⅰ、Ⅱ、Ⅲ型 TIC 病例分别为11、6、3例,乳腺癌分别为4、11、15例。两者 TIC 有统计学差异(χ2=8.713,P =0.013)。结论乳腺炎常呈非肿块样外观,环形强化、灶周水肿、偏良性的 TIC 等 MRI 征象可作为与乳腺癌鉴别诊断的依据。

The value of MRI in the differential diagnosis between chronic mastitis and breast cancer

Objective To compare the appearances between chronic mastitis and breast cancer on MRI and investigate the differ-ential diagnostic value.Methods MRI data of 20 patients with chronic mastitis pathologically proved by biopsy or operation were ret-rospectively analyzed.30 cases of breast cancer were contemporaneously chosen as the control group.Morphological feature and dy-namic contrast-enhanced(DCE)manifestation of the lesions were evaluated and statistical difference was compared between mastitis and breast cancer.Morphological feature included configuration,spiculated sign,ring-like enhancement,peri-focal edema,skin thick-ening,nipple involvement and axillary lymph nodes enlargement.DCE manifestation contained calculating early enhancement ratio and drawing time-intensity curve (TIC).Results There were significant statistical differences among configuration,ring-like en-hancement and peri-focal edema between mastitis and breast cancer,respectively.No statistical differences could be found among spiculated sign,skin thickening,nipple involvement and axillary lymph nodes enlargement.Early enhancement ratio in the group of mastitis was 1.1 56±0.635 while 1.253±0.499 in the group of breast cancer and there was no statistical difference between them. There were 1 1 cases with type Ⅰ TIC,6 with type Ⅱ,3 with type Ⅲ in the lesions of mastitis,while 4 with type Ⅰ,1 1 with typeⅡ,1 5 with type Ⅲ in the lesions of breast cancer and significant statistical differences could be found between two groups.Conclu-sion Mastitis usually manifests as non-mass-like lesions on MRI.Ring-like enhancement,peri-focal edema and benign type TIC can be applied to discriminate mastitis from breast cancer.