MR重T2W首次通过灌注成像鉴别乳腺良恶性肿瘤的价值初探

目的　评价在同 1次检查中T1W动态增强成像之后进行重T2 W (T 2 W )首次通过灌注成像的可行性 ,以及后者在鉴别乳腺良恶性肿瘤方面的诊断价值。方法　 2 9例乳腺病患者在T1W动态增强后进一步行病灶局部的T 2 W首次通过灌注成像 ,分别根据病灶T1W动态增强的早期强化程度和T 2 W首次通过灌注成像的早期信号丢失程度判定病灶的良恶性 ,计算其敏感度、特异度 ,以进行两方法间的比较。结果　应用T1W动态增强成像序列 ,良、恶性病变的信号强度增加率之间差异有显著性意义 (t=2 5 6 3,P =0 0 16 ) ,但两者的早期增强程度范围有很大的重叠 ;早期增强率诊断的敏感度为 94 % ,特异度仅为 2 5 %。应用T 2 W首次通过灌注成像序列 ,良、恶性病变之间的T2 信号强度丢失程度差异有非常显著性意义 (t=4 777,P <0 0 0 1) ,良、恶性病变的早期信号丢失率之间重叠很少 ;早期信号丢失率诊断的敏感度为 88% ,特异度为 75 %。结论　T 2 W首次通过灌注成像在鉴别良恶性乳腺肿瘤方面具有较高特异度 ;在同一患者中 ,T 2 W首次通过灌注成像结合T1W动态增强成像检查是可行的 ,可以提高乳腺MR成像的诊断准确性。

A prospective evaluation with T*2W first-pass perfusion MRI in diagnosing breast neoplasm

Objective To undergo T 2 *-weighted first-pass perfusion imaging after dynamic contrast-enhanced T 1-weighted imaging at the same examination in patients with breast neoplasm, and to evaluate if T 2 *-weighted imaging can provide additional diagnostic information to that obtained with T 1-weighted imaging. Methods Twenty-nine patients with breast lesions verified by pathology(benign 12, malignant 17)underwent MR imaging with dynamic contrast-enhanced T 1-weighted imaging of the entire breasts, then followed immediately with six-sections, T 2 *-weighted first-pass perfusion imaging of the lesions.The diagnostic indices were got by the 3 D T 1-weighted enhancement rate criterion and T 2 * signal intensity loss rate criterion individually.The sensitivity and specificity were calculated and the two methods were compared.Results With the dynamic contrast-enhanced T 1-weighted imaging, there was a significant differences between the benign and malignant breast lesions (t=2.563,P=0.016), but a considerable overlap of the signal intensity increase between the carcinomas and benign lesions was found, with a sensitivity of 94% and a specificity of 25%.With T 2 *-weighted first-pass perfusion imaging, there was a very significant differences between the benign and malignant breast lesions (t=4.777,P<0.001), and the overlap of the signal intensity decrease between the carcinomas and benign lesions on T 2 *-weighted images was less pronounced than the overlap on T 1-weighted images, with a sensitivity of 88% and a specificity of 75%.Conclusion T 2 *-weighted first-pass perfusion imaging may help differentiate between benign and malignant breast lesions with a higher specificity.The combination of T 1-weighted and T 2 *-weighted imaging is feasible in a single patient examination and may improve the accuracy of breast MR imaging.