DWI联合DCE-MRI在诊断鉴别乳腺非肿块样病变中的应用

目的研究弥散加权成像(DWI)联合动态增强扫描(DCE-MRI)在诊断鉴别乳腺非肿块样病变中的应用价值。方法收集我院2015年7月至2018年1月60例乳腺非肿块样病变患者的病历资料,均接受MRI检查,检查后行穿刺活检或手术病理检查。以病理组织结果为金标准,计算DCE-MRI、DWI、DWI联合DCE-MRI诊断乳腺非肿块样良、恶性病变的灵敏度、特异度、阳性预测值、阴性预测值、符合率。结果 60例乳腺非肿块样病变中,良性病变38例,恶性病变22例。以流出型为恶性病变的诊断标准,DCE-MRI的灵敏度、特异度、阳性预测值、阴性预测值、总符合率分别为36.4%、86.8%、61.5%、70.2%、68.3%。以ADC值≤1.205×10-3mm2/s为恶性病变诊断标准,DWI的灵敏度、特异度、阳性预测值、阴性预测值、总符合率分别为72.7%、81.6%、69.6%、83.8%、78.3%。DWI联合DCE-MRI的灵敏度、特异度、阳性预测值、阴性预测值、总符合率分别为95.5%、79.0%、72.4%、96.8%、85.0%。DCE-MRI+DWI的灵敏度、阴性预测值、总符合率显著高于DCE-MRI(P<0.05)。结论 DCE-MRI与DWI在乳腺非肿块样病变的良恶性鉴别中均具有一定作用,二者联合可以提高恶性病变的诊断率。

Application of DWI Combined with DCE-MRI in the Differential Diagnosis of Non-mass Breast Lesions

Objective To explore the value of diffusion weighted imaging(DWI) combined with dynamic contrast-enhanced scanning(DCE-MRI) in the differential diagnosis of non-mass breast lesions. Methods The medical data of 60 patients with non-mass breast lesions who were admitted to the hospital from July 2015 to January 2018 were collected. All patients underwent MRI examination, and needle biopsy or surgical histopathological examination was performed after MRI examination. With the histopathological results as the golden standard, the sensitivity, specificity, positive predictive value, negative predictive value and total coincidence rate of DCE-MRI, DWI and DWI combined with DCE-MRI in the diagnosis of benign and malignant non-mass breast lesions were calculated. Results There were 38 cases of benign lesions and 22 cases of malignant lesions in the 60 patients with non-mass breast lesions confirmed by pathology. With efflux type as the diagnostic criteria of malignant lesions, the sensitivity, specificity, positive predictive value, negative predictive value and total coincidence rate of DCE-MRI were 36.4%, 86.8%, 61.5%, 70.2% and 68.3%, respectively. With ADC value ≤1.205×10-3 mm2/s as the diagnostic criteria for malignant lesions, the sensitivity, specificity, positive predictive value, negative predictive value and total coincidence rate of DWI were 72.7%, 81.6%, 69.6%, 83.8% and 78.3%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and total coincidence rate of DWI combined with DCEMRI were 95.5%, 79.0%, 72.4%, 96.8% and 85.0%, respectively. The sensitivity, negative predictive value and total coincidence rate of DCE-MRI+DWI were significantly higher than those of DCE-MRI(P<0.05). Conclusion Both DCE-MRI and DWI are of certain value in the differential diagnosis of benign and malignant non-mass breast lesions, and the combination of the two methods helps to improve the accuracy in predicting malignant lesions.