MRI鉴别诊断乳腺叶状肿瘤与纤维腺瘤价值

目的 探讨MRI鉴别诊断乳腺叶状肿瘤与纤维腺瘤的价值。方法 回顾性分析2012年1月~2015年12月在笔者医院经术后病理确诊的乳腺叶状肿瘤患者25例（28个病灶）和乳腺纤维腺瘤患者65例（74个病灶）。术前均进行了MRI和乳腺超声检查。比较乳腺叶状肿瘤和纤维腺瘤患者MRI表现的差异；比较MRI和超声诊断乳腺叶状肿瘤和纤维腺瘤的准确率的差异。结果 乳腺叶状肿瘤患者MRI表现病灶形状主要为分叶状、多结节融合状、圆形或类圆形，且大部分边界清楚（96.43%），多数出现T₂WI高信号（89.29%）和不均匀强化（71.43%），有非增强低信号分隔13个（46.43%），有囊性病变11个（39.29%）；乳腺纤维腺瘤患者MRI表现病灶形状主要为圆形或类圆形56个（75.68%），且边界均清楚74个（100%），全部出现T₁WI高信号74个（100%），多数出现T₂WI高信号48个（64.86%）和不均匀强化47个（63.51%），有非增强低信号分隔14个（18.92%），均无囊性病变74个（100%）；乳腺叶状肿瘤和纤维腺瘤患者MRI表现在病灶形状、T₁WI和T₂WI信号、非增强低信号分隔和囊性病变的差异具有统计学意义（P<0.05）；MRI的诊断准确率（97例，95.09%）高于超声检查（83例，81.37%），且差异具有统计学意义（P<0.05）。结论 MRI对乳腺叶状肿瘤与纤维腺瘤鉴别诊断具有明确的价值；两者的病灶形状、信号、增强方式等差异显著，MRI的诊断准确性优于超声检查。

Value of MRI for Differential Diagnosised of Breast Phyllodes Tumor and Breast Fibroadenoma

Objective To evaluate the value of MRI for differential diagnosis of breast phyllodes tumor and breast fibroadenoma. Methods Retrospective analysis of 25 cases (28 lesions) of breast phyllodes tumor and 65 cases (74 lesions) of breast fibroadenoma diagnosis by postoperative pathological in our hospital from January 2012 to December 2015. All patients underwent MRI and ultrasonography before operation.The difference of MRI performance in patients with breast fibroadenoma and phyllodes tumor was compared.The difference of diagnosis accuracy rate between MRI and the ultrasound for breast phyllodes tumor and breast fibroadenoma was compared. Results The MRI shape of patients with phyllodes tumor lesions mainly was phyllodes, multinodular fusion shaped, round or oval,and most of the boundaries were clear (96.43%), most T2WI high signal (89.29%) and uneven enhancement (71.43%), 13 lesions (46.43%) with non-enhanced low signal separation, 11 lesions(39.29%) with cystic lesions. MRI shape of patients with fibroadenoma of breast mainly was round or oval (56 lesions,75.68%), and the boundaries were clear (74 lesions,100%), all T₁WI high signal (74 lesions,100%), most T2WI high signal (48 lesions,64.84%) and uneven enhancement (47 lesions,63.51%), 14 lesions (18.92%) with non-enhanced low signal separation, and all no cystic lesions (74 lesions,100%).There was statistical significance differences of lesion shape, T₁WI and T₂WI signal, non-enhanced low signal separated and sac lesions and tic curve type between the patients with breast phyllodes tumor and breast fibroadenoma(P<0.05). The diagnostic accuracy of MRI (97 cases, 95.09%) was higher than that of ultrasonography (83 cases, 81.37%), and the difference was statistically significant (P<0.05). Conclusion MRI has a definite value for the differential diagnosis of breast phyllodes tumor and breast fibroadenoma. There were significant differences of lesion shape, signal and enhancement between them. The diagnostic accuracy of MRI was better than that of ultrasonic examination.