病理性乳头溢液的MRI评估

目的利用BI—RADSMRI探讨MR检查对病理性乳头溢液的诊断价值。方法应用乳腺专用磁共振AURORA—MR检查61例病理性乳头溢液患者，根据BI—RADS-MRl分析其影像征象包括形态学特征、强化曲线及分类评估并与术后病理诊断对照。结果61例病理性乳头溢液MR检查发现62个病灶，术后恶性病灶16个，包括导管原位癌（DCIS）及导管原位癌伴微浸润（DCIS．MI）12个，DCIS伴黏液腺癌1个及浸润性导管癌（IDC）3个，术前均为BI—RADS4—5级评估，恶性检出率100％；良性病变共46个，包括导管内乳头状瘤（IP）伴不典型增生（ADH）15个，IP10个，多发IP7个，导管上皮乳头瘤样增生12个及纤维囊性乳腺病2个，术前MR评估BI-R．ADS1～3级31个，BI．RADS4—5级15个，良性诊断符合率为67．4％，MRt高估的病变包括交界性质病变IP伴ADH8个，多发IP4个，IP2个和导管上皮乳头瘤样增生1个。增强图像的形态学特征仅段样强化对鉴别良恶性有意义，阳性预测值达73．3％，其易出现在恶性病变中（68．8％掰．8．7％，P〈0．05）；内部强化特征以成群结节样强化对提示恶性有意义（56．3％vs．10．9％，P〈0．05），其阳性预测值为64．3％；内部点状强化更易出现在良性病变中（6．3％螂．37．0％，P〈0．05）。恶性病灶的时间一信号曲线常见为流出型，其在良恶性病灶中的分布具有统计学差异（56．3％vs．17．4％，P〈0．05），阳性预测值为52．4％。结论恶性乳头溢液在MRI上表现具有一定的特点，MR检查为诊断病理性乳头溢液提供了非常有用的信息，有助于提高诊断准确率。

Evaluation of pathologic nipple discharge by magnetic resonance imaging

Objective To explore the diagnostic value of BI-RADS MRI by MR examination in pathologic nipple discharge. Methods Magnetic resonance for breast only （AURORA-MR）was used to detect 61 patients of pathologic nipple discharge, based on BI-RADS-MRI imaging features, including morphological characteristics, strengthening curve, classification evaluation, compared to pathologic diagnosis. Results 62 nidus were found in 61 cases of pathologic nipple discharge by MR detection, 16 malignant nidus （including 12 nidus of DCIS and DCIS-MI, 1 focus of carcinoma muciparum with DCIS and 3 nidus of IDC） were diagnosed after operation, which were diagnosed of BI-RADS grade 4-5 before operation, Malignant detection rate was 100% ;Benign lesion were 46 nidus including 15 nidus of IP with ADH, 10 nidus of IP,7 nidus of pilosity IP, 12 nidus of ductal epithelium papillomatous hyperplasia and 2 nidus of fibroadenosis, 31 nidus were diagnosed as BI-RADS grade 1-3 and 15 nidus as grade 4-5, benign coincidence rate was 67.4%. The lesions which were over estimated were composed of 8 nidus of IP with ADH,4 nidus of pilosity IP, 2 nidus of IP and 1 focus of ductal epithelium papillomatous hyperplasia. The differential diagnosis of benign and malignant in morphological characteristics of enhanced image was only segmental enhancement,positive predictive value was 73.3% ,it was easy to be found in malignant lesions（68. 8% vs. 8.7%, P 〈 0. 05 ）. Hordes of nodular reinforcement was suggestive of malignant meaning in internal reinforcement characteristics（56. 3% vs. 10. 9%, P 〈 0. 05 ）, positive predictive value was 64. 3% ;Strengthen the internal point was easy to be found in benign lesions（6. 3% vs. 37. 0% ,P 〈0. 05）. Time-signal curves of malignant lesions were usually effiux type,its distribution in malignant and benign lesions was of significant difference（56. 3% vs. 10. 9%,P 〈 0. 05 ）, positive predictive value was 52. 4%. Conclusion Malignant nipple discharge have certain characteristics on MRI, magnetic resonance imaging helps provide useful information in patients with suspicious nipple discharge and increases the diagnostic sensitivity.