Value of diffusion weighted magnetic resonance imaging combined with three- dimensional digital tomography in differential diagnosis of benign and malignant calcified lesions of breast
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摘要:
目的 评估磁共振弥散加权成像（DWI）结合三维乳腺数字化断层摄影（DBT）钙化分数对于钙化征象在乳腺良恶性病变诊断的应用价值。 方法 回顾性分析我院118例行乳腺DWI检查和DBT检查的患者，DBT检查发现有钙化征象，其中乳腺癌患者51例，病理类型包括：浸润性导管癌、浸润性导管癌、导管原位癌、髓样癌、浸润性小叶癌、黏液腺癌；乳腺良性病变67例，病理类型包括：纤维腺瘤、腺病、导管内乳头状瘤。对所有患者DBT图像的钙化征象进行钙化评分并且测量相应病变区域的表观扩散系数（ADC）值，分析ADC值、钙化分数及二者联合在乳腺含钙化病变的诊断效能。 结果 乳腺癌组ADC值低于乳腺良性病变组，差异有统计学意义（P < 0.05）；钙化分数高于良性病变组，差异有统计学意义（P < 0.05）。ADC值对诊断乳腺良恶性病变的曲线下面积（AUC）为0.853，钙化分数对诊断乳腺良恶性病变的AUC值为0.855，采用Delong检验得出两种方法对诊断乳腺含钙化病变的良恶性诊断效能一致，差异无统计学意义（P=0.625）。两种方法（钙化分数+ADC值）的Logistic回归分析显示，两种方法相结合的AUC值为0.903，具有很高的诊断效能。将ROC曲线（钙化分数、ADC值、两种方法结合的预测概率）经两两Delong检验结果显示，两种方法结合的ROC与单一ROC的差异有统计学意义（P=0.041、0.022）。 结论 DWI与DBT钙化分数对于钙化征象在乳腺良恶性病变的鉴别诊断效能无差别，两种方法相结合的诊断效能显著高于单一方法，为乳腺含钙化病灶的诊断与鉴别诊断中提供了更加可靠的依据。 -
关键词:
- 乳腺癌 /
- 弥散加权成像 /
- 三维断层乳腺摄影技术 /
- 表观扩散系数 /
- 钙化
Abstract:Objective To evaluate the value of diffusion- weighted magnetic resonance imaging (DWI) combined with three- dimensional digital mammography (DBT) in the diagnosis of benign and malignant breast lesions. Methods A total of 118 cases of breast DWI and DBT in our hospital were retrospectively analyzed. The signs of calcification were found by DBT. There were 51 cases with breast cancer. The pathological types included invasive ductal carcinoma, invasive ductal carcinoma, ductal carcinoma in situ, medullary carcinoma, invasive lobular carcinoma, mucinous adenocarcinoma. Benign breast lesions were found in 67 cases, including fibroadenoma, adenosis and intraductal papilloma. All patients were scored for calcification on DBT images, and the apparent diffusion coefficient (ADC) value of the corresponding lesion area was measured. The diagnostic efficacy of ADC value, calcification score and their combination in breast calcified lesions was analyzed. Results ADC value of breast cancer group was lower than benign breast lesions group (P < 0.05). Calcification score of breast cancer group was higher than benign lesion group (P < 0.05). The area under the curve (AUC) of ADC value for the diagnosis of benign and malignant breast lesions was 0.853, and the AUC of calcification score for the diagnosis of benign and malignant breast lesions was 0.855. Delong test showed that the two methods had the same diagnostic efficiency for benign and malignant breast lesions with calcification, and the difference was not significant (P=0.625). Logistic regression analysis of the two methods (calcification score+ADC value) showed that the AUC value of the combination of the two methods was 0.903, which had high diagnostic efficiency. Calcification score, ADC value and the combination of the two methods was used to carry out Delong test. The results showed that the difference of receiver operating characteristic curve (ROC) combined with ROC and ADC ROC of the two methods were statistically significant (P=0.0409, 0.0216). Conclusion There is no difference in the differential diagnosis of calcification between diffusion- weighted imaging and three- dimensional digital mammography. The diagnostic efficiency of the combination of the two methods is significantly higher than that of a single method, which provides a more reliable basis for the diagnosis and differential diagnosis of breast lesions with calcification. -
图 1 乳腺癌MRI图像及DBT图像
A~B: 左侧乳腺外下象限乳腺癌（橙色箭头）; DWI表现为高信号, ADC表现为低信号; ADC值: 1.06×10-3 mm2/ s; C~D: 乳腺癌DBT钙化特征（蓝色箭头）; 钙化分数: 9.
Figure 1. breast cancer MRI and DBT images.
图 2 乳腺纤维瘤MRI图像及DBT图像
A~B: 左侧乳腺纤维瘤（绿色箭头）; DWI表现为高信号, ADC表现为稍高信号; ADC值: 1.57×10-3 mm2/ s; C~D: 乳腺腺瘤DBT钙化特征（黄色箭头）, 钙化分数: 4.
Figure 2. Breast fibroma of MRI and DBT images.
图 3 乳腺良恶性病变ADC、钙化分数各参数及双模式相结合ROC曲线图
A: 乳腺良恶性病变ADC值ROC曲线图, AUC=0.853; B: 乳腺良恶性病变DBT钙化分数ROC曲线图, AUC=0.855; C~D: 黄色: 钙化分数+ADC预测概率ROC曲线; 蓝色: 钙化分数ROC曲线; 橙色: ADC值ROC曲线; 其中, C: 乳腺良恶性病变双模式（DBT钙化分数和MRI-ADC）联合预测概率ROC曲线图, AUC=0.903; D: 对双模式（DBT钙化分数和MRI-ADC）联合预测概率ROC曲线、钙化分数ROC曲线、ADC值ROC曲线两两进行Delong检验.
Figure 3. ROC curve of ADC, calcification score and dual mode of benign and malignant breast lesions.
表 1 乳腺良恶性肿瘤钙化分数、ADC及两种方法相结合的AUC
Table 1. Calcification fraction, ADC and area under ROC curve of benign and malignant breast tumors combined with the two methods
分类 曲线下面积 敏感度（%） 特异性（%） 钙化分数 0.855 85.3 84.7 ADC 0.853 83.4 84.2 钙化分数+ADC 0.903 86.7 85.9 ADC: 表现扩散系数. 
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