Diagnostic value of dynamic contrast enhancement MRI combined with diffusion weighted imaging sequence for benign and malignant breast nodules
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摘要:
目的 探讨磁共振动态增强（DCE-MRI）联合弥散加权成像（DWI）序列对乳腺小结节良、恶性质的诊断价值。 方法 收集本院收治的123例乳腺小结节患者资料，其中良性肿瘤46例，纳入良性组；恶性肿瘤77例，纳入恶性组。分析其MRI扫描特征；比较乳腺小结节形态、MRI参数，分析DWI、DCE-MRI诊断价值。 结果 良性组边缘多光滑，形状规则，内部强化以均匀为主，时间-信号强度曲线分型Ⅰ型多见，早期增强率 < 60%；而恶性组则相反（P < 0.05）。与恶性组比较，良性组表观弥散系数值更高，Slope及SlopeR值更低（P < 0.05）；两组最大信号强度值、强化峰值的差异无统计学意义（P > 0.05）。DWI鉴别诊断良、恶性乳腺小结节的敏感度、特异性及准确度分别为62.34%、65.22%、63.41%，DCE-MRI分别为71.43%、80.43%、74.80%，两者单独检查均明显低于DWI+DCE-MRI的87.01%、91.30%、88.62%（P < 0.05）。 结论 DCE-MRI联合DWI可提高良、恶性乳腺小结节的诊断敏感度、特异性及准确度，更有助于病变性质的判断。 Abstract:Objective To investigate the diagnostic value of dynamic contrast enhancement MRI (DCE-MRI) with diffusion weighted imaging (DWI) sequence for benign and malignant breast nodules. Methods A total of 123 patients with small breast nodules admitted to our hospital were collected. Among 123 patients, there were 46 cases of benign tumor (benign group) and 77 cases of malignant tumor (malignant group). MRI scan characteristics were analyzed. The morphology and MRI parameters of small breast nodules were compared, and the diagnostic value of DWI and DCE-MRI were analyzed. Results In the benign group, the edges were smooth, the shape was regular, and the internal enhancement was mainly uniform, the TIC type Ⅰ was common, and the early enhancement rate was less than 60%. The malignant group was the opposite (P < 0.05). Compared with the malignant group, the benign group had higher ADC value, lower Slope and SlopeR values (P < 0.05). The differences in maximum signal intensity and peak height between the two groups were not significant (P > 0.05). The sensitivity, specificity and accuracy of DWI for differential diagnosis of benign and malignant breast nodules were 62.34%, 65.22% and 63.41%, respectively. The DCE-MRI were 71.43%, 80.43% and 74.80%, respectively, which were significantly lower than 87.01%, 91.30% and 88.62% of DWI+DCE-MRI. Conclusion DCE-MRI combined with DWI can improve the diagnostic sensitivity, specificity and accuracy of benign and malignant breast nodules. -
图 1 乳腺浸润性导管癌MRI图像
A: MRI扫描T1W1图像; B: T2WI图像; C~D: DWI图像; E~F: DCE-MRI增强扫描图像; G: TIC曲线图.
Figure 1. MRI image of invasive ductal carcinoma of breast
表 1 病理结果
Table 1. Pathological results
疾病性质 例数（n） 占比（%） 良性（n=46） 乳腺腺瘤 19 41.30 导管内乳头状瘤 6 13.04 乳腺增生 21 45.65 恶性（n=77） 浸润性导管癌 53 68.83 导管原位癌 19 24.68 浸润性小叶癌 5 6.49 
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表 2 良、恶性乳腺小结节MRI表现
Table 2. MRI findings of benign and malignant breast nodules [n(%)]
MRI表现 良性组（n=46） 恶性组（n=77） χ2 P 边缘 52.520 < 0.001 光滑 43（93.48） 20（25.97） 毛刺征 3（6.52） 57（74.03） 形状 10.529 0.001 规则 30（65.22） 27（35.06） 不规则 16（34.78） 50（64.94） 内部强化 21.962 < 0.001 均匀 20（43.48） 7（9.09） 不均匀 16（34.78） 47（61.04） 环形强化 8（17.39） 22（28.57） 内部暗分隔 2（4.35） 1（1.30） TIC分型 73.736 < 0.001 Ⅰ型 34（73.91） 5（6.49） Ⅱ型 10（21.74） 11（14.29） Ⅲ型 2（4.35） 61（79.22） 早期增强率 44.130 < 0.001 ≥60% 12（26.09） 66（85.71） < 60% 34（73.91） 11（14.29）
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表 3 良、恶性乳腺小结节MRI参数比较
Table 3. Comparison of MRI parameters of benign and malignant breast nodules (Mean±SD)
组别 ADC（×10-3mm2/s） SImax PH Slope SlopeR 良性组（n=46） 1.71±0.16 361.34±91.69 132.36±20.71 30.51±8.75 2.47±0.21 恶性组（n=77） 1.05±0.04 355.96±78.69 129.64±17.05 63.79±17.65 10.63±2.52 t 34.522 0.345 0.789 11.929 21.880 P < 0.001 0.731 0.432 < 0.001 < 0.001 ADC: 表观弥散系数; SImax: 最大信号强度值; PH: 强化峰值; Slope: 最大线性斜率; SlopeR: 最大线性斜率比值.
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表 4 DWI、DCE-MRI鉴别诊断良、恶性乳腺小结节的价值
Table 4. Values of DWI and DCE-MRI in differential diagnosis of benign and malignant breast nodules
检查 病理诊断（n） 敏感度（%） 特异性（%） 准确度（%） 良性 恶性 DWI 30 48 62.34 65.22 63.41 DCE-MRI 37 55 71.43 80.43 74.80 DWI+DCE-MRI 42 67 87.01 91.30 88.62 DWI: 弥散加权成像; DCE-MRI: 磁共振动态增强.
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