Diffusion weighted magnetic resonance imaging combined with dynamic enhancement technique in identification of benign and malignant breast lesions
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摘要:
目的 评估磁共振弥散加权成像（MR-DWI）、动态增强成像（DCE-MRI）联合鉴别乳腺良恶性肿块的价值。 方法 回顾性分析2012年1月~2015年12月期间经病理证实的女性乳腺肿块患者70名。所有患者均行MR-DWI及DCE-MRI，诊断结果与病理进行对照。 结果 70例患者共77例病灶。25例恶性肿块，动态增强Ⅰ型曲线3例（12%），Ⅱ型曲线7例（28%），Ⅲ型曲线15例（60%）；52例良性肿块，动态增强Ⅰ型曲线35例（67%），Ⅱ型曲线11例（21%），Ⅲ型曲线6例（12%）。良恶性肿块的Ⅰ型及Ⅲ型曲线的差异均有统计学意义（P<0.05）。良恶性肿块的表观弥散系数（ADC）差异亦有统计学意义（P=0.000）。ROC曲线分析，动态增强曲线的敏感性和特异性分别为85%和60%，曲线下面积（AUC）为0.723；ADC值诊断乳腺良恶性肿块的敏感性和特异性分别为88%和78%，AUC为0.830；联合ADC值、动态增强曲线敏感性和特异性分别为90%和98%，AUC为0.943。 结论 DWI的ADC值较DCE-MRI具有更高的敏感性；联合应用DWI、DCE-MR可提高鉴别乳腺肿块良恶性的敏感性和特异性。 Abstract:Objective To assess the value of diffusion weighted magnetic resonance imaging combined with dynamic enhancement technique in identification of benign and malignant breast lesions. Methods Seventy patients with breast lumps confirmed by pathology were retrospectively analyzed.The patients were underwent with DW imaging examination and dynamic contrast-enhanced imaging. The diagnosis result were compared with pathologic results. Results The 70 patients had 77 lesions. DCE-MRI had 3(12%) typeⅠcurving patterns, 7(28%) typeⅡ curving patterns and 15(60.0%) type Ⅲ curving patterns in the malignant group.In benign group, there were 35(67%) typeⅠcurving patterns, 11(21%) type Ⅱ curving patterns and 6(12%) type Ⅲ curving patterns. Curving pattern of TypeⅠand type Ⅲ were significantly different (P<0.05). The difference of ADC values between benign and malignant tumor was significant (P=0.000). The curve of ROC analysis showed DCE-MRI with 85.0% sensitivity, 60% specificity and 0.723 AUC. The sensitivity, specificity, AUC of ADC were 88%, 78% and 0.83, respectively. The combination of two technique had sensitivity of 90%, specificity of 98% and AUC of 0.943. Conclusion Compared to DCE-MRI, ADC have a high accuracy in diagnosis of benign and malignant breast tumor. The application of DWI and DEC-MRI can improve the accuracy of diagnosis of breast tumor. -
表 1 良恶性肿块动态增强TIC类型（n，%）
病理类型 n Ⅰ型（流入型） Ⅱ型（平台型） Ⅲ型（流出型） 恶性肿块 25 3（12） 7（28） 15（60） 良性肿块 52 35（67） 11（21） 6（12） P <0.05 >0.05 <0.05 χ2 21.1 0.19 18.9 
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表 2 ADC、DEC-MRI及两者联合诊断的分析指标
检查方法 曲线下面积 敏感性（%） 特异性（%） ADC 0.830* 88 78 DEC-MRI 0.723* 85 60 两者联合 0.943 90 98 *P<0.05vs两者联合; ADC: 表观扩散系数; DEC-MRI: 动态增强成像.
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