MRI在临床触诊阳性的乳腺X线非对称性致密影病变诊断中的价值

Value of MRI in diagnosis of the cases with positive results of clinical palpation and non-symmetrical dense shadow displayed by mammography

目的:探讨MRI在临床触诊阳性的乳腺X线非对称性致密影病变中良、恶性疾病的诊断价值。方法;收集2009年3月～2012年3月临床触诊阳性的乳腺X线非对称性致密影病变80例,病变不伴肿块、钙化及结构扭曲,于术后分别与病理对照,观察病灶形态、分布、动态增强、时间-曲线及周围影像改变等显示情况,并统计诊断准确率。所有患者在手术前2周内均进行乳腺X线及MRI检查。结果:肿块型强化22例,非肿块型强化58例;病灶强化均匀14例,强化不均匀66例;其内伴多发脓肿,壁呈均匀或非均匀环形强化34例;患侧乳内异常血管增粗并较对侧丰富28例,皮肤局部或广泛性增厚32例,皮下水肿27例,腋下淋巴结实性增大15例;时间-曲线Ⅰ型36例,Ⅱ型22例,Ⅲ型22例。乳腺良性病变48例,其中乳腺增生症8例,硬化性腺病2例;乳腺炎症37例(慢性炎症23例,肉芽肿性乳腺炎8例,浆细胞性乳腺炎2例,囊肿伴感染4例),纤维腺瘤1例;乳腺癌32例,其中乳腺导管癌23例,乳腺小叶癌5例,乳腺血管肉瘤2例,乳腺导管癌合并乳腺小叶癌2例。结论:对临床触诊阳性的乳腺X线非对称性致密影病变中,乳腺MRI在发现病变及良、恶性疾病定性诊断具有重要价值,特别是乳腺癌的早期诊断。

Objective：To explore the value of MRI in diagnosis of benign and malignant breast diseases among the cases with positive results of clinical palpation and non-symmetrical dense shadow displayed by mammography. Methods：Eighty cases with positive results of clinical palpation and non-symmetrical dense shadow displayed by mammography were collected from the hospital from March 2009 to March 2012,without mass,calcification and structural distortion,the results were compared with pathological diagnosis after surgery,the shape,distribution,dynamic contrast,time curve,and surrounding imaging changes of the lesions were observed,the accurate rate of diagnosis was analyzed statistically.All the patients underwent mammography and MRI at two weeks before surgery. Results：Twenty-two cases were found with mass-type enhancement,and fifty-eight cases were found with non-mass-type enhancement;14 cases were found with symmetrical enhancement,and 66 cases were found with asymmetrical enhancement;34 cases were found with multiple abscess and symmetrical or asymmetrical circular enhancement of mass wall;28 cases were found with abnormal dilated vessels with rich blood supply of diseased side compared with contralateral side,32 cases were found with focal and extensive thickening of skin,27 cases were found with subcutaneous edema;15 cases were found with solid enlargement of alar lymph nides;36 cases were found with type Ⅰ time curve,22 cases were found with type Ⅱ time curve,and 22 cases were found with type Ⅲ time curve.Forty-eight cases were found with benign breast lesions,including 8 cases with cyclomastopathy,2 cases with sclerosing adenosis,37 cases with breast inflammation（23 cases with chronic inflammation,8 cases with granulomatous mastitis,2 cases with plasma cell mastitis,and 4 cases with breast cysts combined with infection）,and one case with breast adenofibroma;32 cases were found with breast cancer,including 23 cases with breast duct carcinoma,5 cases with lobular carcinoma of breast,2 cases with breast angiosarcoma,and 2 cases with breast duct carcinoma combined with lobular carcinoma of breast. Conclusion：For the cases with positive results of clinical palpation and non-symmetrical dense shadow displayed by mammography,mammography has important value in finding breast lesions and differential diagnosis of benign and malignant diseases,especially for early diagnosis of breast cancer.