MRI弥散加权成像诊断乳腺导管内增生性病变的研究

Application of Diffusion Weighted Imaging in the Diagnosis of the Intraductal Hyperplasia Lesions of Breast

目的探讨MR弥散加权成像(Diffusion Weighted Imaging,DWI)在乳腺导管内增生性病变中的诊断价值。方法经病理证实的27例共38个乳腺病灶作为研究对象,所有患者均行DWI,取2个扩散敏感因子(b)值(500 s/mm2、1000 s/mm2)行横断面扫描,测量病灶的表观扩散系数(Apparent Diffusion Coefficient,ADC)值。结果①导管原位癌[(1.483±0.257)×10-3mm2/s、(1.296±0.239)×10-3mm2/s]与终末导管-小叶上皮增生组[(1.718±0.190)×10-3 mm2/s、(1.462±0.159)×10-3 mm2/s]、正常组织间[(2.347±0.339)×10-3mm2/s、(1.902±0.164)×10-3mm2/s]2种b值(b=500、1000)条件下ADC值差异均有统计学意义(P<0.05);不典型增生组[(1.577±0.276)×10-3 mm2/s、(1.308±0.223)×10-3 mm2/s]与终末导管-小叶上皮增生、正常组织组之间2种b值条件下ADC值差异均有统计学意义(P<0.05);终末导管-小叶上皮增生与正常组织组间2种b值条件下ADC值差异均有统计学意义(P<0.05);②乳腺导管内增生性病变中34.21%病灶在DWI图像上表现出异常高信号或稍高信号。结论①MR弥散加权成像中b值越高,ADC值越低;ADC值越小,病灶越趋于恶性;②乳腺导管内增生性病变中在DWI图像上表现出异常高信号或稍高信号比率较低,认为仅依靠DWI对乳腺导管内增生性病变的诊断确立较困难。

Objective To investigate the application value of diffusion weighted imaging of MRI in the diagnosis of the intraductal hyperplasia Lesions of Breast.Methods 27 patients with 38 lesions proved by histological results were included.All cases underwent the diffusion weighted imaging.Two different b values(500,1000s/mm2) and the ADC values of lesions were measured.Results With b values of 500 s/mm2 and 1000 s/mm2,the average ADC values of DCTS :(1.483±0.257)×10-3 mm2/s,(1.296±0.239)×10-3 mm2/s,ADH:(1.577±0.276)×10-3 mm2/s,(1.308±0.223)×10-3 mm2/s,TDLU hyperplasia:(1.718±0.190)×10-3 mm2/s和(1.462±0.159)×10-3 mm2/s,normal breast tissue:(2.347±0.339)×10-3 mm2/s、(1.902±0.164)×10-3 mm2/s.DCIS and TDLU hyperplasia in two different b values(500,1000 s/mm2) had significantly statistical difference(P<0.05).DCIS and normal breast tissue in two different b values(500,1000 s/mm2) was statistical difference(P<0.05).ADH and TDLU hyperplasia in two different b values(500,1000 s/mm2) had significantly statistical difference(P<0.05).ADH and normal breast tissue in two different b values(500,1000 s/mm2) showed significantly statistical difference(P<0.05).TDLU hyperplasia and normal breast tissue in two different b values(500,1000 s/mm2) had significantly statistical difference(P<0.05).About 34.21% lesions of the intraductal hyperplasia Lesions of Breast showed high signal or a little high signal in DWI.Conclusion In diffusion weighted imaging of MRI,the larger b value is,the smaller lesions' ADC value tend to;The smaller lesions' ADC value is,the more malignant lesions tend to;About 34.21% lesions of the intraductal hyperplasia Lesions of breast show high signal or a little high signal in DWI.Therefore,currently we suggest that if we only rely on DWI,it is difficult to diagnose the intraductal hyperplasia Lesions of Breast.