多层螺旋CT在乳腺肿块诊断中的应用

The Application of Multi-slice Helical CT in the Diagnosis of Breast Masses

目的探讨多层螺旋CT对乳腺肿块性病变的显示及鉴别诊断价值。方法收集经手术病理证实的78例乳腺肿块性病变,其中浸润性导管癌57例,粘液癌4例,纤维腺瘤13例,导管内乳头状瘤4例。CT检查先平扫,而后分别于静脉注射对比剂后28、90s时进行二期增强扫描,并应用MIP、VRT对动脉期轴位图像进行重建。回顾分析所有病例中乳腺肿块本身、周围结构及淋巴结的CT表现。结果88%的浸润性导管癌及4例导管内乳头状瘤均在动脉期明显强化;4例粘液癌及92.31%的纤维腺瘤在动脉期无强化或轻度强化。恶性肿块中45.90%呈不规则形,54.10%呈边缘有分叶、毛刺的类圆形,55.74%呈不均匀强化,44.26%呈均匀强化;而良性肿块中94.12%呈类圆形,64.71%呈边缘光滑,76.47%呈均匀强化。在61例乳腺癌中,8例出现乳晕粘连,14例伴局部皮肤增厚、凹陷,5例伴胸壁浸润,24例CT术前检出腋窝淋巴结转移。结论多层螺旋CT对乳腺肿块性疾病具有较高的显示及鉴别诊断价值。

Objective To evaluate the value of multi - slice helical CT（MSCT） in manifesting and differentiating breast masses. Methods Seventy eight breast masses confirmed pathologically were enrolled, including invasive duct carcinoma （ n = 57）, mucous carcinoma （ n = 4）, fibroadenoma （ n = 13）, and intraductal papilloma （ n = 4）. Following plain CT scanning, two phases enhanced scanning was initiated respectively at 28 and 90 second after contrast injection, then MIP and VRT methods were used in the arterial phase images reconstruction. The CT findings of breast masses, surrounding structures and axillary lymph nodes were retrospectively analyzed. Results During the arterial phase, 88 % invasive duct carcinoma and 4 cases intraductal papilloma had great enhancement; while 4 cases mucous carcinoma and 92.31% fibroadenoma had no or little enhancement. Malignant masses were irregular （45.90%） or round with lobular and spiculate boundary （54.10%）, inhomogeneous enhancement （55.74%） or homogeneous enhancement （44.26%）, while benign masses were round （94.12%） with smooth boundary （64.71%） and homogenous enhancement （76.47%）. Of all the 61 breast cancer cases, 8 cases showed nipple adherence and skin incrassation, 5 cases displayed chest wall invasion and 24 cases manifested axillary lymph node metastasis. Conclusion Multi - slice helical CT is of great value in manifesting and differentiating breast masses.