多层螺旋CT增强检查对乳腺病变的诊断价值

Diagnostic value of contrast enhancement of multi-slice helical CT in breast lesions

目的:探讨多层螺旋CT(MSCT)增强检查对乳腺疾病的鉴别诊断价值。方法:经手术病理证实的84位患者,共检出93例乳腺病变,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,其他良性病变15例。CT检查先平扫,而后分别于静脉注射对比剂后28s、90s时进行二期增强扫描。对照手术病理结果,分析所有乳腺病变的CT表现。结果:乳腺良、恶性病变的平扫密度之间的差异无统计意义(P>0.05)。乳腺良、恶性病变的形状、边缘及强化形式之间的差异有统计意义(P=1.57×10-4;P=1.75×10-28;P=1.78×10-2)。以25HU为分界点,本组乳腺良、恶性病变动脉期强化程度之间的差别有高度统计意义(P<0.001)。MSCT诊断本组乳腺病变的敏感性为96.7%,特异性为90.6%,阳性预测值为95.2%,阴性预测值为93.5%。MSCT对61例乳腺癌腋窝淋巴结转移的术前检出率为88.8%。结论:多层螺旋CT增强检查在鉴别乳腺良恶性病变方面具有较高的诊断价值。

Objective：To evaluate contrast enhancement of multi-slice helical CT in differentiating benign breast lesions from malignant breast lesions. Methods：The subject were 84 patients with 93 breast lesions confirmed by pathology, including invasive ductal carcinoma （n = 57）, mucous carcinoma （n = 4）, fibroadenoma （n = 13）, intraductal papilloma （n = 4） and other benign lesions （n = 15）. Following plain CT scanning, two phases enhanced scanning was initiated respectively at 28 and 90 second after contrast agent injection. Compared with ltistopathologic results, the CT findings of all breast lesions were analyzed. Results： There was no statistical significant difference between malignant and benign group in the density of mass on non-contrast phase （ P 〉 0.05）. There was statistical difference between the benign and the malignant group in the shape, edge, and enhancement pattern of mass （ P = 1.57×10^-4; P = 1.75×10^-28; P = 1.78×10^-2）. Regarding a lesion with an enhancement of.25HU or more on the arterial contrast phase as a criterion, there is a statistical significant difference between breast malignant and benign lesions （ P 〈 0.001）. MSCT had a sensitivity of 96.7%, a specificity of 90.6%, a positive predictive value of 95.2%, and a negative predictive value of 93.5% in differentiating between benign and malignant breast masses. 88.8% axillary lymph node metastasis could be preoperatively detected by MSCT. Conclusion： Contrast en- hancement of multi-slice helical CT is of great value in differentiating benign from malignant breast lesions.