氢质子磁共振波谱在乳腺病变中的应用价值

Clinical value of ^1H-MRS in breast disease

目的研究乳腺氢质子磁共振波谱(1H-MRS)的代谢特征,判断其在鉴别乳腺良、恶性病变中的应用价值。方法回顾性分析有明确病理结果的57例乳腺病变(恶性32例,良性25例)及12例正常腺体的1H-MRS的代谢特征。结果32例恶性病变中有15例于3.23ppm处出现Cho峰(SNR≥2),12例Cho峰为阴性,有5例采集失败,不能确定有无Cho峰。25例良性病变中,有2例在3.23ppm处出现Cho峰(SNR<2),3例采集失败,另外20例良性病变及12例正常腺体中均未探及Cho峰。以Cho峰鉴别良恶性病变的平均敏感性为55.6%±7.1%,特异性为100%,准确性75.5%±6.1%,阳性预测值为100%,阴性预测值为64.7%±6.8%。Kappa=0.529±0.104,P=0.000<0.05,有统计学意义。结论1H-MRS在鉴别乳腺良、恶性病变中有一定的实用价值,但由于影响因素较多,目前敏感性较低,其临床应用价值有待进一步研究。

Objective To study the ^1H-MRS metabolic features of breast diseases and assess the clinical usefulness in distinguishing benign from malignant lesions.Methods Analyze retrospectively the ^1H-MRS metabolic features of 57 breast diseases（32 malignant and 25 benign）confirmed by pathology and 12 normal breast.Results Spectroscopy findings were positive in 15 of 32 carcinomas（show increased choline resonance peak at 3.23 ppm,SNR≥2）but negative for all benign lesions and normal breast.Eight cases were（5 malignant and 3 benign）failed（ie,determination of positive or negative of choline could not be made）.The mean sensitivity and specificity were 55.6%±7.1% and 100% respectively,mean accuracy was 75.5%±6.1%,and positive predictive value was 100%,the negative predictive value was 64.7%±6.8%.Kappa=0.529±0.104,P=0.000〈0.05.Conclusion ^1H-MRS is useful in distinguishing benign from malignant lesions,but the sensitivity of choline is low owe to many influencing factors now.The clinical value of spectroscopy want to be study further.