^1H-MRS联合DCE-MRI在乳腺癌中的应用价值

Clinical Application of ^1H - MRS Associated with DCE - MRI in Breast Cancer

目的:探讨MR氢质子波谱(1H-MRS)联合动态增强磁共振成像检查(DCE-MRI)在乳腺癌中的临床应用价值。材料和方法:38例临床疑似乳腺肿瘤患者行DCE-MRI和1H-MRS检查,分析病灶时间-信号强度曲线及MRS表现,并与病理结果比较,判断DCE-MRI和MRS诊断乳腺癌的敏感性、特异性和准确性。结果:手术病理证实乳腺癌20例,良性肿瘤18例。20例乳腺癌中,2例时间-信号强度曲线呈缓慢上升型(I型),6例呈上升平台型(II型),12例呈快进快出型(III型);MRS检查11例出现胆碱峰。18例良性肿瘤中,12例时间-信号强度曲线呈I型,6例呈II型;MRS检查3例出现胆碱峰。时间-信号强度曲线诊断的敏感性为90.0%,特异性66.7%,准确性78.9%;胆碱峰诊断乳腺癌的敏感性55.0%,特异性83.3%,准确性68.4%;两者相结合诊断的敏感性为100%,特异性66.7%,准确性84.2%。结论:由于病灶本身和技术等因素,胆碱峰单独诊断乳腺癌的敏感性较低,联合时间-信号强度曲线表现可提高乳腺癌诊断的敏感性和准确性。

Purpose： To investigate the clinical values of ^1H magnetic resonance spectroscopy（^1H - MRS） associated with dynamic contrast - enhanced MRI （DCE - MRI）in breast cancer. Materials and Methods： 38 patients with breast tumors examined by dynamic contrast - enhanced MRI and ^1H - MRS were studied. The types of time - signal intensity curve, and MRS findings of lesions were analyzed. Compared with pathological results, the sensitivity, specificity and accuracy of dynamic contrast - enhanced MRI associated with ^1H - MRS in detecting breast cancer were evaluated. Results： Of 38 patients, 20 were pathologically cancer and 18 were pathologically benign. In 20 breast cancers 2 showed type Ⅰcurve, 6 showed type Ⅱ curve, and 12 showed type Ⅲ curve, only 11 demonstrated increased choline peak. 18 benign tumors demonstrated nodular enhancement, among them, 12 showed type Ⅰ curve, 6 showed type Ⅱ curve, only three had increased choline peak. The sensitivity, specificity and accuracy of time - signal intensity curve in diagnosising breast cancer were 90.0%, 66.7% and 78.9% respectively; the sensitivity, specificity and accuracy of by using choline peak were 55.0%, 83.3%and 68.4% respectively; the sensitivity, specificity and accuracy of the combination criteria were 100%, 66.7% and 84.2% respectively. Conclusion： Diagnosis breast cancer only by using choline peak has low sensitivity due to technological factor or lesions. The combination of choline peak and patterns of time - signal intensives curve can improve the sensitivity and accurary of diagnosing breast cancer.