乳腺X线摄影、超声与MRI增强检查在乳腺疾病诊断中的比较

Comparison of mammography,ultrasound and MRI contrast-enhanced scans in the diagnosis of breast disease

目的:比较乳腺X线摄影、超声与磁共振增强检查在乳腺良恶性病变中的诊断价值。方法:回顾分析2008年1月至2009年1月107例乳腺疾病病人的影像学资料,所有病人均进行乳腺X线摄影、超声与MRI动态增强检查,按照美国放射学会推荐的"乳腺影像报告和数据系统"(BI-RADS)进行分类,以手术病理诊断为金标准,应用受试者工作特征曲线(ROC)评价不同检查方法及联合检测的价值。结果:107例病人共检出117个病灶,以BI-RADS分级4类以上为检查阳性,结果显示MRI增强检查的灵敏度优于乳腺X线摄影(97.06%比80.88%,P=0.003)和超声(97.06%比88.24%,P=0.049),而其特异度不低于乳腺X线摄影和超声(P=0.274和P=0.798)。ROC分析结果显示,MRI增强检查的曲线下面积明显大于乳腺X线摄影(0.935比0.867,P=0.001)和超声(0.935比0.886,P=0.001),而联合3种检查方法曲线下面积最大,明显大于单独行乳腺X线摄影(P=0.001)、超声(P=0.005)和MRI增强检查(P=0.008)。结论:MRI增强检查在有症状的乳腺疾病病人中的诊断价值高于乳腺X线摄影和超声,联合运用三种检查方法,诊断价值可进一步提高。

Objective To investigate and compare the values of mammography,ultrasound and MRI contrastenhanced scans in diagnosis of benign or malignant breast lesions.Methods A retropective study of 107 female patients with breast disease,who received surgery in Shanghai Sixth People＇s Hospital from Jan 1st,2008 to Jan 1st,2009,was performed.The results of mammography,ultrasound and MRI contrast-enhanced scans,all categorized by Breast imaging reporting and data system（BI-RADS） were evaluated by Receiver Operating Characteristic Curve（（ROC） analysis.Results There were 117 lesions found in the 107 patients.When referred BI-RADS caterogory 4 and above as positive,comparing with the pathological results,the results showed that the sensitivity of MRI contrast-enhanced scan significantly better than the mammography（97.06% vs.80.88%,P=0.003） and ultrasound（97.06% vs.88.24%,P=0.049） but the specifity were not worse than the mammography and ultrasound（P=0.274 and P=0.798,respectively）.The ROC analysis demonstrated that the area under curve（AUC） of MRI contrast-enhanced scan were larger than the ones of mammography（0.935 vs.0.867,P=0.001） and ultrasound（0.935 vs.0.886,P=0.001）.Furthermore,the AUC of combination of the three tests were the largest one and significantly larger than that of mammography（P=0.001）,ultrasound（P=0.005） and MRI（P=0.008）.Conclusions MRI contrast-enhanced scan were of greater value in the diagnosis of breast disease than mammography and ultrasound.Combination of the three tests provide more diagnosis value than ultrasound,mammography or MRI contrast-enhanced scans alone.