MRI在浆细胞性乳腺炎分期中的价值

The Value of MRI in Staging of Plasma-cell Mastitis

目的探讨浆细胞性乳腺炎(plasma-cell mastitis,PCM)发展不同时期的MRI表现,分析MRI征象及其在PCM分期中的价值。资料与方法回顾性分析47例经手术病理证实的不同时期PCM的MRI信号特征、动态增强曲线类型、病灶位置及累及范围、扩张导管征显示、增粗引流静脉显示以及是否伴有腋下淋巴结肿大。结果 PCM炎症期主要表现为非肿块样病灶,节段性或区域性分布,累及范围相对较小;脓肿期表现为大小不等的薄壁脓腔形成,伴有丰富的扩张引流静脉,累及范围广泛;瘘管期是脓肿破溃形成与皮肤表面相同的瘘管,表现为强化后中央低信号,而两侧窦道壁强化的"轨道征",多伴有脓肿及炎症改变。在各期均可出现"扩张导管征",显示率为71.9%(23/32),主要表现为T1WI呈高信号、抑脂T2WI呈低信号,可以认为是PCM的特征性表现。PCM的动态增强曲线表现多样,主要以上升型和平台型为主,但也存在少数病例表现为流出型。结论 MRI上乳腺"扩张导管征"的显示有助于正确诊断PCM,同时MRI可以很好地区分不同时期的PCM,为临床治疗提供可靠的分期信息。

Objective To explore MRI findings of different stages in plasma-cell mastitis（PCM）.Materials and Methods 47 patients with different stages of PCM confirmed by operation and pathology were retrospectively analyzed.MRI signs included signal characteristics,dynamic enhancing curve,location and range,＂duct ectasia＂ sign,thickening draining vein,alarunderarm lymphadenectasis.Results Inflammatory stage of PCM mainly showed segmental or regional non-mass like lesions with limited range involved;abscess stage showed many thin-wall cavity with thickening draining vein and wide bound range involved;abscess broken to form fistula,and fistula stage showed ＂rail＂ sign,in which fistula wall appeared apparent enhancement and cavity was not enhanced with abscess and inflammation.＂Duct ectasia＂ sign could appear in three stages（24/32,71.9%）,which was mainly hyperintensity in T1WI and hypointensity in fat suppressed T2WI.＂Duct ectasia＂ sign was characteristics of PCM.The dynamic enhancement curves of PCM were mainly type Ⅰ and type Ⅱ.Conclusion ＂Duct ectasia＂ sign on MRI is helpful to diagnose PCM,and MRI can differentiate different stages of PCM.