数字化钼钯X线与MR扩散加权成像诊断乳腺良恶性病变的对比研究

The Comparative Research of Digital Mammography and Diffusion Weighted MR Imaging in Diagnosising Breast Lesions

目的探讨数字化乳腺X线检查与MR扩散加权成像(DWI)对乳腺良恶性病变的诊断价值。资料与方法搜集经手术病理证实或穿刺活检证实的50例乳腺癌患者和59例乳腺良性病变患者。应用数字化乳腺机行乳腺内外侧斜位、头尾位摄片。采用GE 1.5T超导磁共振扫描仪,乳腺专用线圈,DWIb值分别为400 s/mm2、600 s/mm2、800 s/mm2、1000 s/mm2,测量病灶区域的表观扩散系数(ADC)值,并用SPSS 11.5软件进行统计学分析。结果钼钯X线发现钙化灶36例,其中乳腺癌16例。4组b值乳腺癌及良性病变,恶性组ADC值明显低于良性组,差异有统计学意义(P<0.05)。并分别绘制受试者工作特征(ROC)曲线,以b=1000 s/mm2时,曲线下面积(AUC)最大,诊断价值最高。以ADC值为1.23×10-3 mm2/s作为诊断阈值与钼靶进行比较,乳腺钼钯X线发现乳腺癌的敏感性、特异性、阳性预测值、阴性预测值分别为56.8%、67.7%、54.3%、69.8%;DWI分别为90.0%、59.4%、56.3%、91.1%。结论 DWI检测乳腺癌的敏感性较高,特异性较低,但乳腺X线摄影可以很好地显示钙化灶,两者结合可以明显提高乳腺癌的诊断准确性。

Objective To investigate the value of digital mammography and diffusion-weighted imaging（DWI）in differential diagnosis of breast lesions.Materials and Methods Fifty cases of breast cancer and 59 cases of benign breast lesion confirmed by pathological results from 2010.2 to 2010.8 were included in our study.MLO and CC images of breasts were obtained by mammography.DWI images were obtained by 1.5 T GE MRI with breast coil.b values were set at 400 s/mm2,600 s/mm2,800 s/mm2 and 1000 s/mm2.ADC values of all lesions were measured and analyzed by SPSS 11.5 software.Results Calcifications were found in 36（33.0%） cases on mammography,including 16（32.0%） cases of breast cancer.ADC values of malignant lesions were lower than those of benign lesions（P0.05） in 4 groups of b values.AUC of ROC curve with b value of 1000 s/mm2 was the highest among the 4 groups.With the ADC value of 1.23×10-3 mm2/s as the threshold,the sensitivity,specificity,positive predict value,negative predict value were 56.0%,83.1%,53.7%,69.0% respectively for mammography,and 90.0%,57.8%,68.2%,91.4% for DWI respectively.ConclusionSensitivity of DWI for detecting breast cancer was higher than those of mammography,while mammography was sensitive for detecting calcifications.Combining the two methods can improve the diagnosis accuracy of breast cancer.