MR乳腺容积成像技术诊断乳腺肿块性病变的价值研究

Diagnosis of breast lesions presenting as mass by VIBRANT enhanced MRI

[目的]探讨乳腺容积成像(Volume Imaging for Breast Assessment,VIBRANT)技术诊断乳腺肿块性病变的临床价值。[方法]对52例(57灶)经病理证实的女性乳腺患者术前行VIBRANT动态增强检查。分析良恶性病变VIBRANT动态增强形态学特征及时间-信号强度曲线(Time-Signal intensity Curves,TIC)。采用评分法根据积分情况进行综合定性诊断。[结果]利用毛刺征鉴别乳腺良恶性病变的特异度97.1%(33/34)。乳腺恶性病变的TIC类型中III型比例最大,占14/23;乳腺良性病变的TIC类型中Ⅰ型比例最大,占19/34。乳腺良恶性病变的信号增强比率(Signal Enhancement Ratio,SER)差异有显著性意义(t=3.243,P<0.01),以恶性病变的95%CI上界作为SER值的阈值即1.33。通过对乳腺病变VIBRANT动态增强形态学和TIC类型综合的评分诊断乳腺病变的敏感度、特异度和阳性似然比、阴性似然比分别为86.96%(20/23)、85.29%(29/34)和5.913、0.153,诊断符合率为86.0%;通过对乳腺病变SER值的评分诊断乳腺病变的敏感度、特异度和阳性似然比、阴性似然比分别为82.6%(19/23)、82.4%(28/34)和4.681、0.211,诊断符合率为82.5%;联合VIBRANT动态增强形态学、TIC的分型和半定量参数值诊断乳腺病变良恶性的敏感度、特异度和阳性似然比、阴性似然比分别为91.3%(21/23)、88.2%(30/34)和7.761、0.099,诊断符合率为89.5%。[结论]VIBRANT技术对乳腺肿块性病变的诊断可提供更有价值和更接近真实的信息。病灶边缘的毛刺征是VIBRANT动态增强鉴别乳腺良恶性肿块性病变特异度较高的征象。将乳腺MR VIBRANT的形态学与血流动力学表现相结合,可以提高乳腺病变诊断的准确率。当病灶形态学、TIC类型可疑恶性时,SER值能提供更有价值的信息。

[ Objective] To investigate the value of VIBRANT enhanced MR imaging in diagnosis of breast lesions presenting as mass. [ Methods ] Fifty - two female patients with histologically proven malignant and benign breast lesions were examined with VIBRANT enhanced MR imaging. The morphological manifestations and time - signal intensity curves of VIBRANT enhanced MR imaging were analyzed, and the validities of VIBRANT enhanced MR imaging were evaluated according the score summed up. [ Results] The diagnostic specificity of spinous margin for malignant lesions was 97.1% （33/ 34）. The type III of time - signal intensity curves for malignant lesions was 14/23. The type I for benign lesions was 19/ 34. There was significant difference between benign and malignant lesions of SER （ t = 3. 243 ,P 〈 0.01 ）. The thresholdvalue of SER was 1.33. The combination of morphologic and type of TICs had a sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of 86.96% （20/23）, 85.29% （29/34）, 5. 913, 0. 153 and the accuracy was 86.0%. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of SER value were 82.6% （19/23）, 82.4% （28/34）, 4. 681,0. 211 and the accuracy was 82.5%. The combination of morphologic and kinetic characteristics had a sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of 91.3% （21/23）, 88.2% （30/34）, 7. 761,0.099 and the accuracy was 89.5%. [ Conclusions] VIBRANT enhanced MR imaging can provide better and more accuracy information about morphologic and kinetic characteristics of breast lesions presenting as mass. The diagnostic specificity of spinous margin for malignant lesions is the highest than other enhanced MRI signs. The accuracy of diagnosis can be improved by combination of morphologic and kinetic characteristics. In addition, more valuable information can be acquired by SER while morphologic or type of TIC character is suspicious of malignant.