乳腺导管原位癌的影像学表现及与病理分级的关系

The imaging performances of ductal carcinoma in situ and relationship with pathology grade

目的评估乳腺导管原位癌(DCIS)的MRI形态学及动态增强表现,提高对DCIS的认识,并进一步分析MRI表现与组织学核级别是否具有相关性。方法回顾性分析22例经病理证实为DCIS患者的MRI表现,研究其MRI形态学特点及动态增强表现,并分析MRI特点与组织学核级别的相关性。结果 22例患者中,非肿块样强化14例(段样强化9例,其内部均表现为轨道样或簇状小环样强化;区域性强化4例;线样强化1例),肿块样强化8例,均有恶性肿瘤征象,如分叶、毛刺、不均匀强化等。动态增强表现:Ⅰ型曲线5例、Ⅱ型曲线12例、Ⅲ型曲线5例;早期强化率包括早期缓慢强化2例、早期中度强化8例、早期快速强化12例。早期强化率及病灶大小与组织学核级别显著相关,P值分别为0.031和0.002;动态增强曲线类型和形态学表现与组织学核级别无相关性,P值分别为0.4和0.225。结论乳腺DCIS的MRI表现具有相对特异性,结合形态学及血流动力学,可较全面评价DCIS组织学核级别程度,对临床具有重要的指导意义。

Objective To evaluate and recognize the dynamic and morphological MRI characteristics of ductal car- cinoma in situ （DCIS） of the breast, and to analyze its relationship with nuclear grade. Methods All MRI data of 22 patients with histologically proved DCIS were analyzed retrospectively. The following lesion characteristics were recorded or measured： lesion morphology, maximum lesion size, peak initial enhancement, and time-intensity curve on dynamic contrast-enhanced （DCE）-MRI. Logistic regression analysis was performed to identify MRI features that could optimally differentiate high nuclear grade （HNG） from non-HNG DCIS. R.esults 14 lesions had non-mass-like enhancement, and 8 showed masses. Among the non-mass-like lesions, 9 lesions were segmental distribution, 4 were regional distribution, and 1 was lineal distribution. Dynamic enhanced performance： 12 exhibited enhancement plateau curves and 5 exhibited washout curves. Two lesions exihibited slow enhancement, 8 lesions exhibited moderate enhancement, and 12 exhibited fast enhancement. HNG lesions exhibited larger mean maximum lesion size （P=0.002） . The peak initial enhancement and lesion size were significantly correlated with nuclear grade （P=0.031, P=0.002）. The lesion morphology （P=0.4） and time-intensity curve （P=0.225） were not correlate with nuclear grade. Conclusion The preliminary findings suggest that DCE-MRI features is helpful in identifying patients with high-risk DCIS.