3.0TMRI对乳腺癌诊断指标的优选及检查方案的优化

Optimization of diagnosis indicator selection and inspection plan by 3.0T MRI in breast cancer

目的:优选乳腺癌的3.0T MRI诊断指标并探讨其最佳MRI检查方案。方法:收集乳腺癌病例45例,另以乳腺良性肿瘤病人35例作为对照组,对上述二组所有病人行3.0TMRI检查,包括T1加权成像、抑脂的T2加权成像、扩散加权成像、氢质子波谱分析及动态增强序列成像,以手术病理结果作为诊断乳腺疾病的金标准,病理结果的良、恶性作因变量,将MRI的各个诊断指标作为自变量进行Logistic回归分析,建立Logistic模型,优选MRI检查的诊断指标并以此为基础优化乳腺癌的MRI检查方案。结果:经Logistic回归分析,筛选引入方程的指标包括:肿块的边缘、时间–信号强度曲线类型及b=500 s/mm2时病变的表观弥散系数值,回归方程Logit(P)=–21.936+20.478X6+3.267X7+21.488X3。结论:对乳腺癌的诊断价值较高的诊断指标是肿块的边缘情况、时间–信号强度曲线类型及b=500 s/mm2时病变的表观弥散系数值;常规MRI平扫加动态增强扫描与扩散加权成像为较好的检查方案,而1H-MRS只作为诊断困难时的补充检查。

Objective： To optimize 3.0T MRI diagnosis indicator in breast cancer and to select the best MRI scan program. Methods： Totally 45 patients with breast cancers were collected, and another 35 patients with benign breast tumor served as the control group. M1 patients underwent 3.0T MRI, including T1- weighted imaging （T 1WI）, fat suppression of the T2-weighted imaging （T2WI）, diffusion weighted imaging （DWI）, 1H magnetic resonance spectroscopy （IH-MRS） and dynamic contrast enhanced （DCE） sequence. With operation pathology results as the gold standard in the diagnosis of breast diseases, the pathological results of benign and malignant served as dependent variables, and the diagnostic indicators of MRI were taken as independent variables. We put all the indicators of MRI examination under Logistic regression analysis, established the Logistic model, and optimized the diagnosis indicators of MRI examination to further improve MRI scan of breast cancer.Results： By Logistic regression analysis, some indicators were selected in the equation, including the edge feature of the tumor, the time-signal intensity curve （TIC） type and the apparent diffusion coefficient （ADC） value when b=500 s/mm2. The regression 21.488X3. equation was Logit （P）=-21.936＋20.478X6＋3.267XT＋ Conclusion： Valuable indicators in the diagnosis of breast cancer are the edge feature of the tumor, the TIC type and the ADC value when b=500 s/mm2. Combining conventional MRI scan, DWI and dynamic enhanced MRI is a better examination program, while MRS is the complementary program when diagnosis is difficult.