MRM BI-RADS 3-5类肿块性病变的DCE-MRI及DWI联合应用价值探讨

Application value of combined dynamic contrast-enhanced MR imaging and diffusion-weighted MR imaging in magnetic resonance mammography BI-RADS category 3-5 breast mass lesions

目的:探讨磁共振乳腺成像(MRM)BI-RADS 3-5类肿块性病变的动态增强(DCE)MR征象、弥散加权成像(DWI)及两者联合应用对乳腺良恶性病变的诊断价值。方法:回顾性分析118个初诊为BI-RADS 3-5类肿块性病变的磁共振征象,对病变形态学、血流动力学及ADC值进行统计学分析,并计算敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)及准确性。结果:DCE-MRI征象中,形状不规则或分叶、边缘不规则或毛刺征、环状强化、早期强化率>100%及廓清型曲线提示恶性病变征象;ROC曲线分析ADC最佳诊断阈值为1.25×10-3mm2/s,且具有高诊断效能(>0.900);两者联合应用的敏感性、特异性、PPV、NPV及准确性分别为90.4%、91.4%、96.2%、80%及90.7%。结论:DCE-MRI与DWI联合应用对提高BI-RADS 3-5类肿块性病变的诊断特异性及准确性有重要价值。

Objective： To evaluate the diagnostic value of conventional MR mammography （MRM） combined with dynamic contrast-enhanced （DCE） MR imaging, and diffusion-weighted MR imaging （DWI） in the diagnosis and differential diagnosis of BI-RADS category 3-5 breast lesions. Methods： In 118 cases diagnosed as BI-RADS category 3-5 mass lesions, tumor mor- phology, bemodynamics of the masses and apparent diffusion coefficient （ADC） value were analysed retrospectively. Sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV） and accuracy were calculated. Results： In DCE-MRI, irregular and lobular shape, irregular and speculated margins, rim enhancement, early contrast-enhanced rate more than 100% and washout time-intensity curve（TIC） were the indicators of malignancy. The optimal threshold of 1.25×lO-3mm2/s from receiv- er operating charactcristic（ROC） curve, and have better diagnosis values（〉0.900）. The combined application provide sensitivity, specificity, PPV, NPV and accuracy were 90.4%, 91.4%, 96.2%, 80% and 90.7%. Conclusion： Conventional MRI combined with DCE-MRI and DWI were helpful to improve the diagnostic specificity and accuracy of BI-RADS category 3-5 breast mass lesions.