乳腺导管原位癌的动态增强MRI表现:与病理对照

Ductal carcinoma in situ:Dynamic contrast-enhanced MRI features and correlation with pathologic findings

目的探讨乳腺导管原位癌(DCIS)的动态增强MRI特征。方法回顾性分析44例经病理证实的DCIS患者的MRI,根据BI-RADS分类观察其动态增强形态学特征。结果①44例DCIS中共发现43个强化病灶,1个病灶未见强化。非肿块性强化病灶35个(35/43,81.40%),其中节段性强化17个(17/35,48.57%),局灶性强化6个(6/35,17.14%),导管样强化4个(4/35,11.43%),区域性强化8个(8/35,22.86%);肿块性强化病灶8个(8/43,18.60%)。②对42个病灶绘制TIC,Ⅰ型5个,Ⅱ型19个,Ⅲ型18个。③单纯DCIS共30个,其中非高核级13个,高核级17个;DCIS微浸润性癌(DCIS-MI)共13个。单纯DCIS中,非高核级与高核级在强化分布方式、内部强化特征方面差异无统计学意义(P均>0.05),而TIC差异有统计学意义(P=0.0375);单纯DCIS与DCIS-MI在强化分布方式、内部强化特征和TIC类型方面差异均无统计学意义(P均>0.05)。结论 DCIS多表现为节段分布的非肿块性强化,以节段性分布的簇状小环状强化最具特征;TIC类型以Ⅱ型和Ⅲ型多见;DCIS的TIC类型与病理学核分级存在一定相关性。

Objective To explore dynamic contrast-enhancement MRI features of ductal carcinoma in situ （DCIS） of breast. Methods Totally 44 patients with DCIS confirmed by pathology were retrospectively reviewed on the basis of breast imaging reporting and data system （BI-RADS）. Results （DAmong 44 DCIS lesions, 43 lesions enhanced. Eight lesions showed mass-like enhancement, while 35 lesions showed non-mass-like enhancement. Among non-mass-like lesions, 17 （17/35, 48.57%） segmentally enhanced, 6 （6/35, 17.14%） focally enhanced, and ductal distribution enhancement was observed in 4 lesions （4/35, 11.43 %）, and regional distribution of enhancement was found in 8 lesions （8/35, 22.86 %）. Mass-like enhancement was noticed in 8 lesions （8/43, 18.60%）. ②Time-signal intensity curve （TIC） was drawn for 42 lesions, TIC of type I , type Ⅱ and type Ⅲ was demonstrated in 5, 19, 18 lesions, respectively. ③Among 30 lesions of pure DCIS, 13 were non-high-grade, 17 were high-grade, whereas 13 were DCIS microinvasion （DCIS-MI）. There was significant difference of TIC type （P=0. 0375）, but no statistic difference for distribution of enhance pattern, internal en- hancement between non-high-grade and high-grade （all P〉0.05）. No statistical differences was found between pure DCIS and DCIS-MI （all P〉0.05）. Conclusion Non-mass-like enhancement, especially segmental cluster ring enhancement is the most characteristic feature of DCIS. Type Ⅱand Ⅲ are the most common types of TIC. Significant relation exists between TIC type and different nuclear grade.