MRI-DWI技术及ADC值对乳腺病变的诊断价值

Effectiveness of the DW-MRI Technique & ADC Measurements in Diagnosis of Breast Lesions

目的探讨MRI扩散加权成像(DWI)技术及表观扩散系数(ADC)值鉴别乳腺良恶性病变的诊断效能及价值。方法纳入经活检或手术后病理证实的278例病人的301个病灶,其中234个乳腺病灶ADC值可测量,用诊断试验的评价方法计算相关评价指标以评价良恶性病灶的ADC差异;根据受试者工作特征曲线(ROC)确定曲线下面积,比较ADC值对肿块性病变及非肿块性病变诊断效能的差异。结果 ADC值可测量的234例乳腺病变中,肿块性病变ADC均值<非肿块性病变ADC均值;恶性肿块性病变ADC均值显著低于良性肿块性病变;恶性非肿块性病变.ADC均值与良性非肿块性病变、恶性肿块性病变ADC值与恶性非肿块性病变之间的差异无统计学意义。肿块性病变ADC值的ROC下面积为0.837。非肿块性病变ADC值的ROC下面积为0.592。结论 DWI应纳入乳腺MRI常规标准化检查程序中,但由于肿块性病变和非肿块性病变ADC值有很大差异,应将病变根据形态学分为肿块和非肿块并采取不同诊断策略。

Objective To explore the effectiveness of the DW-MRI （Diffusion-Weighted Magnetic Resonance Imaging） technique and ADC （Apparent Diffusion Coefficient） measurements in diagnosis of breast lesions. Methods Among 301 lesions found in 278 patients who had been confirmed by biopsies and postoperative pathology, there were 234 breast lesions with their ADC values measurable. Calculation of various diagnostic indicators were made with the evaluation methods of diagnostic testing, following the measurement of ADC values in 234 breast lesions, so as to differentiate the ADC values between benign and malignant lesions. Based on the ROC （Receiver Operating Characteristic） curves of patients involved in this study, the area under the curves as well as the effectiveness of different ADC values in diagnosis of mass-like and non-mass-like lesions were identified. Result Among 234 breast lesions whose ADC values were measurable, the average ADC value of mass-like lesions was lower than that of non-mass-like ones; malignant mass-like lesions showed a markedly lower average ADC value in comparison with benign mass-like ones; no statistical significance in the average ADC value was observed neither between malignant and benign non-mass-like lesions nor between malignant mass-like and non-mass-like lesions. The area under the ROC curve was 0.837 for non-mass-like lesions versus 0.592 for mass-like ones. Conclusion DWI was highly recommended to be listed as a conventional procedure of breast examinations. Nevertheless, considering that the breast lesions were morphologically divided into the mass-like type and non-mass-type as well as the fact that the ADC values of both types varied greatly, it is necessary to deploy different diagnostic strategies accordingly.