乳腺导管原位癌的磁共振成像特点

MRI characteristics of breast ductal carcinoma in situ

目的 探讨乳腺导管原位癌的磁共振成像（MRI）特点及诊断价值.方法 参照乳腺影像报告和数据系统（BI-RADS）标准,回顾性分析80例乳腺导管原位癌患者的MRI表现.结果 MRI诊断为良性31例,恶性49例.MRI诊断乳腺导管原位癌的符合率为61.2%（49/80）,其中肿物型诊断符合率为80.0%（16/20）,高于非肿物型的55.0%（33/60）（χ2=3.95,P＜0.05）.肿物型20例,形态呈圆形7例（35.0%）,分叶状6例（30.0%）,不规则型7例（35.0%）;边缘清楚7例（35.0%）,不规整12例（60.0%）,毛刺1例（5.0%）;肿物均匀强化7例（35.0%）,边缘强化7例（35.0%）,内部分隔强化6例（30.0%）;时间-强度曲线呈Ⅰ型3例（15.0%）,Ⅱ型9 例（9/20,45.0%）,Ⅲ型8例（40.0%）.非肿物型60例,均匀强化6例（25.0%）,不均匀强化24例（30.0%）,点状强化3例（5.0%）,丛状环形强化27例（45.0%）;强化分布呈局灶样15例（25.0%）,导管样3例（5.0%）,区段样24例（40.0%）,区域样18例（30.0%）;时间-强度曲线呈Ⅰ型20例（33.3%）、Ⅱ型31 例（51.7%）、Ⅲ型9例（15.0%）.结论 MRI对肿物型乳腺导管原位癌诊断符合率高于非肿物型,非肿物型乳腺导管原位癌的主要表现是区段、区域样分布的丛状或不均匀强化,时间-强度曲线以平台型居多.

Objective To investigate the magnetic resonance imaging （MRI） characteristics of breast ductal carcinoma in situ （DCIS）. Methods A retrospective analysis of MRI features in 80 breast DCIS patients was performed according to breast imaging reporting and data system （BI-RADS）. Results Thirty-one patients were diagnosed benign by MRI, 49 cases were diagnosed malignancy. Of the 20 mass-like lesions, 7 cases （35.0%） were round, 6 cases （30.0%） were lobulated, 7 cases （35.0%） were irregular. The coincidence rate of MRI in detecting mass-like and non-mass-like lesions was 80.0% and 55.0% （P〈0.05）, respectively. Seven cases （35.0%） had distinct margins, 12 cases （60.0%） had indistinct margins and 1 case （5.0%） had spiculated margins. Seven cases （35.0%） showed internal homogeneous enhancement, 7 cases （35.0%） had ring enhancement and 6 cases （30.0%） had septal enhancement. TypeⅠ, Ⅱ, and Ⅲ time-signal intensity curve （TIC） was identified in 3,9 and 8 lesions, respectively. 6 cases（10.0%） were homogeneous enhancement, 24 cases （40.0%） were heterogeneous enhancement, 3 cases （5.00%） were punctate enhancement and 27 cases （45.0%） were clumped enhancement. TypeⅠ, Ⅱ, and Ⅲ TIC was observed in 20, 31 and 9 lesions, respectively. Conclusion MRI is effective on detecting mass-like lesions. In non-mass-like lesions, clumped or heterogeneous enhancement of segmental or regional lesion is the main MRI feature.