氢质子磁共振波谱在乳腺良恶性病变诊断中的价值探讨

Value of 1H-MRS in the diagnosis of breast lesions

目的：研究乳腺氢质子磁共振波谱（1H-MRS）的特点，评估其在鉴别乳腺良恶性病变中的价值。方法回顾性分析有明确病理结果且波谱采集成功的55个乳腺病灶（恶性37个、良性18个）及10个健康腺体的1H-MRS特点。结果37个恶性病灶中有28个在3.22×10^-6处出现胆碱（Cho）峰，9个未出现Cho峰；18个良性病灶有3个在3.22×10^-6处出现Cho峰，其他15个良性病灶和10个健康腺体都未出现Cho峰。以Cho峰鉴别良恶性病变的敏感度76%（28/37），特异度83%（15/18），阳性预测值90%（28/31），阴性预测值63%（15/24）。差异有统计学意义（Kappa=0.781，P＜0.01）。1H-MRS阳性病例中，病灶最大径＞2.5 cm占48%（15/31），2.0-2.5 cm占42%（13/31），1.5-2.0 cm为10%（3/31）。结论1H-MRS对乳腺肿瘤的敏感性及特异性较高，对病灶＞1.5 cm的乳腺肿块性病变，可用1H-MRS协助鉴别病变的良恶性。

Objective To study the features of breast proton magnetic resonance spectroscopy （ 1H-MRS）, as-sessing its value on differentiating bengin from malignant lesions. Methods Retrospective analysis on 55 breast le-sions （37 malignant cases,18 benign cases） and 10 normal glands which had specific pathological results and spectral acquisition success, study the 1H-MRS features of them. Results Of 37 malignant lesions, Choline （Cho） peak ap-peared at 3.22×10^-6 in 28 items, 9 items didn′t have Cho peak;of 18 benign lesions, Cho peak appeared at 3.22×10^-6 in 3 items, the other 15 benign lesions and 10 normal glands didn′t obtain Cho peak. The sensitivity, specificity, pos-itive predictive value, negative predictive value of Cho peak on differentiate benign from malignant lesions was 76%（28/37）, 83%（15/18）, 90%（28/31）, 63%（15/24） respectively, which had statistically significance （Kappa=0.781, P=0.000）. The maximum diameters of positive 1H-MRS cases were 〉2.5 cm, 2.0-2.5 cm, and 1.5-2.0 cm, accounting for 48% （15/31）, 42%（13/31） and 10%（3/31） respectively. Conclusion 1H-MRS have a relatively higher sensitivity and specificity for breast tumors, which can be used to help identify benign or malignant lesions for breast mass〉1.5 cm.