肉芽肿性乳腺炎的MRI诊断

An analysis of MRI features and diagnosis of granulomatous mastitis

目的:探讨肉芽肿性乳腺炎(GM)的MRI诊断价值。方法:回顾性分析34例经病理证实的GM的临床及MRI资料。结果:34例病灶在T1WI上呈等、低信号,32例在抑脂T2WI上呈略高信号,2例呈等信号。增强扫描显示强化病灶呈不规则形态肿块样分布11例(占32.4%),非肿块形式分布23例(占67.6%),其中呈段样分布15例(占44.1%),呈区域样分布8例(占23.5%)。34例增强后病灶内部表现为均匀强化3例、厚壁环形强化10例及薄壁环形强化21例,31例厚壁及薄壁环形强化病灶内均可见脓肿形成,且脓肿内壁光滑。34例病灶时间-信号强度曲线(TIC)呈流入型、平台型和流出型分别为17、9和8例。13例病灶周围腺体呈网格样改变,对应皮肤受牵拉,21例周围组织未见受累,腋下淋巴结增大10例。血管减影图显示30例患乳病灶旁血管增加。结论:GM的MRI具有一定的特征,特别是当病灶内出现脓肿且内壁光滑时,有助于GM的诊断。

Objective：To improve the MRI diagnosis level of granulomatous mastitis （GM）. Methods：To conduct a retrospective analysis of clinical materials and MRI of GM of 34 cases proven by pathology, and to summarize the signs of MRI by combining them with pathology. Results：The lesions of 34 cases presented equal and low signals on T1WI,32 cases presented high signals on （at suppressed T2WI, and 2 cases presented equal signals. On contrast enhanced MRI, the enhanced lesions showed mass like distribution （pattern） with irregular shape in 11 cases （32.4%） and non-mass like distribution （pattern） in 23 cases. From these 23 cases, there was segmental distribution in 15 cases （44.1 % ） and regional distribution in 8 cases （23.5%）. In 34 cases, homogeneous enhancement of internal structure was shown in 3 cases, thick wall circular enhancement in 10 cases and thin wall circular enhancement in 21 cases. Abscesses were formed in the lesion of the thick-wall and thin-wall ring enhancement,the inner wall of the abscessus was smooth. The time-signal intensity curves of 34 cases presented as inflow type, insistent type, and outflow type in 17,9 and 8 cases respectively. There were web-like changes in 13 cases of surrounding glandular structures, and the corresponding skins were tracted. There was no involvement of surrounding glandular structures in 21 cases,and axillary lymph nodes were enlarged in 10 cases. The subtraction angiography showed an increase of blood vessels around the lesions in 30 cases. Conclusion： The MRI of GM has certain characteristics,especially when there are abscesses whose inner walls are smooth in the lesion, this is helpful to the diagnosis of GM.