动态增强乳腺磁共振在乳腺疾病诊治中的应用价值

Application value of dynamic contrast-enhanced Breast MR in breast diseases

目的探讨动态增强乳腺磁共振（MR）在乳腺疾病诊治中应用价值。方法回顾『生分析2008年10月～2011年5月广西医科大学第一附属医院90例良性乳腺疾病、144例乳腺癌女性患者的动态增强乳腺MR影像及病理结果，比较动态增强MR、B超、钼靶在乳腺疾病诊断中的敏感性、准确性、特异性。结果动态增强MR诊断乳腺疾病的敏感性和准确性较B超、钼靶高，特异性较B超高（均P〈0．01），而与钼靶比较，差异无统计学意义（P〉0．05）。乳腺恶性病变动态增强MR的形态学征象主要包括病灶早期增强、周围血管增粗迂曲、皮下脂肪间隙模糊、同侧腋窝淋巴结肿大并明显增强等。动态增强MR诊断乳腺癌腋窝淋巴结转移敏感性为61．19％（41／67），特异性为61．04％（47／77）、准确性为61．11％（88／144）。结论动态增强MR对乳腺疾病诊断的敏感性、准确性较高，病灶形态显示效果较好，能观察腋窝及内乳淋巴结，在乳腺疾病的诊断上价值较高。术前应用动态增强MR判断乳腺癌腋窝淋巴结是否转移具有一定价值，有助于术前进行临床分期。

Objective To investigate the clinical application value of dynamic contrast-enhanced breast MR in breast diseases. Methods Pathology results and breast dynamic enhancement MR （DCE-MR） image of 90 female patients with benign mammary gland disease, 144 female patients with breast cancer from October 2008 to May 2011 in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed. Sensitivity, specificity and accuracy of DCE-MR, ultrasound and mammography in the diagnosis of mammary gland disease were compared. Results The accu- racy and sensitivity of DCE-MR was significantly better than the ultrasound and the mammography, the specificity of the DCE-MR was significantly better than the ultrasound （all P 〈 0.01）, but showed no significant difference with mam- mography （P 〉 0.05）. The morphologic features of malignant lesion in breast DCE-MR included rapid enhancement, peripheral vascular thickening and tortuosity, fuzzy subcutaneous fat ,marked enhancement of ipsilateral axillary lymph nodes. The sensitivity, specificity, accuracy of DCE-MR for diagnosis of breast cancer axillary lymph nodes metastasis were 61.19% （41/67）, 61.04% （47/77）, 61.11% （88/144） respectively. Conclusion The sensitivity and accuracy of DCE- MR for diagnosing breast diseases are quite high, display effect of lesions form is better, DCE-MR has higher value in diagnosis of breast diseases. DCE-MR is valuable for estimating axillary lymph nodes metastasis which are beneficial for the stage of breast cancer before operation.