联合应用MRDCE、DWI与^1H-MRS对乳腺肿瘤的诊断价值

Diagnostic Value of DCE-MRI Time Intensity Curve、DWI and Magnetic Resonance Spectroscopy in Breast Tumors

目的探讨MR动态增强扫描（DCE）、DWI、氢质子磁共振波谱（^1H-MRS）三者联合检查在乳腺肿瘤的临床应用价值。方法回顾性分析54例乳腺肿瘤患者（恶性29例,良性25例）的DCE、DWI和^1H-MRS表现,并与手术后病理结果对比,得出以DCE为主,分别联合DWI ADC（方法 A）、^1H-MRS（方法 B）及三者结合（方法 C）三种方法对乳腺癌诊断的敏感度、特异度、准确率,并分别评价三种方法与病理诊断的一致性。结果所有患者均得到术后病理证实,方法 A诊断乳腺癌的敏感度为84.0%、特异度为72.4%、准确率为77.8%;方法 B诊断乳腺癌的敏感度为75.9%、特异度为84.0%、准确率为79.6%;方法 C诊断乳腺癌的敏感度为89.6%、特异度为88.0%、准确率为88.9%;方法 A、B法、C法与病理诊断的Kappa值分别0.551、0.594、0.777。结论 DCE、DWI和^1H-MRS三者联合诊断乳腺癌的敏感度、特异度、准确率均明显高于DCE联合DWI或^1H-MRS,且与病理诊断的一致性好。

Objective To evaluate the value of dynamic contrast-enhanced breast magnetic resonance scan（ DCEMRI） time-intensity curves combined with diffusion-weighted imaging（ DWI） apparent diffusion coefficient（ ADC value）and1H- magnetic resonance spectroscopy（ MRS） in the diagnosis of breast tumors. Methods Retrospectively analyzed the DCE time-intensity curves、DWI-ADC value and^1H-MRS findings of 54 cases,including 29 malignant cases and 25 benigncases,and compared with the pathological results after surgery. Time-intensity curves、ADC value and^1H-MRS of all cases were jointly analyzed in the identification of benign and malignant breast tumors,and the consistency of the three methods with pathological diagnosis was evaluated. Results All cases were confirmed by pathology after operation. The diagnostic sensitivity,specificity and accuracy rate for combined application of TIC and ADC was 84. 0%,72. 4% and 77. 8% respectively. The diagnostic sensitivity,specificity and accuracy rate for combined application of TIC and^1H-MRS was 75. 9%,84. 0% and 79. 6% respectively,while it was 89. 6%,88. 0% and 88. 9% respectively for combined application of TIC、ADC and^1H-MRS. The Kappa value of method A,B,C with pathological diagnosis was 0. 551,0. 594 and 0. 777,respectively. Conclusion The diagnostic performance of sensitivity,specificity and accuracy rate for combined application of Dynamic enhanced TIC,DWI ADC values and MRS is superior to the combined application of Dynamic-enhanced TIC and DWI ADC values or the combined application of Dynamic enhanced TIC and MRS,and the consistency with the pathological diagnosis is good.