动态增强磁共振联合扩散加权成像技术对乳腺环形强化病变的诊断应用价值研究

The Diagnostic Value of Combining Dynamic Contrast Enhanced MRI and Diffusion Weighted Imaging in Breast Lesions with Peripheral Enhancement

目的探讨动态增强MRI(DCE-MRI)联合扩散加权成像(DWI)技术对乳腺环形强化病变的诊断应用价值。方法搜集经病理证实的乳腺环形强化病变28例,共30个病灶(良性17个,恶性13个),术前行磁共振扫描。统计病变的动态增强MRI征象(形态学特点、时间-信号曲线)及扩散加权成像参数(表观扩散系数值),并运用χ2检验及t检验分析良恶性组差异;采用二分类Logistic回归分析获得与乳腺环形强化病变良恶性相关的危险因素。将DCE-MRI及DWI纳入不同的诊断模型,并评价其诊断准确性。结果动态增强MRI征象(包括形态、边缘、周围供血血管及时间-信号曲线)及扩散加权成像参数在乳腺良、恶性环形强化病变中有显著性差异(P<0.05);且经二分类Logistic回归分析提示这些征象及参数均为鉴别良恶性乳腺环形强化病变有意义的参数。当表观扩散系数(ADC)值取1.05×10^(-3)mm^2/s作为乳腺恶性环形强化病变的诊断阈值时,敏感性及特异性分别为92.3%、70.6%(P=0.001)。DCE-MRI联合DWI可进一步提高乳腺环形强化病变的诊断准确性,其敏感性、特异性及符合率分别为94.1%、76.9%及86.7%。结论动态增强MRI联合DWI技术,可明显提高乳腺环形强化病变的定性诊断价值。

Objective To investigate the diagnostic value of combining dynamic contrast enhanced MRI（ DCE-MRI）and diffusion weighted imaging（ DWI） in breast lesions with peripheral enhancement. Methods The MRI of pre-operative and pathologically confirmed 28 patients with 30 breast lesions with peripheral enhancement was collected（ benign,n= 13; malignant,n = 17）. The features of DCE-MRI（ including the morphological features and time signal intensity curves） and DWI（ including the ADC value） were focused. Chi-square test and two-sample t-test were applied to analyze the different features between benign and malignant breast lesions with peripheral enhancement. Binary Logistic regression analysis was employed to identify the risk factors for predicting malignant breast lesions with peripheral enhancement. DCEMRI and DWI were used to establish the different diagnostic models. Fourfold table was performed to evaluate the diagnostic ability of these models. Results The feature of DCE-MRI（ including shape,margin,adjacent blood supply,and signal intensity time curve） and DWI（ including the ADC value） had significant difference between benign and malignant groups（ P〈0. 05）. Meanwhile,these features were also significant variables for predicting malignant breast lesion with peripheral enhancement. When an apparent diffusion coefficient（ ADC） value of 1. 05 × 10-3mm2/ s was used as the threshold for diagnosing malignant breast lesion with peripheral enhancement,the obtained sensitivity and specificity were 92. 3%,70. 6%,respectively. A Combination of DCE-MRI and DWI could further improve the diagnostic accuracy of malignant breast lesion with peripheral enhancement（ sensitivity,94. 1%; specificity,76. 9%; agreement rate,86. 7%）. Conclusion Combination of DCE-MRI and DWI could improve the diagnostic value of breast lesions with peripheral enhancement significantly.