乳腺硬化性腺病的影像特征分析

Radiological features of breast sclerosing adenosis

目的：探讨乳腺硬化性腺病（SA）的乳腺X线摄影、超声和MRI特征。方法回顾性分析经手术病理证实为SA或伴有SA改变，且术前有X线、超声或乳腺MRI资料的44例患者的影像资料。44例中单纯SA 18例，伴SA改变26例；36例行乳腺X线摄影，38例行乳腺超声，34例行乳腺MRI检查。观察乳腺X线摄影、超声和MRI表现，并进行乳腺影像报告和数据系统（BI-RADS）分类，以BI-RADS分类≥4b诊断为恶性，计算误诊率。结果（1）X线表现：36例SA患者的X线像上，表现为腺体结构扭曲、钙化、肿块或结节、非对称性致密、肿块合并钙化者分别为30.6%（11/36）、22.2%（8/36）、19.5%（7/36）、11.1%（4/36）及8.3%（3/36）；3例未见明确异常。（2）超声表现：38例行超声检查的SA患者中，33例可见结节，5例未发现异常。SA患者超声多表现为形状规则（54.5%，18/33）、回声不均匀（69.7%，23/33）、无或少量点线状血流信号（90.9%，30/33）的低回声结节灶。（3）MRI增强表现：所有病灶均明显强化，28例（82.4%，28/34）为肿块样强化，其中18例呈星芒状肿块样改变。时间信号曲线Ⅰ型18例、Ⅱ型14例、Ⅲ型2例。根据BI-RADS分类，乳腺X线摄影、超声及MRI诊断SA的误诊率分别为19.4%（7/36）、18.4%（7/38）和35.3%（12/34）。结论乳腺SA在X线摄影显示结构扭曲或钙化，超声多表现为回声不均匀的无或少血流信号的低回声结节，MRI多表现为星芒状小肿块样强化。

Objective To study the imaging features of breast sclerosing adenosis （SA）, and to enhance the recognition of this disease, as well as to assist in accurate clinical diagnosis. Methods Imaging findings in 44 women with SA lesions confirmed by pathology were retrospectively reviewed （including 36 cases of mammography, 38 cases of ultrasound and 34 cases of MRI）. Mammography, ultrasound and MRI features of the disease were observed, misdiagnosis rates were calculated according to breast imaging reporting and data system （BI-RADS）≥4b. Results （1） On the mammogram of 36 SA cases, the percentage of distortion, calcifications, nodular or mass, asymmetric density and mass combining with calcifications were 30.6%（11/36）, 22.2%（8/36）, 19.5%（7/36）, 11.1%（4/36）and 8.3%（3/36）respectively. Three cases had no abnormal findings. （2） On the sonogram （excluding five normal finding cases）, the majority of lesions showed low echo-level nodules with regular shape （54.5%,18/33）, heterogenous echo （69.7%,23/33）, and no or small spot-liner blood vessels （90.9%,30/33）. （3） All lesions showed marked enhancement, including 82.4% （28/34） lesions with mass-like enhancement（18 star-shaped masses included）. For the time intensity curve, 18 cases were typeⅠ, 14 cases typeⅡ, and two cases typeⅢ. The misdiagnosis rates of mammography, ultrasound and MRI were 19.4%（7/36）, 18.4%（7/38） and 35.3%（12/34） respectively. Conclusion The majority of SA lesions showed distortion or calcifications on mammograms, low echo-level nodules with heterogeneous echo and no or small blood vessels on ultrasound, and star-shaped mass-like lesions on enhanced MRI.