肿块型肉芽肿性乳腺炎与浸润性导管癌的MRI诊断及鉴别诊断

MRI Diagnosis and Differential Diagnosis of Mass Type Granulomatous Mastitis and Invasive Ductal Carcinoma

目的探讨肿块型肉芽肿性乳腺炎(GM)的MRI诊断价值,并与浸润性导管癌(IDC)进行鉴别分析。方法回顾性分析经手术病理证实的15例肿块型GM和23例IDC患者的临床及MRI资料,总结病灶的分布特点、形态、边缘、信号特点、强化特点、时间-信号强度曲线(TIC)类型、表观扩散系数(ADC)值、相关发现等,并通过χ~2检验及独立样本t检验进行对比分析。结果 (1)15例GM中8例累及乳腺区段(53.3%),7例累及乳晕后区(46.7%);圆形病灶7例(46.7%)、分叶状病灶4例(26.7%)、不规则形病灶4例(26.7%);病变边缘光滑3例(20.0%)、边缘模糊10例(66.7%)、边缘呈毛刺样表现2例(13.3%)。23例IDC中21例累及乳腺区段(91.3%),仅2例累及乳晕后区(8.7%);圆形病灶11例(47.8%)、分叶状病灶3例(13.1%)、不规则形病灶9例(39.1%);病变边缘光滑2例(8.7%)、边缘模糊6例(26.1%)、边缘呈毛刺样表现15例(65.2%)。(2)15例GM中均匀强化2例(13.3%),不均匀强化6例(40.0%),不均匀伴内部小环形强化7例(46.7%);TICⅠ型2例(13.3%),Ⅱ型8例(53.3%),Ⅲ型5例(33.4%)。23例IDC中均匀强化3例(13.0%),不均匀强化18例(78.3%),不均匀伴内部小环形强化2例(8.7%);TIC曲线类型Ⅰ型2例(8.7%),Ⅱ型9例(39.1%),Ⅲ型12例(52.2%)。(3)15例GM病灶实性部分的平均ADC值为(1.09±0.18)×10^(-3)mm^2/s,23例IDC病灶实性部分的平均ADC值为(0.92±0.21)×10^(-3)mm^2/s。(4)15例GM中乳头或皮肤回缩7例(46.7%),皮肤增厚8例(53.3%),同侧腋窝淋巴结增大9例(60.0%);23例IDC中乳头或皮肤回缩6例(26.1%),皮肤增厚6例(26.1%),同侧腋窝淋巴结增大8例(34.8%)。结论肿块型GM和IDC的临床与MRI表现有较多的重叠处,病灶的分布特点、边缘、强化特点、ADC值有助于二者的鉴别。

Objective To discuss MRI diagnosis value of mass type granulomatous mastitis and to conduct discriminant analysis on invasive ductal carcinoma. Methods A retrospective analysis was carried out on clinical and MRI data of 15 patients with confirmed mass type granulomatous mastitis by surgical pathology and 23 patients with confirmed invasive ductal carcinoma. The lesion distribution characteristics,boundary,signal characteristics,strengthening characteristics and TIC curve type,ADC values and related findings were concluded and comparative analysis was conducted via χ~2 test and independent sample t test. Results（ 1） among 15 GM cases,8 cases involved the mammary gland segment（ 53. 3%） and7 cases involved the mammary areola posterior area（ 46. 7%）; there were 7 cases with round lesions（ 46. 7%）,4 cases with lobulated lesions（ 26. 7%）,4 cases with irregular lesions（ 26. 7%）; 3 cases with smooth lesion edges（ 20. 0%）,10 cases with blurred edges（ 66. 7%）,2 cases with burr-like edges（ 13. 3%）. Among 23 IDC cases,21 cases involved the mammary gland segment（ 91. 3%） and only 2 cases involved the mammary areola posterior area（ 13. 3%）; there were11 cases with round lesions（ 47. 8%）,3 cases with lobulated lesions（ 13. 1%）,9 cases with irregular lesions（ 39. 1%）;2 cases with smooth lesion edges（ 8. 7%）,6 cases with blurred edges（ 26. 1%）,15 cases with burr-like edges（ 65. 2%）.（ 2） Among 15 GM cases,there were 2 cases with uniform enhancement（ 13. 3%）,6 cases with non-uniform enhancement（ 40. 0%）,7 cases with non-uniform and internal ring enhancement（ 46. 7%）; there were 2 cases with TIC curve type Ⅰ（ 13. 3%）,8 cases with type Ⅱ（ 53. 3%）,5 cases with type Ⅲ（ 33. 4%）. Among 23 IDC cases,there were 3 cases with uniform enhancement（ 13. 0%）,18 cases with non-uniform enhancement（ 78. 3%）,2 cases with nonuniform and internal ring enhancement（ 8. 7%）; there were 2 cases with TIC curve type Ⅰ（ 8. 7%）,9 cases with typeⅡ（ 39. 1%）,12 cases with type Ⅲ（ 52. 2%）.（ 3） The average ADC value of 15 GM solid lesions component was（ 1. 09± 0. 18） × 10^-3mm^2/s and the average ADC value of 15 GM solid lesions component was（ 0. 92 ± 0. 21） × 10^-3mm^2/s.4. Among 15 GM cases,there 7 cases with nipple or skin retraction（ 46. 7%）,8 cases with skin-thickening（ 53. 3%）,9cases with ipsilateral axillary lymph node enlargement（ 60. 0%）. Among 23 IDC cases,there 6 cases with nipple or skin retraction（ 26. 1%）,6 cases with skin-thickening（ 26. 1%）,8 cases with ipsilateral axillary lymph node enlargement（ 34. 8%）. Conclusion The clinical and MRI manifestations of mass type granulomatous mastitis and invasive ductal carcinoma overlap in many aspects and the lesion distribution characteristics,edges,strengthening characteristics and ADC values will be helpful to identify them.