动态增强磁共振成像在乳腺非肿块性强化病变中的应用价值

Application value of dynamic contrast-enhanced magnetic resonance imaging in breast lesions presented as non-mass-like enhancement

目的探讨动态增强磁共振成像(DCE-MRI)在乳腺非肿块性强化(NMLE)病变良恶性鉴别诊断中的应用价值。方法回顾性分析2012年1月至2015年12月在沧州市人民医院经病理证实的70例NMLE患者的DCE-MRI影像资料,对NMLE病变的分布特点、强化特点、时间-信号强度曲线(TIC)类型进行单因素分析(χ~2检验和非参数检验)及多因素Logistic回归分析,表观扩散系数(ADC)值比较行t检验,探讨良恶性病变的影像学差异。结果 70例NMLE患者中28例为良性,42例为恶性。NMLE良性病灶ADC值为(1.36±0.27)×10-3mm2/s,恶性病灶ADC值为(1.09±0.22)×10-3mm2/s,差异有统计学意义(t=4.644,P<0.001)。单因素分析显示,NMLE的良恶性与分布特点和强化方式有关(χ~2=11.013,P=0.009;χ~2=8.163,P=0.041)。多因素Logistic回归分析显示,节段性分布为恶性病变的独立危险因素(OR=7.543,95%CI:1.963~28.981,P=0.003)。结论 DCE-MRI在NMLE病变良恶性鉴别中具有较高的应用价值。节段性分布常提示恶性病变。

Objective To investigate the application value of dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） in differential diagnosis of benign and malignant breast lesions presented as non-mass-like enhancement （NMLE）. Methods DCE-MRI data of 70 patients with NMLE confirmed by pathology in Cangzhou People＇s Hospital were analyzed retrospectively from January 2012 to December 2015. The distribution characteristics, enhancement characteristics and time-intensity curve （TIC） types of NMLE lesions were analyzed by univariate analysis （χ2 text and nonparametrie test ） and multivariate Logistic regression analysis, and apparent diffusion coefficient （ADC） was compared by t test to explore the difference between benign and malignant lesions. Results In 70 patients with NMLE, 28 patients had benign lesions and 42 patients had malignant lesions. The ADC value was （ 1.36 ± 0. 27） ×10-3 mmE/s in benign lesions and （1.09 ±0. 22） ×10-3 mma/s in malignant lesions, indicating a significant difference （t=4. 644, P〈0. 001 ）. Univariate analysis showed that malignancy of NMLE lesions was related to distribution characteristics and enhancement characteristics （ χ2 = 11. 013, P = 0. 009 ; χ2 = 8. 163, P = 0. 041 ）. Multivariate Logistic regression analysis showed that segmental distribution was an independent risk factor for malignant lesions （ OR = 7. 543, 95% CI： 1. 963 - 28. 981, P = 0. 003 ）. Conclusions DCE-MRI has a high application value in differential diagnosis of benign and malignant lesions of NMLE. Segmental distribution often indicates malignant lesions.