磁共振动态增强和弥散加权成像在不同类型乳腺炎性疾病诊断与鉴别诊断的应用价值

Value of magnetic resonance dynamic enhancement and diffusion weighted imaging in the diagnosis and differential diagnosis of different types of mastitis disease

目的探讨弥散加权成像(diffusion weighted imaging,DWI)和磁共振动态增强(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)在不同类型乳腺炎性疾病诊断与鉴别诊断中的价值,为乳腺炎性疾病的诊断提供依据。方法选择湖州市妇幼保健院2013年5月-2016年6月非特异性乳腺炎患者、乳腺脓肿患者和肉芽肿性乳腺炎患者各50例为研究对象,将其分为A组(非特异性乳腺炎组)、B组(乳腺脓肿组)和C组(肉芽肿性乳腺炎组),磁共振扫描测量各组的表观扩散系数(apparent diffusion coefficient,ADC)值和时间-信号强度曲线(Time-signal strength curve,TIC)。结果 A、B、C组非肿块强化率分别为60.0%、68.0%、86.0%,3组比较差异有统计学意义(P<0.05),C组非肿块强化率高于A和B组,差异有统计学意义(P<0.05);B组和C组ADC值(1.098±0.476、1.254±0.363)低于A组(1.463±0.189),差异有统计学意义(P<0.05);A组和B组、A组和C组、B组和C组ADC比较ROC曲线下面积分别为0.796、0.728、0.655,其中A组和B组ADC比较ROC曲线下面积最大,其最佳诊断界值为1.352×10-3 mm2/s,灵敏度为0.807,特异度为0.829;3组患者TIC曲线类型比较差异有统计学意义(P<0.05),A组TIC以Ⅰ型为主,占68.0%,C组TIC以Ⅱ型为主,占66.0%。A组和B组、A组和C组、B组和C组TIC曲线比较ROC曲线下面积分别为0.721、0.779、0.526,其中A组和C组TIC曲线比较ROC曲线下面积最大,其最佳诊断界值为1.5,灵敏度为0.827,特异度为0.693。结论 DCEMRI、DWI在非特异性乳腺炎、乳腺脓肿和肉芽肿性乳腺炎的诊断及鉴别诊断中具有一定价值,两者结合可以对三种类型乳腺炎进行更准确的鉴别。

OBJECTIVE To investigate the value of diffusion weighted imaging（DWI）and dynamic contrast enhanced magnetic resonance imaging（DCE-MRI）in the diagnosis and differential diagnosis of different types of mastitis disease,so as to provide the basis for the diagnosis of mastitis disease.METHODS A total of 50 patients with nonspecific mastitis,50 patients with breast abscess and 50 patients with granulomatous mastitis in Huzhou Maternity Child Health Care Hospital from May 2013 to Jun 2016 were selected as research subjects,and were divided into group A（nonspecific mastitis group）,group B（breast abscess group）and group C（granulomatous mastitis group）.The apparent diffusion coefficient（ADC）values and time-signal strength curve（TIC）in each group were measured by MRI scans.RESULTS The non-tumor strengthen rates of group A,group B,and group C were 60.0%,68.0%,and 86.0%,the difference in the three groups was statistically significant（P〈0.05）,and the non-tumor strengthen rate of group C was higher than that of group A and group B（P〈0.05）.The ADC values of group B and group C（1.098±0.476 and 1.254 ± 0.363）were significantly lower than that of group A（1.463±0.189）（P〈0.05）.The area under ROC curve of the ADC comparisons of group A and group B,group A and group C,group B and group C were 0.796,0.728,0.655,the area under ROC curve of the ADC comparison of group A and group B was the largest,the best diagnostic cutoff was 1.352 × 10-3 mm2/s,the sensitivity was0.807,and the specificity was 0.829.The difference of TIC curve type in three groups of patients was significant（P〈0.05）,the typeⅠof TIC in group A was 68.0%,and the typeⅡ of TIC in group C was 66.0%.The area under ROC curve of TIC curve comparisons of groups A and group B,group A and group C,group B and group C were 0.721,0.779,0.526,the area under ROC curve of TIC curve comparison of group A and group C was the largest,the best diagnostic cutoff value was 1.5,the sensitivity was 0.827,and the specificity was 0.693.CONCLUSIONDCE-MRI and DWI have a certain value in the diagnosis and differential diagnosis of nonspecific mastitis,breast abscesses and granulomatous mastitis.Combination of DCE-MRI and DWI can indentify more accurately on the three types of mastitis.