乳腺磁共振动态增强减影MIPs的诊断价值探讨

Diagnostic value of MIPs in breast dynamic contrast and digital subtraction MRI

目的:探讨乳腺磁共振动态增强减影的多层最大密度投影(MIPs)图的诊断价值。方法:收集手术治疗和(或)针吸穿刺活检的214例(239个乳腺病灶)乳腺疾病患者为研究对象,乳腺磁共振动态增强扫描8个时相的MIPs冠状位、轴位图,分析磁共振动态增强减影的MIPs(SUB-MIPs)图中病灶与血管之间的关系,统计MIPs诊断的敏感性、特异性、准确性及ROC曲线下面积(AUC)。结果:SUB-MIPs诊断的敏感性、特异性、准确性分别为79.9%、87.3%、72.8%,AUC值为0.686。MIPs图较好地去除了脂肪高信号对图像评估的干扰,对病灶的形态学特征显示清晰,立体反映病灶的空间位置及病灶周边、病灶内的异常血管与病灶之间的空间关系,在同一幅图上即能反映同侧或对侧的多发病灶及其血供情况。动态增强扫描减影生成的MIPs图,乳腺肿瘤侧的血管显示较健侧多。早期乳腺癌病灶周边多见细小密集的血管影,中晚期乳腺癌病灶周边多可见粗大扭曲的血管影,而瘢痕组织周围的血管中断。结论:MIPs无需增加扫描序列和延长扫描时间,将8个时相的2000多幅动态扫描图信息浓缩于16幅冠状位、轴位图像中,对乳腺疾病的观察,尤其对乳腺良、恶性肿瘤的判定起重要作用。

Objective：To study the value of dynamic contrast enhanced subtraction MRI of MIPs in the diagnosis of breast disease.Methods：A total of 239 breast lesions（214cases）confirmed by operation and（or）fine-needle aspiration biopsy（FNAB）were included in the study,then eight phases MIPs coronal and axial images were collected after MRI dynamic enhanced subtraction,the relationship between lesions and vessels in the MRI dynamic contrast enhanced subtraction images（SUB-MIPs）were analyzed,the diagnostic sensitivity,specificity,accuracy and area under the ROC curve（AUC）of MIPs were statisticed.Results：The diagnostic sensitivity,specificity,accuracy of MIPs was 79.9%,87.3%,72.8%respectively,the AUC was 0.686.MIPs images can remove the interference from fatty high signal intensity effectively and display the lesions morphological features clearly.The lesions space position and the relationship between lesions and abnormal vessels inside and around the lesions were reflected,multifoci and its blood supply in the ipsilateral or contralateral breast can be reflected on the same image.MIPs images produced by MRI dynamic contrast enhanced subtraction showed that the vessels in the breast tumor side were more than the normal side.Breast cancer showed small vessels around the lesions,middle-advanced breast cancer showed large and tortuous blood vessels,while the vessels were interrupted in the peripheral of the scar tissue.Conclusion：MIPs can be performed without additional scanning sequence and time,and eight phases included more than two thousand enhanced images were compressed into sixteen coronal and axial images,it is important for the diagnosis and differential diagnosis of breast benign and malignant tumors.