乳腺占位性病变内液性信号区表观扩散系数对病变性质的诊断价值研究

Diagnostic Value of Apparent Diffusion Coefficient of the Liquid Area Inside a Breast Space-Occupying Lesions for Determining the Nature of the Lesion

目的探讨乳腺占位性病变内液性信号区MRI表观扩散系数(ADC)值对病变性质的鉴别诊断价值。方法回顾性分析内含液性区并经病理证实的54例乳腺疾病患者资料,根据其病理结果分为恶性肿瘤组(28例)、良性肿瘤组(13例)、炎性病变组(13例)。术前行MRI扫描,测量病变内液性区域ADC值,并采用单因素方差分析,比较三组乳腺病变内平均ADC值的差异性。采用受试者工作特征曲线(ROC)分析液性区ADC值对乳腺病变性质的诊断效能。结果乳腺恶性肿瘤组、良性肿瘤组和炎性病变组液性区的ADC均值分别为(2.03±0.52)×10^(-3)mm^2/s、(1.99±0.56)×10^(-3)mm^2/s和(1.17±0.66)×10^(-3)mm^2/s,差异具有统计学意义(F=11.242,P<0.01)。确定1.61×10^(-3)mm^2/s作为肿瘤性病变与炎性病变的鉴别诊断阈值时,其诊断敏感度、特异度以及约登指数分别为83%、77%和0.60;取1.61×10^(-3)mm^2/s作为恶性肿瘤与炎性病变的鉴别诊断阈值时,其诊断敏感度、特异度以及约登指数分别为89%、77%和0.66;采用1.32×10^(-3)mm^2/s作为鉴别良性占位性病变和炎性病变的诊断阈值时,其诊断敏感度、特异度以及约登指数分别为85%、69%和0.54。结论乳腺占位性病变液性区ADC值对于乳腺恶性肿瘤与炎性病变的鉴别具有较高的应用价值,能够为临床诊断提供一条新的途径。

Objective The value of MRI apparent diffusion coefficient （ADC） of the liquid area inside breast spaceoccupying lesions for the differential diagnosis of lesions was explored, so as to improve the diagnostic value of breast diseases by MR DWI. Methods Fifty-four patients with breast diseases, whose lesions contained liquid areas which were confirmed pathologically, were analyzed retrospectively. The patients were divided into malignant tumor group （28 cases） , benign tumor group （13 cases） and inflammatory lesion group （13 cases） according to the pathological results. MRI was conducted before operation. The ADC value of the liquid area inside the lesion was measured. The difference in average ADC value among the three groups was analyzed by one-way ANOVA. ROC analysis was used to calculate and analyze the diagnostic efficiency of ADC value on the nature of breast lesions. Results The average ADC of malignant tumor group, benign tumor group and inflammatory lesion group was （2.03 ± 0.52） , （ 1.99 ± 0.56） and （ 1.17 ± 0.66） × 10^-3 mm2/s, respectively, with significant difference （F = 11. 242, P 〈 0.01 ）. When 1.61 × 10^-3 mm2/s was used as the differential diagnosis threshold of neoplastic lesions and inflammatory lesions, the diagnostic sensitivity, specificity and Youdeng index were 83% , 77% and 0.60, respectively. When 1.61×10^-3mmZ/s was used as the differential diagnosis threshold of malignant tumor and inflammatory lesions, the diagnostic sensitivity, specificity and Youden＇s index were 89%, 77% and 0.66, respectively. When 1.32 ×10^-3mmZ/s was used as the differential diagnosis threshold of benign space-occupying lesions and inflammatory lesions, the diagnostic sensitivity, specificity and Youdeng index were 85% , 69% and 0.54, respectively. Conclusion The ADC value of the liquid area of breast space-occupying lesions is valuable for the identifica-tion of malignant tumor and inflammatory lesions of the breast, and can provide a new approach to clinical diagnosis.