体素内不相干运动成像在乳腺良恶性病变诊断中的价值

Diagnostic Value of Intravoxel Incoherent Motion Imaging in Distinguishing Benign and Malignant Breast Lesions

目的:探讨MR体素内不相干运动成像法鉴别诊断乳腺肿块样病变良恶性的价值,并与常规DWI检查对比。方法:本研究回顾性分析31例乳腺肿块患者(单发病灶23例,多发病灶8例,总病灶41个,良性病变23个,恶性病变18个),所有纳入研究的患者均行乳腺多b值DWI成像扫描,图像质量佳,并获得病理结果。后处理获得IVIM模型及常规扩散加权成像参数:单纯扩散系数(D)、假性扩散系数(D*)、灌注分数(f)及表观扩散系数(ADC值)。采用t检验分析良恶性病变各参数的差异,并采用ROC曲线分析差异有统计学意义的各参数鉴别诊断效能。结果:良性病变的ADC、D值均高于恶性病变,而f值高于恶性病变,差异均有统计学意义(P<0.05),而两者D*值比较差异无统计学意义(P=0.327)。D、ADC、f值的曲线下面积分别为0.854、0.778、0.714,其中D值的曲线下面积最大,且敏感性与特异性均较佳。结论:采用IVIM模型扩散加权成像可为诊断乳腺肿块样病变提供更多定量信息,对鉴别病变良恶性具有一定价值。

Objective ： To explore the value of intravoxel incoherent motion imaging （ IVIM ） in the differential diagnosis of benign and malignant breast lesions, and to compare IVIM with the routine examination of diffusion-weighted imaging （ DWI ） .Method： Thirty one cases of breast masses were retrospectively ana｜yzed, including 23 cases of single lesion and 8 cases of multiple lesions.Among them were 23 benign lesions and 18 malignant lesions with a total lesion number of 41 lesions.All patients were subjected to multiple B-value imaging scans, and clear images and pathology reports were obtained.IVIM model and the conventional DWI parameter values of pure diffusion coefficient （ D ）, pseudodiffusion coefficient （ D^＊ ）, perfusion fraction （f）, and apparent diffusion coefficient （ ADC ） weie identified by post-processing.The differences of the parameters of benign and malignant lesions were assessed with student＇s t-tests, and the differential diagnostic efficacies of the parameters with statistical difference were evaluated by receiver operator characteristic curve （ ROC ） .Result： Compared to those for malignant lesions, the values of ADC and D for benign lesions were higher, while the values of f were lower （ P〈0.05 ） .There was no significant differences between benign lesions and malignant lesions in D^＊ values （ P=0.327 ） .The area under the curve （ AUC ） values for D, ADC and f were 0.854, 0.778 and 0.714.AUC values of D were higher with better sensitivity and specificity.Conclusion： IVIM diffusion-weighted imaging can provide more quantitative information for the diagnosis of breast masses, and is valuable for the differential diagnosis of benign and malignant lesions.