MRI鉴别诊断乳腺癌腋窝淋巴结转移

MRI in differential diagnosis of metastatic axillary lymph nodes in breast cancer

目的探讨MRI对乳腺癌患者腋窝淋巴结转移的鉴别诊断价值。方法分析经病理证实并行腋窝MR扫描的44例乳腺癌患者资料,分析MRI表现,包括淋巴结长径、短径、皮质厚度、ADC值、淋巴门情况、淋巴结边缘、周围脂肪间隙情况、DWI信号、强化方式及时间—信号强度曲线等,并绘制的ROC曲线分析淋巴结长径、短径、皮质厚度、ADC值对腋窝淋巴结转移的诊断效能。结果病理结果显示有淋巴结转移者24例(24/44,54.55%),无淋巴结转移者20例(20/44,45.45%),两者淋巴结长径、短径、皮质厚度、ADC值、淋巴门是否消失、淋巴结边缘、周围脂肪间隙、DWI信号、强化方式差异均有统计学意义(P均<0.05)。淋巴结长径、短径、皮质厚度及ADC值的ROC曲线下面积分别为0.797、0.765、0.848、0.749。结论 MRI在鉴别乳腺癌腋窝淋巴结状态中有重要价值,皮质厚度大于0.54cm高度提示腋窝淋巴结转移。

Objective To explore the value of axillary MRI in differential diagnosis of metastatic axillary lymph nodes in patients with breast cancer. Methods Axillary MRI was performed in 44 breast cancer patients proved by pathology. Long axis, short axis, cortex thickness, ADC value, hilus, margin, perifocal fat gap, signal intensity on DWI, enhancement pattern and time-signal intensity curve were analyzed. The diagnostic ability of long axis, short axis, cortex thickness and ADC value were analyzed with ROC curves. Results Twenty-four patients （24/44, 54.55%） were proved with metastases axillary lymph nodes, the other 20 patients （20/44, 45.45% ） were negative. Long axis, short axis, cortex thickness, ADC value, hilus absence, irregular margin, fuzzy perifocal fat gap, high signal intensity on DWI and heterogeneous en hancement showed statistically significant between patients with metastatic and without metastatic axillary lymph nodes （all P〈0.05）. The area under ROC curve of long axis, short axis, cortex thickness and ADC value were 0. 797, 0. 765, 0. 848, 0. 749 respectively. Conclusion MRI plays an important role in differential diagnosis of axillary lymph nodes metastasis. The cortex thickness larger than 0.54 cm can help to predict metastatic axillary lymph nodes.