多模态磁共振成像诊断乳腺环形强化病变

Multimodality MRI in diagnosis of breast lesions with ring enhancement

目的探讨多模态MRI对动态增强扫描(DCE)表现为环形强化的乳腺病变的诊断价值。方法回顾性分析经手术病理证实的67例乳腺病变患者的DCE-MRI、DWI资料,病灶DCE-MRI均表现为环形强化。根据病理结果将67例分为良性组和恶性组,比较2组DCE-MRI病灶整体形态学指标、"强化环"形态学指标、时间-信号强度曲线类型、DWI扩散受限分布位置指标、DCE-MRI半定量参数指标及"强化环"多点ADC值的差异。以病理结果为应变量,上述具有统计学差异的指标为自变量,建立Logisitc回归模型构建新的联合参数并评价其诊断效能。结果良、恶性组间"环形强化"环壁形态(χ~2=14.19,P=0.001)、是否具有壁结节(χ~2=12.48,P=0.001)、DWI扩散受限分布位置指标(χ~2=19.60,P=0.003)差异均有统计学意义;且2组间早期强化率(t=2.35,P=0.02),峰值达峰时间(T_(max);t=-4.66,P=0.007),ADC_(环内)(t=1.35,P=0.001)、ADC_(环壁)值(t=-2.88,P=0.005)差异均有统计学意义。新构建"强化环"形态学指标+DWI扩散受限分布位置+T_(max)+ADC_(环内)参数联合诊断乳腺病变性质的约登指数最高为0.83,ROC曲线下面积为0.87[95%CI(0.82,,0.91)],诊断敏感度及特异度分别为91.96%和91.31%。结论乳腺MR多模态成像对乳腺环形强化病变具有较高的诊断效能。

Objective To investigate the value of multimodality MRI in diagnosis of breast lesions with ring enhancement（internal enhancement pattern）on dynamic contrast enhanced（DCE）MRI.Methods Data of 67 patients with breast lesions confirmed by surgical pathology who underwent DCE MRI and DWI examinations were analyzed retrospectively.Finally,67 patients with breast lesions manifested as ring enhancement on DCE MRI were included in the study.According to the pathological findings,all patients were divided into benign group and malignant group.The overall morphology,morphology of ＂enhanced ring＂,time-signal intensity curve（TIC）types on DCE MRI,the distribution location of limited diffusion on DWI between the two groups were compared.Also the differences in semi-quantitative parameters on DCEMRI and multi-point ADC values of the ＂enhanced ring＂ between the two groups were compared.Using pathological results as the dependent variables,indexes with statistical differences as the independent variables,the Logistic regression model was established to construct the newly combined parameters and to evaluate the diagnostic efficacy of the stepwise combined parameter.Results There were significant differences of different wall shapes concerning ＂ enhanced ring＂（χ~2=14.19,P=0.001）,wall nodules（χ~2= 12.48,P=0.001）and distribution locations of limited diffusion on DWI（χ~2= 19.60,P=0.003）between the two groups.There were also significant differences of the semi-quantitative parameters including early enhancement ratio（EER;t=2.35,P=0.02）,maximum enhancement time（T_（max）;t=-4.66,P=0.007）,ADC_（ring inner）（t=1.35,P=0.001）and ADC_（ring wall）（t=-2.88,P=0.005）between the two groups.The maximum Youden index of a newly-constructed parameter combination（morphological indexes of ＂enhanced ring＂ ＋distribution locations of limited diffusion on DWI＋T_（max）＋ADC_（ring inner））was 0.83 for combined diagnosis.The area under ROC curve was 0.87（95%CI[0.82,0.91]）,and the diagnostic sensitivity and specificity was 91.96%and 91.31%,respectively.Conclusion Multimodality MR can provide high diagnostic efficacy for breast lesions with ring enhancement