磁共振增强形态及强化方式对乳腺病变的诊断价值研究

Diagnosis value of enhancement shape and reinforcement schedule of DCE-MRI in breast diseases

目的:探讨乳腺磁共振对比增强扫描(DCE-MRI)的增强形态、强化方式在乳腺良恶性病变中的特征性表现及诊断价值。方法:选取手术和(或)穿刺组织病理活检证实的214例乳腺占位性病变患者(239个乳腺病灶)的MRI资料,其中恶性病灶155个,良性病灶84个,均行乳腺MRI对比剂动态增强扫描,统计分析乳腺良恶性病灶的对比增强形态、强化方式。结果:乳腺恶性病灶的特征性表现为肿块型病变,占96.7%,其中浸润性导管癌最多,占82.9%;肿块型良性病变中纤维腺瘤最多见,占61.1%。线样或导管样强化,以浸润性导管癌及导管乳头状癌多见;局限性强化,以硬化性腺病多见。MRI增强形态诊断恶性肿瘤的敏感性、特异性、准确率分别为79.1%、50.0%、68.6%;强化方式诊断恶性肿瘤的的敏感性、特异性、准确率分别为81.9%、58.9%、74.5%;动态增强扫描病灶充填型强化的恶性发生率最高,为95.8%。结论:乳腺恶性病灶的特征性表现为肿块型病变,其边缘不清、形态不规则,信号不均匀,环形强化,周围细毛刺征,以浸润性导管癌多见。良性占位性病变表现为中心向周围扩散的离心样强化或均匀强化,边界清晰,以纤维腺瘤多见。因此,DCE-MRI增强形态及强化方式在乳腺良恶性病变的诊断中具有重要价值。

Objective：To explore the diagnostic value and characteristic appearances of enhancemrnt shape and reinforcement schedule of dynamic contrast enhanced MRI（DCEMRI）in breast benign and malignant lesions.Methods：A total of 214 patients（239 lesions）with breast space occupying solid lesions confirmed by operation and pathology included 155 malignant lesions and 84 benign lesions were selected in this study.All cases were given examination of DCE-MRI.The lesions enhancement shape and reinforcement schedule of breast benign and malignant were analyzed.Results：Breast malignant mass accounted for96.7%,and infiltrating ductal carcinoma accounted for 82.9% of that.The majority of breast benign mass were mammary gland fibroma and it accounted for 61.1%.Linear or tube enhancement were usually found in infiltrating ductal carcinoma and ductal papillary carcinoma,most of the mammary sclerosing adenosis were focal enhancement.The diagnosis sensitivity,specificity,accuracy of breast cancer enhancement shape were 79.1%,50.0%,68.6%,reinforcement schedule were 81.9%,58.9%,74.5% respectively.The filling type of enhancement shape had the highest incidence rate of breast carcinoma（95.8%）.Conclusion：Breast malignant lesions demonstrates a mass with ill-defined margins,irregular shape,heterogeneous signal,rim enhancement,and spicules of margin,most of the infiltrating ductal carcinoma are showed.Breast benign lesions are mammary gland fibroma and show center enhanced earlier and margin enhanced next,and homogenous enhancement,clear margins.In conclusion,enhancement shape and reinforcement schedule of DCE-MRI has important diagnostic value of breast space occupying diseases.