磁共振扩散加权成像联合动态增强扫描在鉴别乳腺癌术后复发与瘢痕的临床研究

DWI combined with DCE in differentiating recurrence and scar after surgery of breast cancer

目的探讨MR扩散加权成像(DWI)联合动态增强扫描(DCE)在鉴别乳腺癌术后复发与瘢痕中的价值。方法收集因怀疑乳腺癌复发就诊于我院的患者35例,35例患者均有乳腺癌手术史,自手术至MR检查时间为6~52个月。所有患者接受MR检查,加常规扫描加扫DWI与DCE,且所有病灶均于MR检查后2周内行经穿刺活检或再次手术获得病理证实。结果 35例乳腺癌术后复查患者中,DWI联合DCE共检出病灶39个,病理证实其中23个病灶为瘢痕,16个病灶为肿瘤复发,复发的肿瘤ADC值为(1.02±0.31)×10^(-3)mm^2/s,明显低于术后炎症改变或纤维瘢痕的ADC值(1.34±0.29)×10^(-3)mm^2/s(P<0.05)。DWI联合DCE诊断乳腺癌复发灶的敏感性为93.8%、特异性为91.3%、阳性预测值为88.2%、阴性预测值为95.5%;准确性为92.3%。结论 DWI联合DCE鉴别乳腺癌复发与术后瘢痕具有较高的准确性、敏感性、特异性以及阳性预测值,建议在乳腺癌患者术后的随访MRI检查将DWI联合DCE纳入常规扫描序列。

Objective To investigate the value of diffusion weighted imaging（ DWI） combined with dynamic contrast enhanced scan（ DCE） in the differential diagnosis of breast cancer recurrence and scar. Methods A total of 35 patients with suspected breast cancer recurrence in our hospital were enrolled. 35 patients had breast cancer surgery history. The time from surgery to MRI was 6 - 52 months. All patients underwent magnetic resonance imaging,with conventional scan plus DWI and DCE scan,and all lesions were pathologically verified by biopsy or reoperation in two weeks after magnetic resonance imaging. Results In these 35 cases,DWI combined with DCE detected 43 lesions,including 29 scars and 14 lesions of tumor recurrences confirmed by pathology. ADC value of tumor recurrence was（ 1. 02 ± 0. 31） × 10^-3mm^2/s,significantly lower than that of inflammation or fibrous scar（ 1. 34 ± 0. 29） × 10^-3 mm^2/s,（ P〈0. 05）. The accuracy,sensitivity,specificity and positive predictive value of DWI combined with DCE in the diagnosis of breast cancer recurrence were 92. 3%,93. 8%,88. 2%,and 95. 5% respectively.Conclusion DWI combined with DCE in differential diagnosis of breast cancer recurrence and postoperative scar has high accuracy,sensitivity,specificity,positive predictive value,which can be used as a routine method in follow-up of patients with breast cancer.