动态增强MRI及DWI对乳腺导管原位癌和腺病的诊断

The Diagnostic Value of Dynamic Contrast-Enhanced MRI and DWI in DCIS and Adenosis

目的探讨动态增强磁共振成像(DCE-MRI)联合扩散加权成像(DWI)对乳腺导管原位癌(DCIS)和腺病的诊断价值。方法搜集74例经病理证实的乳腺疾病患者的MRI资料,其中DCIS 38例、腺病36例,术前均行DCE-MRI及DWI。统计病灶的形态学特征、时间-信号强度曲线(TIC)及表观扩散系数(ADC)值,并运用χ2检验和t检验分析DCIS和腺病组差异;采用受试者工作特征曲线(ROC)确定DCIS和腺病的ADC界值。结果 DCIS和腺病均以非肿块样强化多见(96.8%,94.4%),前者以导管样、节段样强化为主(22/38,57.8%),后者以区域性、弥漫性强化为主(20/36,55.5%);DCIS以均匀强化多见(15/38,39.5%),而以点簇样强化更具特征性。乳腺腺病多表现为不均匀强化(21/36,58.3%),且强化方式多变;Ⅰ型TIC多见于乳腺腺病(18/36,50%),而Ⅲ型曲线多见于DCIS(13/38,34.2%),Ⅱ型曲线在两者之间无显著差异。DCIS的ADC值(1.048±0.163)×10^(-3)mm^2/s显著低于乳腺腺病ADC值(1.521±0.323)×10^(-3)mm^2/s(b=800 s/mm^2),差异具有统计学意义(P<0.0001)。根据ROC曲线确定ADC界值为1.30×10^(-3)mm^2/s,诊断敏感性和特异性分别为79.8%、81.8%(b=800 s/mm^2)。结论DCE-MRI有助于鉴别DCIS和乳腺腺病,联合DWI能够提高诊断效能。

Objective To evaluate the diagnostic value of Dynamic enhanced MRI combined with DWI in ductal carcinoma in situ（ DCIS） and adenosis of mammary glands. Methods 74 cases of breast disease which were histologically confirmed were retrospectively reviewed on DCE-MRI and DWI,including 38 cases of DCIS and 36 cases of adenosis. Morphological characteristics of the lesions,time-signal intensity curve（ TIC） and the ADC value were focused. Chi-square test and two-sample t-test were applied to analyze the different features between DCIS and adenosis. The threshold ADC values for identifying DCIS were determined using a receiver operating characteristic curve（ ROC） analysis. Results Ductal and segmental enhancement patterns were mostly seen in DCIS（ 22/38,57. 8%）,regional and diffuse enhancement patterns were mostly seen in adenosis（ 20/36,55. 6%）. Homogeneous enhancement patterns were mostly seen in DCIS（ 15/38,39. 5%）. Clumped nodular enhancement patterns were seen in DCIS characteristically. Heterogeneous enhancement was frequently seen in adenosis（ 21/36,58. 3%）. Type Ⅲ time-signal curve was mostly seen in DCIS（ 13/38,34. 2%）. TypeⅠtime-signal curve was mostly seen in adenosis（ 18/36,50%）. Type Ⅱ time-signal curve is not different between the two kinds of pathological changes. The mean ADCs of DCIS were significantly lower than that of adenosis[（ 1. 048 ± 0. 163） ×10-3 mm2/s vs（ 1. 521 ± 0. 323） × 10-3 mm2/s,P 0. 0001 ]（ b = 800 s/mm2）. The sensitivity and specificity of the ADCs for identifying DCIS using a threshold of less than × 10-3 mm2/s was 79. 8% and 81. 8%,respectively（ b = 800 s/mm2）. Conclusion 3. 0 T dynamic enhanced MRI is helpful to identify DCIS and adenosis,and combined with DWI can improve the diagnostic efficiency.