CESM在乳腺普查中应用可行性的初步研究和探讨

Preliminary Study and Discussion on the Feasibility of Application of CESM in Breast General Screening

目的初步研究和探讨增强光谱钼靶(CESM)在乳腺普查中应用的可行性。方法以2017年7月—2018年1月经我院医学影像科确诊需进一步检查的123例普查对象为受试者,均接受X线摄影检查及磁共振成像(MRI)检查。由2名高年资的医学影像诊断医生对所有受试者的乳腺CESM及MRI检查影像进行读片,并作出诊断以及做出BI-RADS分期。计算并比较CESM和MRI的诊断结果,比较两种方法的诊断敏感性、阳性预测值。结果 CESM检查出的病灶共147个,BI-RADS分期Ⅰ期6个,Ⅱ期98个,Ⅲ期30个,Ⅳ期13个。MRI检查出病灶共152个,BI-RADS分期Ⅰ期5个,Ⅱ期103个,Ⅲ期31个,Ⅳ期13个。CESM测量的病灶直径大小最大51.8 mm,最小3.06 mm。MRI检查测量的病灶直径最大53.32mm,最小3.12 mm。经分析,2种检查测量结果差异无统计学意义(P>0.05)。两种检查方法均能检测出直径大小约等于3 mm的病灶。以磁共振动态增强扫描(DCE-MRI)结果作为金标准,CESM在检查出乳腺恶性肿瘤的敏感性为100%(13/13),阳性预测值为96.71%(147/152)。结论 CESM的诊断敏感性、阳性预测值均较高,且CESM的检查方法较MRI简单,检查禁忌证及检查时间较少,故更适合用于乳腺疾病的普查。

Objective To preliminarily study and explore the feasibility of application of enhanced molybdenum target （CESM） in breast screening. Methods 123 patients who confirmed the need for further examination in the medical imaging department of our hospital from July 2017 to January 2018 were selected, all patients were given X-ray examination and MRI examination. Two senior medical imaging diagnosticians performed the CESM and MRI examination images of all breasts of all subjects and made diagnosis and BI-RADS staging. The diagnostic results of CESM and MRI were compared and the diagnostic sensitivity and positive predictive value of the two methods were compared. Results A total of 147 lesions were detected by CESM, including 6 cases in BI-RADS stage I, 98 cases in stage II, 30 cases in stage III, and 13 cases in stage IV. A total of 152 lesions were examined by MRI, including 5 cases in BI-RADS stages, 103 cases in stage II, 31 cases in stage III, and 13 cases in IV stages. The lesion diameter measured by CESM was up to 51.8 mm, a minimum of 3.06 mm. The diameter of the lesion measured by MRI examination was up to 53.32 mm, a minimum of 3.12 mm. After analysis, there was no statistically significant difference between the two inspection results （P 〉 0.05）. Both methods can detect lesions with diameters of approximately 3 mm. Using DCE-MRI as the gold standard, the sensitivity of CESM in detecting mammary malignancy was 100% （13/13）, and the positive predictive value was 96.71% （147/152）. Conclusion CESM＇s diagnostic sensitivity, positive predictive value and MRI are comparable, and it has a higher sensitivity and accuracy in detecting breast disease. CESM examination method is simpler than MRI, and examination of contraindication and examination time is less, so it is more suitable for census of the disease.