乳腺包裹性乳头状癌的MRI特点

MRI features of encapsulated papillary carcinoma

目的分析乳腺包裹性乳头状癌(EPC)的磁共振成像(MRI)特点,探究单纯EPC及EPC伴浸润或导管原位癌(DCIS)影像表现差异。方法回顾性分收集我院经病理证实且术前行乳腺MRI检查的乳腺EPC15例。分析乳腺EPC的MRI形态学特点、表观扩散系数(ADC)、动态增强特征及时间-信号强度曲线(TIC)特点。探讨单纯EPC及EPC伴浸润或DCIS两组的临床及MRI特征差异。结果 15例EPC中在MRI上表现为肿块,其中3例伴有节段性异常强化病灶。15例中,其中8例为囊实性肿块,7例为实性肿块;形态圆形及类圆形者10例,不规则形者5例;边缘清楚者11例,不规则者4例。EPC实性区域的ADC值为(1.14±0.27)×10^(-3) mm^2/s。15个肿块TIC类型以流出型(11例)多见,上升型(2例)及平台型(2例)少见。15个肿块中,14例增强晚期图像可见环形强化包膜,包膜于T2加权图像上多呈低信号(10例)。单纯EPC组平均为72.6岁,大于EPC伴浸润或DCIS组(61.2岁),两组差别有统计学意义(P=0.025)。单纯EPC及EPC伴浸润或DCIS两组MRI特点差异无统计学意义。结论 EPC在MRI上多表现为边缘清楚的囊实性或实性肿块,并可见包膜结构,ADC值较低,TIC多为流出型。EPC在MRI上表现具有一定的特征性,有助于术前正确诊断。

Objective To evaluate the MRI features of encapsulated papillary carcinoma（EPC） and to distinguish EPC with invasion or ductal carcinoma in situ（ DCIS） from pure EPC. Methods MRI of 15 patients with pathologically confirmed EPC was reviewed. The MRI features including the morphology, apparent diffusion coefficien t（ADC） values, dynamic contrast enhancement characteristics, and time-signal intensity curve（TIC） of the lesions were reviewed. The difference between pure EPC and EPC with invasion or DCIS was investigated. Results All 15 EPCs presented as masses and 3 were accompanied by segmental enhancement.The 15 masses were mixed cystic-solid（8） or purely solid（7）, round/oval（10） or irregular（5） with smooth（11） or irregular（4） mar-gins. The mean ADC value of the solid part of the mass was 1. 14 ± 0. 27 ×10^-3 mm^2/s. The TIC pattern was more commonly washout（ 11） than the persistent（ 2） and plateau（ 2） types. The masses showed capsules in delayed phase（ 14）, and the capsule was hy pointense on T2-weighted images（10）. The mean age of pure EPC（72.6 years） was significantly（ P =0.025） greater than that of EPC with invasion or DCIS. The MRI features showed no significant difference between these two groups. Conclusion EPC commonly presents as a cystic-solid or purely solid mass with smooth margin and capsule, lower ADC values, and washout TIC pattern.