3.0T磁共振联合序列检查对乳腺良恶性病变的鉴别诊断价值

Differential diagnosis significance of 3.0T MRI united-sequence examination for benign and malignant breast lesions

目的探索3.0T磁共振联合序列检查对乳腺良、恶性病变的鉴别诊断价值。方法前瞻性收集2015年11月至2017年1月期间于电子科技大学附属医院·四川省人民医院行乳腺MRI检查的59例乳腺病变患者的67个病灶作为研究对象,分析动态增强扫描形态学特点(Fischer评分)、时间-信号强度曲线(TIC)、表观扩散系数(ADC)及三者的联合应用对乳腺良、恶性病变的鉴别诊断价值。结果 67个病灶经病理学检查证实恶性49个,良性18个。乳腺良性病变和恶性病变的多期动态增强扫描形态学特点(包括边缘、形态、边界及信号均匀度)、TIC分型及ADC值比较差异均有统计学意义(P<0.05)。Fischer评分诊断乳腺良恶性病变的灵敏度为89.8%(44/49),特异度为61.1%(11/18);TIC分型诊断乳腺良恶性病变的灵敏度为83.7%(41/49),特异度为77.8%(14/18);ADC值诊断乳腺良恶性病变的最佳界点为1.012×10–3 mm2/s,此时灵敏度为91.8%(45/49),特异度为83.3%(15/18);Fischer评分联合TIC分型诊断乳腺良恶性病变的灵敏度为95.9%(47/49),特异度为72.2%(13/18);Fischer评分、TIC分型和ADC值三者联合诊断乳腺良恶性病变的灵敏度为98.0%(48/49),特异度为83.3%(15/18)。结论 3.0T磁共振扫描的Fischer评分、TIC分型和ADC值三者联合对乳腺良恶性病变的鉴别诊断价值比单一检查方法较高。

Objective To explore the differential diagnosis significance of 3.0T MRI united-sequences examination in the diagnosis of benign and malignant breast lesions. Methods A total of 67 breast lesions of 59 patients were collected prospectively, which be treated at the Sichuan Provincial People＇s Hospital during July 2015 to January 2017. All patients were underwent bilateral breast 3.0T magnetic resonance plain scan, diffusion weighted imaging, and dynamic enhanced scan successively before surgical operation. Analysis of morphological features of the benign and malignant breast lesions, the time-signal intensity curve （TIC）, the apparent diffusion coefficient （ADC）, and the combination diagnosis of them were performed. Results Of all 59 patients, 67 lesions were confirmed by histopathology, including 18 benign lesions and 49 malignant lesions. The morphological features （including margin, shape, border, and evenness）, the types of TIC of dynamic enhancement, and ADC value between the benign lesions and malignant lesions were statistically significant （P〈0.05）. The sensitivity and specificity of Fischer scoring system was 89.8% （44/49） and 61.1% （11/18） respectively. The sensitivity and specificity of TIC types was 83.7% （41/49） and 77.8% （14/18） respectively. The diagnostic threshold of ADC value was 1.012× 10-3 mm2/s, with the sensitivity and specificity forthe diagnosis was 91.8% （45/49） and 83.3% （15/18） respectively. The sensitivity and specificity of the combination of Fischer scoring system and TIC type for diagnosis between benign and malignant breast lesions was 95.9% （47/49） and 72.2% （13/18） respectively. The sensitivity and specificity of the combination of Fischer scoring system, TIC type, and ADC value for benign and malignant breast lesions was 98.0% （48/49） and 83.3% （15/18） respectively. Conclusion The combination of Fischer scoring system, TIC type, and diffusion-weighted imaging for the differential diagnosis between benign lesions and malignant lesions was more effective than single imaging method.