乳腺弥散加权成像在乳腺疾病诊断中的应用

Application of breast diffusion weighted imaging in the diagnosis of breast disease

目的探讨乳腺弥散加权成像(DWI)在乳腺疾病诊断中的应用价值。方法选择2010年3月至2017年5月间广东省第二中医院诊治的60例乳腺占位患者及20例健康体检者为研究对象,行DWI检查,测量并比较病变及正常乳腺表观弥散系数(ADC)值,观察其诊断效力。结果随着b值升高,乳腺病变DWI图像的ADC值减少。当b取值为500 s/mm^2和1 000 s/mm^2时,正常乳腺组织、良性及恶性病变的ADC值变化趋势逐渐减少,组间比较差异有统计学意义(P<0.05);以各b值恶性病变95%可信区间上限作为良、恶性肿瘤的ADC阈值,当b取值为500 s/mm^2和1 000 s/mm^2时,其判断乳腺癌的敏感度、特异性及准确性分别为81.48%、84.91%、83.75%和96.30%、94.34%、95.00%,差异均有统计学意义(P<0.05)。结论应用DWI鉴别乳腺疾病具有一定优越性,结合ADC值,当b值取1 000 s/mm^2时,鉴别乳腺良恶性病变有较高的敏感性和特异性。

Objective To investigate the application of diffusion weighted imaging（DWI） in the diagnosis of breast disease. Methods From March 2010 to May 2017, 60 breast occupying patients and 20 healthy persons in the Second Hospital of Traditional Chinese Medicine of Guangdong were selected as the subjects. DWI examination was performed. The apparent diffusion coefficient（ADC） values of the lesions and normal breast were measured and compared, and the diagnostic potency was observed. Results With the increase of B value, the ADC value of the DWI image of the breast lesions reduced. When the b value was 500 s/mm^2 and 1 000 s/mm^2, the trend of ADC value in normal breast tissue, benign and malignant lesions gradually decreased, and the difference between groups was significant（P0.05）. The upper 95% confidence interval of each b value of malignant lesions was used as the ADC threshold of benign and malignant tumors. When B was 500 s/mm^2 and 1 000 s/mm^2, the sensitivity, specificity and accuracy of breast cancer were respectively 81.48%, 84.91%, 83.75% versus 96.30%, 94.34%, 95.00%（P0.05）. Conclusion DWI has superiority in identifying breast diseases. Combined with ADC value, when b value is 1 000 s/mm^2, it is highly sensitive and specific for differentiating benign and malignant breast lesions.