男性乳腺癌的磁共振影像学表现及与炎性肉芽肿的鉴别

The differential expression of magnetic resonance imaging between male breast cancer and inflammatory granuloma

目的:探讨男性乳腺癌的MR影像学表现及与乳腺炎性肉芽肿病变的鉴别诊断特征。方法:经手术和病理证实男性乳腺癌4例,乳腺炎性肉芽肿6例。所有患者均行MR动态增强和DWI成像。结果:二组病变发病部位均为乳头后,均表现为肿块性病变。乳腺癌组形态上卵圆形2例、不规则形2例;边缘清晰和不规则形各2例;内部强化不均匀1例和边缘强化3例;2例病变累及皮肤;TIC曲线表现为Ⅲ型3例,Ⅱ型1例;ADC值均值0.897×10^(-3) mm^2/s。炎性肉芽肿组形态上卵圆形2例、不规则形4例;边缘不规则和毛刺状各2例;内部强化不均匀2例和边缘强化4例;TIC曲线均为Ⅱ型平台型。ADC值均值0.901×10^(-3)mm^2/s。乳腺癌病灶边缘强化明显,中心强化低于边缘(3例)或不均匀强化(1例);炎性肉芽肿组病灶内见范围不等无强化区(4例),此无强化区于T_2WI呈明显高信号;在动态图像上可以观察到病变离心性强化和病变边缘逐渐模糊改变(2例)。结论:男性乳腺癌与炎性肉芽肿病灶内部强化方式和强化曲线在二组疾病鉴别诊断中发挥重要作用。乳腺癌病灶内部不均匀强化或边缘强化明显,中心强化低于边缘,曲线以Ⅲ型曲线为主;炎性肉芽肿组病灶内见范围不等无强化区或者在动态图像上可以观察到离心性强化和病变边缘逐渐模糊改变,强化曲线为Ⅱ型。

Objective： To investigate the differential diagnosis of MR imaging findings of male breast cancer and inflam- matory granuloma. Methods： Confirmed by operation and pathology, 4 cases of male breast cancer and 6 cases of granuloma- tous mastitis were underwent dynamic contrast-enhanced MR imaging and DWI. Results： The location of the lesions in the two groups were all behind the nipple, and all showed mass lesion. 2 cases of breast cancer were morphologically oval, irregular in 2 cases; clear edge in 2 cases and irregular shape in 2 cases. Internal inhomogeneous enhancement in 2 cases and edge enhancement in 4 cases. 2 cases of skin were involved. The TIC curve showed 3 cases of type Ⅲ, 1 cases of type Ⅱ. The average ADC value was of 0.897x10-3 mm2/s. Inflammatory granuloma were morphologically oval in 2 cases and irregular in 4 cases. There was irregular edge and spiculated in 2 cases. Internal inhomogeneous enhancement in 2 cases and edge enhancement in 4 cases. The TIC curve were all of type 1I. The average ADC value of 0.901x10-3 mm2/s. The edge of the mass were enhanced highly, edge enhancement is higher than that of the center （3 cases） or uneven enhancement （1 cases）. There was no enhancement zone （4 cases） in the inflammatory granuloma group. There was no obvious enhancement in the area where high intensity on T/WI. Centrifugal enhanced and the edge of the lesion gradually blurred in the dynamic images（2 cases）. Conclusion： For the diagnosis of male breast cancer and inflammatory granuloma lesions, internal enhancement and enhancement curves play an important role in the differential diagnosis of disease in two groups. Breast cancer lesions were of inhomogeneous enhancement or obvious enhancement. Edge enhancement is higher than that of center curve and with TIC curve type Ⅲ. No enhancement area could be observed in granuloma group lesions. Centrifugal enhancement and the edge of lesions gradually blurred could be observed on dynamic image. Enhancement curve were type II.