乳腺良性及交界性叶状肿瘤与纤维腺瘤磁共振的差异性表现

Differentiation of breast benign and borderline phyllodes tumors from fibroadenomas on MRI

目的分析乳腺低级别叶状肿瘤(phyllodes tumors,PT)与纤维腺瘤(fibroadenoma,FA)的磁共振特征,提高两者的鉴别诊断水平。材料与方法搜集术后经病理证实且有完整磁共振资料的良性及交界性叶状肿瘤52例、纤维腺瘤68例,对其MRI征象表现进行统计学分析。结果叶状肿瘤以分叶状或多结节融合状多见,纤维腺瘤以圆形或类圆形多见,无多结节融合状;叶状肿瘤及纤维腺瘤都以边缘光滑多见;T1WI上18个良性及交界性叶状肿瘤病灶内见片状高信号影,病理提示出血,纤维腺瘤只有5例出现高信号;T2WI上叶状肿瘤多呈高信号,纤维腺瘤多呈低或等低信号;动态增强叶状肿瘤多呈明显不均匀强化,可见无强化分隔及囊变;纤维腺瘤多表现为均匀强化,1例出现囊变,可见无强化分隔;时间信号强度曲线(time-signal intensity curve,TIC)分型,叶状肿瘤以Ⅱ型多见,纤维腺瘤以Ⅰ型多见;DWI信号表现,叶状肿瘤全部表现为高信号,纤维腺瘤有8例表现为等低或低信号。结论乳腺良性及交界性叶状肿瘤与纤维腺瘤在形状、信号、强化方式及TIC表现上具有一定差异,有助于其与纤维腺瘤的鉴别诊断。

Objective： To analyze the MRI characteristics of benign and borderline phyllodes tumors （PT） and fibroadenomas of the breast, and to improve the differential diagnosis. Materials and Methods： We analyzed MRI features statistically of 52 cases of benign and borderline lohulated tumors and 68 cases of fibrous adenoma, which were confirmed by postoperative pathology and had complete magnetic resonance data in our hospital. Results： The phyllodes tumors were more common in lobulated or multi nodular fusion shapes or round like shape, and there were no Fibroadenomas were more common in round multi nodular fusion. Both phyllodes tumors and fibroadenomas were commonly smooth. Eighteen phyllodes tumors showed a flaky high signal in the lesion on T1WI, and the pathology showed bleeding. Only 5 cases of fibroadenomas showed high signal. On T2WI, phyllodes tumors showed high signal and fibroadenomas showed low or equal-low signal. After dynamic enhanced scanning, phyllodes tumors showed obvious and uneven enhancement, cystic changes were seen in part. Fibroadenomas showed uniform enhancement, only 1 case showed cystic change, both showed no reinforcement separation. Time signal intensity curve （TIC） classification, phyllodes tumors was more common in type Ⅱ, fibroadenomas was more common in type Ⅰ. On DWI performance, phyllodes tumors all showed high signal, and 8 cases of fibroadenomas showed low or equal-low signal. Conclusions： The benign and borderline phyllodes tumors and fibroadenomas of the breast have some differences in shape, signal, enhancement mode and TIC curve, which are helpful for the differential diagnosis of fibroadenomas.