特发性肉芽肿性乳腺炎磁共振特征分析

Analysis of MRI Features of Idiopathic Granulomatous Mastitis

目的分析特发性肉芽肿性乳腺炎(IGM)的磁共振特征,提高对本病的认识及术前诊断正确率。方法收集2014年1月至2017年12月期间我院行乳腺磁共振检查并经病理证实为特发性肉芽肿性乳腺炎的16例患者资料,依据美国放射学会提出的乳腺影像报告和数据系统磁共振成像(BI-RADS-MRI)标准,回顾性分析病变的磁共振表现,包括形态学、平扫T1WI及T2WI信号、动态增强(DCE)、时间-信号强度曲线(TIC)类型及表观扩散系数(ADC)值。结果共16例患者均为单侧病灶,右侧11例,左侧5例,磁共振平扫T1WI均呈等或稍低信号,T2WI均呈不均匀高信号,增强扫描呈肿块状强化9例,非肿块状强化6例。可见异常强化的15例患者中,病灶均边界不清,内均可见囊变信号,增强扫描14例早期(注射2min内)见快速强化,TIC呈流入型1例、平台型10例、流出型3例。13例累及乳头、乳晕及临近皮肤,5例与胸大肌间脂肪间隙消失。13例周围见增粗迂曲血管。6例伴同侧腋窝淋巴结肿大。16例患者中可测得ADC值者14例,范围0.87×10^(-3)mm/s-1.97×10^(-3)mm/s。结论DCE、TIC类型结合形态学分析、临床病史综合考虑有助于提高特发性肉芽肿性乳腺炎术前诊断的正确率。

Objective To analyze the MRI features of idiopathic granulomatous mastitis(IGM)and to improve the preoperative diagnostic accurancy of IGM.Methods A total of 16 patients with pathologically-proved IGM,who were encountered at Fujian Province Cancer Hospital during the period from Jan 2014 to Dec 2017,were enrolled in this study.Breast MRI examination was performed in all patients.According to Breast Imaging and Reporting Data System Magnetic Resonance Imaging(BI-RADS-MRI)standard,which was proposed by American Radiological Society,the MRI manifestations,including morphology,signal intensity on plain T1WI and T2WI,dynamic contrast enhanced MRI(DCE-MRI),the pattern of time-signal intensity curve(TIC)and apparent diffusion coefficient(ADC)values,were retrospectively analyzed.Results The lesions of 16 cases located in unilateral breast,11 cases on the right breast and 5 cases on the left.All of them presented iso-intensity and hypo-intensity signal on T1WI,and presented heterogeneous hyper-intensity signal on fat suppressed T2WI.On contrast enhanced MRI,the enhanced lesions showed mass-like enhancement in 9 cases and non-mass like enhancement in 6 cases,all of the enhanced lesions appeared as unclear edge and cystic areas.14 lesions presented with fast enhancement in 2 minutes,and the TIC types presented as inflow type,insistent type,and outflow type in 1,10 and 3 lesions respectively.13 cases showed nipple involved and skin thickening.5 cases showed fuzzy fat gap between lesion and pectoralis major.There were 13 cases with supplying arteries dilated.6 cases with ipsilateral axillary lymph nodes enlarged.ADC values ranged from 0.87×10^-3 mm/s to 1.97×10^-3 mm/s in 14 cases.Conclusion The DCE-MRI and TIC curve combined with morphology and clinic data,can help to improve the preoperative diagnostic accurancy of IGM.