MRI动态增强定量分析在鉴别乳腺良恶性结节中的诊断价值

The quantitative analysis of MR dynamic contrast-enhancement in benign and malignant breast nodules

目的探讨磁共振动态增强(DCE-MRI)的血流动力学定量参数在鉴别乳腺良恶性病变中的应用价值。方法搜集2016年1月～2018年2月行乳腺DCE-MRI扫描,且均有病理和临床随访证实的乳腺结节患者51例。先行乳腺常规MRI平扫,然后采用T_1高分辨率各向同性容积采集技术(T_1 high resolution isotropic volume excitation, THRIVE)先后进行5次不同翻转角(3°、6°、9°、12°、15°)扫描、再进行DCE-MRI的60期动态扫描,将5组不同翻转角序列、60个动态增强序列先后导入到Omni-Kinetics分析软件中,计算出病灶的K^(trans)、K_(ep)、V_e、iAUC等动力学参数。并运用t检验分析良恶性结节的差异,采用受试者工作特征曲线(ROC)确定良恶性结节的界值。结果良恶性结节的K^(trans)、V_e值比较有显著性统计学差异(P<0.05),K_(ep)、iAUC之间无统计学差异(P>0.05)。恶性结节的K^(trans)、V_e值明显高于良性结节,根据ROC曲线确定K^(trans)的诊断价值较大,K^(trans)选取0.72为截点时,诊断敏感性为75.8%,特异度为84.7%。结论 DCE-MRI可以量化分析乳腺结节的血流动力学,其中的K^(trans)、V_e值有助于乳腺良恶性结节的鉴别诊断。

Objective To investigate the differential value of DCE-MRI in benign and malignant breast lesions. Methods In this retrospective study, we enrolled 51 patients with breast nodules who were confirmed by DCE-MRI scan from January 2016 to February 2018. Firstly, regular breast MRI scan was done, then MRI dynamic scanning was done with T 1 high-resolution isotropic volume acquisition (T 1 high resolution isotropic volume excitation, THRIVE) technology which has five different turn angles (3°, 6°, 9°, 12° and 15°) and finally, 60 dynamic enhanced sequences of MRI dynamic scanning were done. These image sequences were imported into the Omni - Kinetics analysis software and the kinetic parameters of K trans , K ep , V e and iAUC were calculated. T test was used to analyze the difference between benign and malignant nodules and the boundary value of benign and malignant nodules was determined by using the work characteristic curve (ROC). Results There were significant differences in K trans and V e values of benign and malignant nodules ( P <0.05), and there was no statistical difference between K ep and iAUC ( P >0.05). The K trans and V e values of malignant nodules were significantly higher than that of benign nodules. According to the ROC curve, the diagnostic value of K trans was relatively larger, the diagnostic sensitivity was 75.8% and the specificity was 84.7% when K trans was selected as the interception point. Conclusion DCE-MRI can quantitatively analyze the hemodynamics of breast nodules, and the K trans and V e values are helpful for the differential diagnosis of benign and malignant breast nodules.