非特异性肉芽肿性小叶性乳腺炎的MRI诊断

MRI diagnosis of nonspecific granulomatous lobular mastitis

目的研究非特异性肉芽肿性小叶性乳腺炎(idiopathic granulomatous lobular mastitis,IGM)在磁共振成像(magneticresonanceimaging,MRI)上的影像表现,提高对非特异性肉芽肿性小叶性乳腺炎的认识。材料与方法收集本院均经病理证实的非特异性肉芽肿性小叶性乳腺炎20例,依据乳腺影像报告和数据系统,观察、记录IGM的T2WI、扩散加权成像(diffusionweightedimaging,DWI)、动态增强扫描分布及内部强化特征、时间-信号强度曲线(time signal intencity curve,TIC)等,综合分析其MRI表现特点。结果非特异性肉芽肿性小叶性乳腺炎表现为肿块者1例,边界清楚,边缘强化,表现为非肿块者19例,非脓肿形成区域表观扩散系数(apparent diffusion coefficient,ADC)值为(0.93±0.15)×10^(-3)mm^2/s,以区域分布(11/19,57.9%)、段样分布(6/19,31.6%)为主,内部强化方式主要表现为不均匀强化(14/19,73.7%),纵横比1.73±0.66,伴微脓肿(T2WI、DWI明显高信号,ADC值明显减低,无强化)形成者17例。结论非特异性肉芽肿性小叶性乳腺炎在MRI上有相对特征性的表现,微脓肿的形成更有利于此病的诊断,对IGM的正确认识和诊断,可为临床诊疗方式的选择提供有价值的参考。

Objective: To explore the imaging features of non-specific granulomatous lobular mastitis (IGM) on MRI and to improve the understanding of the disease. Materials and Methods: Twenty cases of IGM confirmed by pathology were collected. According to the breast imaging reporting and data system (BI-RADS-MRI) of 5th edtion, T2WI, diffusion weighted imaging (DWI), dynamic enhanced scan distribution and internal enhancement characteristics, time-signal curve (TIC) of IGM were observed and recorded. Then reserved the comprehensive analysis of MRI performance characteristics of IGM. Results: IGM showed mass enhancement in 1 case with circumscribed margin and rim enhancement. There were 19 cases of non mass enhancement. The apparent diffusion coefficient (ADC) value in the non-abscess forming area was (0.93±0.15)×10^-3 mm^2/s. They mainly appeared regional distribution (11/19, 57.9%) and segmental distribution (6/19, 31.6%). The internal enhancement characteristics was mainly inhomogeneous enhancement (14/19, 73.7%) and the aspect ratio was 1.73±0.66. There were 17 cases accompanied by micro-abscess. Conclusions: IGM has a relatively characteristic appearance on MRI. The formation of micro-abscess is more valuable to the diagnosis of this disease. The correct understanding and diagnosis of IGM can provide valuable reference for the clinical diagnosis and treatment.