核磁共振扩散加权成像定量参数在鉴别乳腺良恶性病变中的应用价值

Application value of quantitative parameters of magnetic resonance diffusion-weighted imaging in differentiation between benign and malignant breast lesions

目的探讨核磁共振扩散加权成像(DWI)定量参数表观扩散系数(ADC)、相对表观扩散系数(rADC)和ADC差值在鉴别乳腺良恶性病变中的应用价值。方法回顾性分析经病理确诊的70例乳腺疾病患者的临床资料。共73个病变,其中良性病变34个,恶性病变39个。比较良性及恶性病灶的ADC、rADC及ADC差值。采用受试者工作特征曲线评价3种DWI参数单独及联合应用对乳腺良恶性病变的鉴别效能。结果乳腺良性病灶的ADC、rADC大于恶性病灶,而ADC差值小于恶性病灶(均P<0.05)。ADC、rADC、ADC差值及三者联合诊断乳腺恶性病灶的曲线下面积分别为0.811、0.827、0.805、0.844;rADC值诊断准确率高于ADC及ADC差值,而三者联合的诊断敏感度、特异度、准确率、阳性及阴性预测值均高于单一参数。结论DWI定量参数ADC、rADC及ADC差值对鉴别乳腺良恶性病变有一定的价值,其中rADC值的诊断准确率更高,而三者联合应用可以更好地提高DWI对乳腺良恶性病变的鉴别效能。

Objective To investigate the application value of quantitative parameters of magnetic resonance diffusion-weighted imaging(DWI)in the differentiation between benign and malignant breast lesions,including apparent diffusion coefficient(ADC),relative apparent diffusion coefficient(rADC)and ADC difference.Methods The clinical data of 70 patients with breast diseases confirmed by pathology were analyzed retrospectively.There were 73 lesions in total,including 34 benign lesions and 39 malignant lesions.The ADC,rADC and ADC difference were compared between the benign and malignant breast lesions.The receiver operating characteristic curve was used to evaluate the efficacy of each DWI parameter and the combination of the three parameters for differentiation between benign and malignant breast lesions.Results The benign breast lesions yielded greater ADC and rADC,whereas a smaller ADC difference(all P<0.05).For diagnosing malignant breast lesions,the areas under the curve of ADC,rADC,ADC difference and the combination of the three parameters were 0.811,0.827,0.805 and 0.844 respectively;the diagnostic accuracy rate of rADC was higher than that of ADC or ADC difference,while the combination of the three parameters exhibited higher diagnostic sensitivity,specificity,accuracy rate,positive and negative predictive values compared with the single parameter.Conclusion The quantitative DWI parameters ADC,rADC and ADC difference,achieve certain diagnostic value in the differentiation between benign and malignant breast lesions,among which rADC had a higher diagnostic accuracy rate;however,the combined application of the three parameters can enhance the efficacy of DWI for differentiation between benign and malignant breast lesions.