磁共振动态增强成像联合扩散加权成像对乳腺良恶性疾病鉴别诊断价值

The value of DCE-MRI combined with DWI in differential diagnosis of breast benign and malignant diseases

目的探讨磁共振动态增强成像中的动态增强时间信号强度曲线(time-signal intensitycurve,TIC)类型、早期强化率及扩散成像的表观扩散系数(apparentdiffusion coefficient,ADC)值在乳腺良、恶性病变中的鉴别诊断价值。材料与方法回顾性分析2017年4月至2019年4月中国医学科学院肿瘤医院深圳医院140个经病理证实的乳腺病灶的术前磁共振以及临床病理资料,依据病理分为良性病变组及恶性病变组。比较乳腺良、恶性病变间的TIC类型及早期强化率有无差异;并比较两组间ADC值的差异性。结果140个病灶中良性病变43个病灶,恶性病变97个病灶。乳腺良、恶性病变的TIC类型、第一期早期强化率类型差异具有统计学意义(P<0.05)。乳腺恶性病变平均ADC值[(0.965±0.215)×10^-3 mm^2/s]低于良性病变平均ADC值[(1.335±0.266)×10^-3 mm^2/s],两者间差异有统计学意义(P<0.05),ADC阈值取1.085×10^-3mm^2/s时,曲线下面积最大为0.857,其鉴别乳腺良、恶性病变的敏感性为73.2%,特异性为86.0%,准确性为77.1%。TIC曲线、第一期早期强化率及ADC三者联合诊断,诊断乳腺良、恶性病变的敏感性为83.5%,特异性为79.1%,准确性为78.5%,曲线下面积AUC为0.882,高于其他三者单独诊断的曲线下面积(0.728、0.562、0.857)。结论动态增强成像中的TIC曲线类型及第一期早期强化率与扩散加权成像的ADC值三者联合进行诊断,对乳腺良、恶性病变的鉴别诊断具有较好的价值。

Objective:To explore time-signal intensity curve(TIC)type,early enhancement rate and the value of apparent diffusion coefficient(ADC)in differential diagnosis of benign and malignant breast lesions.Materials and Methods:The preoperative magnetic resonance imaging and clinicopathological data of 140 pathologically confirmed breast lesions in our hospital from April 2017 to April 2019 were retrospectively analyzed.The lesions were divided into benign lesion group and malignant lesion group according to the pathology after operation.The difference of TIC curve type and early enhancement rate between benign and malignant breast lesions were compared and the difference of ADC value between the two groups was compared.Results:140 lesions of 107 patients were included in the study.Three of them had breast cancer and breast fibroadenoma simultaneously,one had ipsilateral breast and two had bilateral breast respectively.43 benign lesions,97 lesions of malignant tumors.The TIC curve type,the type of early enhancement rate of benign and malignant breast lesions were significantly different(P<0.05).The average ADC value of benign lesions was(1.335±0.266)×10^-3 mm^2/s and that of malignant lesions was(0.965±0.215)×10^-3 mm^2/s.There was a significant difference between the two groups(P<0.05).When the threshold value of ADC was 1.085×10^-3 mm^2/s,the sensitivity,specificity,accuracy and area under the curve of ADC were 73.2%,86.0%,77.1%and 0.857 respectively.The sensitivity,specificity and accuracy of TIC curve,early enhancement rate and ADC were 83.5%,79.1% and 78.5%respectively.The area under the curve of AUC was 0.882,which was higher than that under the curve of other three diagnostic methods(0.728,0.562,0.857).Conclusions:The combined diagnosis of ADC value of diffusion weighted imaging,semi-quantitative parameters of dynamic contrast-enhanced imaging(TIC curve type and early enhancement rate of the first stage)is of great value in differential diagnosis of benign and malignant breast lesions.