磁共振成像鉴别诊断乳腺恶性乳头状病变与其他恶性病变的价值

The value of magnetic resonance imaging in the differential diagnosis between malignant papillary lesions and other malignant lesions of the breast

目的:分析磁共振成像(magnetic resonance imaging,MRI)对乳腺恶性乳头状病变与其他恶性病变的鉴别诊断价值。方法:回顾并分析590例均行乳腺MRI检查并经病理学检查证实乳腺恶性病变患者的临床资料。参照2013年版乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分析病灶形态,使用Siemens公司MAGNETOM Aera1.5T后处理工作站获得时间信号强度曲线(time-signal intensity curve,TIC)及表观扩散系数(apparent diffusion coefficient,ADC),探讨其鉴别诊断价值。结果:恶性乳头状病变以非肿块型病灶为主,其他恶性病变以肿块型病灶为主。肿块型病灶中,恶性乳头状病变位于乳晕后区较其他恶性病变多见;两者均以形态不规则、直径1~5 cm、不均匀强化为主。非肿块型病灶中,恶性乳头状病变以节段分布为主,其他恶性病变以区域、弥漫分布为主。恶性乳头状病变伴导管扩张较其他恶性病变多见。恶性乳头状病变以囊性成分为主者(实性占比<25%)较其他恶性病变多见。所有恶性病变均以流出型曲线为主。恶性乳头状病变的平均ADC值为(0.94±0.23)×10-3mm2/s,其他恶性病变的ADC值为(0.86±0.21)×10-3mm2/s,其最佳区分阈值为1.04×10-3mm2/s,灵敏度为88.7%,特异度为35.0%,准确率为82.7%,曲线下面积为0.620。结论:肿块位置、非肿块分布、导管是否扩张、ADC值对乳腺恶性乳头状病变和其他恶性病变具有鉴别诊断价值。

Objective:To assess the value of magnetic resonance imaging(MRI)in differential diagnosis of malignant papillary lesions and other malignant lesions of the breast.Methods:A total of 590 patients with malignant breast lesions were retrospectively analyzed.All patients underwent breast MRI and confirmed by pathological examination.The MRI findings were categorized according to Breast Imaging Reporting and Data System(BI-RADS)2013 edition.Time-signal intensity curve(TIC)and apparent diffusion coefficient(ADC)were achieved from the 1.5 T Siemens MAGNETOM Aera workstation,which were used in differential diagnosis of breast lesions.Results:The malignant papillary lesions tended to present as non-mass enhancement,and the other malignant lesions tended to present as mass.Malignant papillary lesions tended to locate in the retroareolar regions more than those in other malignant group.All the malignancies tend to appear irregular shaped,1-5 cm in diameter,heterogeneous enhanced.In the non-mass enhancement lesions,malignant papillary lesions tended to appear segmental distribution,other malignant lesions tended to appear regional or diffuse distribution.Ductal dilation was more common in malignant papillary lesions than other malignant lesions.The solitary proportion<25%is more common in malignant papillary lesions than the other malignant lesions.All the malignant lesions tend to appear wash-out curve.Mean ADC was[(0.94±0.23)×10-3mm2/s vs(0.86±0.21)×10-3mm2/s]in the group of malignant papillary lesions and other malignant lesions respectively.The best discriminative value of ADC was 1.04×10-3mm2/s and the area under curve was 0.620.The sensitivity,specificity and accuracy were 88.7%,35.0%and 82.7%,respectively.Conclusion:The location of the mass,the distribution of the non-mass enhancement,ductal dilation,solid proportion and ADC values which have differential diagnosis of malignant papillary lesions and the other malignancies.