肿块型肉芽肿性乳腺炎多种MRI征象的多因素分析

Multivariate Analysis of Multiple MRI Signs of Massive Granulomatous Mastitis

目的探讨多种MRI征象在肿块型肉芽肿性乳腺炎中的诊断价值。方法回顾性分析MRI扫描肿块型乳腺炎、组织病理学证实肉芽肿性乳腺炎268例(312处)与手术证实为肿块型乳腺癌患者297例(337处)的MRI征象(包括病灶象限分布、形态、边缘、实性部分ADC值、乳头或皮肤凹陷、乳房皮肤增厚、强化特点、时间-信号曲线、病变中心增粗迂曲血管、腋窝淋巴结肿大),通过多因素Logistic回归对多种MRI征象进行统计分析,并计算不同阳性MRI征象在肿块型肉芽肿性乳腺炎诊断中的敏感度和特异度。结果多因素Logistic回归分析显示病灶边缘模糊、不均匀强化伴病变内部小环状强化及ADC值范围(1.10±0.18×10^-3mm^2/s)更常见于肿块型肉芽肿性乳腺炎中(P<0.05),OR值分别为10.223(95%CI:5.836~18.367)、11.413(95%CI:6.811~19.896)和12.845(95%CI:6.781~23.902),病灶象限分布、形态、乳头或皮肤凹陷、乳房皮肤增厚、时间-信号曲线、病变中心增粗迂曲血管、腋窝淋巴结肿大在多因素分析中无统计学意义(P>0.05)。三种阳性单一征象中,病变边缘模糊敏感度最高(87.4%),不均匀强化伴病变内部小环状强化特异度最高(82.7%),两种联合征象中,病变边缘模糊+ADC值范围(1.10±0.18×10^-3mm^2/s)敏感度(90.5%)最高,不均匀强化伴病变内部小环状强化+ADC值范围(1.10±0.18×10^-3mm^2/s)特异度(88.6%)最高,3种征象联合时,敏感度及特异度分别为93.9%、92.4%。结论病灶边缘模糊、不均匀强化伴病变内部小环状强化及ADC值范围(1.10±0.18×10^-3mm^2/s)在肿块型肉芽肿性乳腺炎的诊断中具有重要价值,多种征象联合观察能有效提高肿块型肉芽肿性乳腺炎诊断的特异度。

Objective To explore the value of various MRI signs in the diagnosis of mass granulomatous mastitis.Methods A retrospective analysis was made of the MRI signs(including quadrant distribution,shape,margin,ADC value of solid part,nipple or skin depression,breast skin thickening,enhancement characteristics,time-signal curve,thickening of lesion center)in 268 cases(312 lesions)of granulomatous mastitis which confirmed by MRI and 297 cases(337 lesions)of breast cancer which confirmed by surgery.Tubular and axillary lymphadenopathy were analyzed by multivariate logistic regression.The sensitivity and specificity of different positive MR signs and their combination in the diagnosis of mass-type granulomatous mastitis were calculated.Results Multivariate logistic regression analysis showed that blurred margin,uneven enhancement with small ring enhancement and ADC value range(1.10±0.18×10^-3mm^2/s)were more common in mass-type granulomatous mastitis(P<0.05),with OR values of 10.223(95%CI:5.836~18.367),11.413(95%CI:6.811~19.896)and 12.845(95%CI:6.781~23.902),respectively.Morphology,nipple or skin depression,breast skin thickening,time-signal curve,lesion center thickening and tortuous blood vessels,axillary lymph node enlargement were not statistically significant in multivariate analysis(P>0.05).Among the three positive single signs,the sensitivity of edge blurring was the highest(87.4%)and the specificity of small ring enhancement was the highest(82.7%).Among the two combined signs,the sensitivity of edge blurring+ADC value range(1.10±0.18×10^-3 mm^2/s)was the highest(90.5%)and that of small ring enhancement+ADC value range(1.10±0.18×10^-3mm^2/s)was the highest.The specificity(88.6%)was the highest.When the three symptoms were combined,the sensitivity and specificity were 93.9%and 92.4%respectively.Conclusion Fuzzy margin,uneven enhancement with small ring enhancement and ADC value range(1.10±0.18×10^-3mm^2/s)play an important role in the diagnosis of mass-type granulomatous mastitis.Combined observation of multiple signs can effectively improve the specificity of diagnosis of mass-type granulomatous mastitis and reduce the occurrence of misdiagnosis.