钼靶X线摄影联合增强磁共振成像在乳腺导管原位癌诊断中的价值

Value of mammography combined with enhanced magnetic resonance imaging in diagnosing ductal carcinoma in situ

目的探讨乳腺导管原位癌(DCIS)的特征性影像学表现以及钼靶X线摄影以及增强磁共振成像(MRI)联合诊断的优势。方法收集本院行手术治疗且术后病理证实为乳腺DCIS及DCIS伴微浸润的45例患者的影像资料,分析DCIS在钼靶X线和增强MRI上的特征性影像学表现,并评价钼靶X线联合增强MRI的诊断效能。结果钼靶X线可见钙化28例(28/45,62.2%),其中簇状钙化12例(12/28,42.9%),段样分布钙化13例(13/28,46.4%),区域分布钙化3例(3/28,10.7%)。增强MRI可见非肿块样强化33例(33/45,73.3%),其中段样分布强化11例(11/33,33.3%),线样分布强化10例(10/33,30.3%),局灶性强化9例(9/33,27.3%),区域分布的强化3例(3/33,9.1%)。非肿块样强化内部可见集群状强化18例(18/33,54.5%),不均匀强化13例(13/33,39.4%),均匀强化2例(2/33,6.1%),簇状环形强化21例(21/33,63.6%)。钼靶X线摄影、增强MRI及两者联合诊断对DCIS诊断准确率分别为53.3%、71.1%、86.7%,3种方法的诊断准确率比较差异有统计学意义(P<0.05)。结论乳腺钼靶X线上簇状或段样分布的钙化灶,增强MRI上线样或段样分布的非肿块样强化,内部呈集群样强化或簇状环形强化,是DCIS的特征性影像学表现。钼靶X线摄影与增强MRI的联合诊断可以优势互补,提高DCIS诊断的准确率。

Objective To investigate characteristic imaging manifestation of ductal carcinoma in situ(DCIS)and the advantages of mammography combined with enhanced magnetic resonance imaging(MRI)in diagnosing DCIS.Methods Imaging results of 45 patients undergoing surgery and confirmed as DCIS and DCIS with small invasive foci were retrospectively reviewed in our study.The imaging manifestations of DCIS in mammography and enhanced MRI were analyzed,and diagnostic efficacy of mammography combined with enhanced MRI in diagnosing DCIS was evaluated.Results Mammograms findings of DCIS showed calcification in 28 cases(28/45,62.2%),including clustered calcification in 12 cases(12/28,42.9%)and segmental calcification in 13 cases(13/28,46.4%),and regional distribution calcification in 3 cases(3/28,10.7%).Enhanced MRI findings showed that there were 33 cases(33/45,73.3%)with non-mass enhancement,and the distribution patterns included segmental enhancement in 11 cases(11/33,33.3%),linear enhancement in 10 cases(10/33,30.3%),focal enhancement in 9 cases(9/33,27.3%)and regional distribution enhancement in 3 cases(3/33,9.1%).The internal enhancement patterns of non-mass enhancement included clumped pattern in 18 cases(18/33,54.5%),heterogeneous enhancement in 13 case(13/33,39.4%),homogeneous enhancement in 2 cases(2/33,6.1%)and clustered ring enhancement in 21 cases(21/33,63.6%).The accuracy rates of mammography,enhanced MRI and their combination in diagnosis of DCIS were 53.3%,71.1%and 86.7%,and there were statistically significant differences in accuracy rates(P<0.05).Conclusion Clustered or segmental calcification in mammograms,segmental or linear enhancement with clumped internal architecture and clustered ring enhancement in enhanced MRI are the characteristic imaging manifestations of DCIS.The combination of mammography and enhanced MRI could achieve mutual complementarity and improve the diagnostic accuracy of DCIS.