磁共振成像评价乳腺血供在乳腺良恶性疾病鉴别诊断中的价值

The Value of Ipsilateral Breast Vascularity in Differential Diagnosis of Benign and Malignant Breast Lesions by MRI

目的研究MRI动态增强扫描及血管三维重建技术评价乳腺血供在乳腺良恶性病变鉴别诊断中的价值。方法研究自2016年1月至2017年6月经乳腺钼靶摄影、超声波检查或临床体检发现有单侧乳腺单发病变来我院行MRI检查的40例女性患者的MRI影像资料。在MRI最大密度投影(MIP)及血管三维重建图像上,详细记录患侧与对侧乳腺血管的数目、直径、长度及可见性,并根据Sardanelli血供评分进行评分,2~3分均被认为血供增加,MRI诊断恶性病变。以病理结果为金标准,比较乳腺血供情况与乳腺良恶性病变的关系。结果 40例患者经病理证实16例为良性,24例为恶性。乳腺良性病变患侧与对侧血供数目与血供评分差别无统计学意义(P>0.05),乳腺恶性病变患侧血供数目与血供评分大于对侧,差别有统计学意义(P<0.05);乳腺良恶性病变同侧血供数目间差别有统计学意义(P<0.05),血供评分间差别有统计学意义(P<0.05)。以患侧血供增加作为乳腺癌的诊断标准的灵敏度为100%,特异度为75%,一致率为90%,Youden指数为0.75。结论血供增加与同侧乳腺恶性病变相关,但乳腺良恶性病变的鉴别诊断仍需结合形态学及时间信号曲线特征综合分析。

Objective To study the value of ipsilateral breast vascularity in differential diagnosis of benign and malignant breast lesions by DCE-MRI and VRT.Methods 40 cases'MRI date of unilateral breast lesion treated by our hospital from January 2016 to June 2017 were collected,and all patients had the mammography,ultrasound or clinical examination before.The vessel number,size,length and conspicuity were recored in the MIP and VRT of MRI,and scored according to the methods of Sardanellie.The score 2~3 were recognized increase in breast vascularity and diagnosed malignant breast lesions by MRI.The vascularity of benign and malignant breast lesions were compared using pathology as the gold standard.Results 16 cases were finally proved benign lesions and the other 24 cases were malignant by pathology.The number and score of vascularity were not different between two breast in benign breast lesions(P>0.05),and were higher than contralateral breast in malignant breast lesions(P<0.05);The number and score of vascularity were different between benign and malignant breast lesions(P<0.05).The sensitivity,specificity,agreement rate and Youden,s index of increase in breast vascularity as the standard of diagnosing malignant breast lesion were 100%,75%,90%,0.75 respectively.Conclusion There was a relationship between increase in ipsilateral breast vascularity and malignant breast lesion,but differential diagnosis of benign and malignant breast lesions also need to be combined with imaging sign and TIC(time-intensity curve).