MRI对含可疑钙化乳腺良性增生性病变的诊断价值

MRI in the diagnosis of breast benign proliferative disease with Suspicious calcification

目的:探讨乳腺MRI对含可疑钙化良性增生性病变的诊断价值。方法:搜集行乳腺钙化灶立体定位引导真空负压旋切活检术或术前钩丝定位局部切除活检术后,经病理证实为良性增生性病变的48例患者(51个病灶),所有患者术前均行乳腺X线摄影和MRI检查,且病灶包含可疑钙化。分析病灶内可疑钙化的形态、分布及病灶在乳腺MRI上的表现,结合患者乳腺X线摄影腺体构成、乳腺MRI背景实质强化情况,与组织病理学结果进行对照。结果:48例患者均为女性,平均年龄为(47.2±9.5)岁。51个病灶中不伴非典型增生的良性增生性病变33个(64.7%),伴非典型增生的良性增生性病变18个(35.3%)。乳腺腺体构成以c、d型多见,乳腺背景实质强化以中度型、显著型多见,乳腺X线摄影中可疑钙化以无定形(58.8%)、成簇(62.7%)多见,且以上表现在伴与不伴非典型增生的良性增生性病变中差异均无统计学意义(P>0.05)。乳腺MRI中,病变以非肿块样强化多见(78.4%),不伴非典型增生者多表现为多区域或区域性(61.5%)、不均匀强化(84.6%),伴非典型增生者常表现为线样(42.9%)、均匀或不均匀强化(42.9%),非肿块样强化内部强化和分布方式在伴与不伴非典型增生的良性增生性病变中差异有统计学意义(P<0.05)。结论:乳腺X线摄影中含可疑钙化的良性增生性病变在乳腺MRI上以非肿块强化多见,不伴非典型增生者常表现为多区域或区域性强化、内部强化不均匀,伴非典型增生者常表现为线样强化、内部强化均匀或不均匀。

Objective:To evaluate the value of MRI in the diagnosis of breast benign proliferative disease with suspicious calcification.Methods:Forty-eight patients with 51 benign proliferative disease(BPD)were collected in this study.The histopathologic diagnosis was obtained by stereotactic vacuum-assisted needle core biopsy or excisional biopsy with hook wire localization.All patients underwent mammography and MRI showing suspicious calcification.Retrospective reviewing under the basis of histologic diagnosis including the morphology and distribution of suspicious calcification,the characteristics of the lesions on MRI,the density of breast in mammography and the background parenchymal enhancement(BPE)in MRI.Results:All the 48 patients were women with an average of 47.2±9.5 years old.A total of 51 BPD was found,including 33 BPD without atypia and 18 BPD with atypia.In mammography,Amorphous calcification(30,58.8%)and clustered distribution(32,62.7%)were the most common feature of BPD with suspicious calcification no matter with or without atypia.In MRI,most BPD performed non-mass enhancement(40,78.4%).BPD without atypia were often manifested as regional or multi-regional distribution(16,61.5%)and heterogenous enhancement(6,62.9%),and BPD with atypia were often manifested as linear distribution(6,42.9%),heterogenous or homogenous enhancement(6,42.9%).There was a significant difference in the distribution and internal enhancement of non-mass enhancement between the two group.Most patients have c or d type of mammography breast density and moderated or marked BPE,with no significant difference between BPD with atypia and without atypia.Conclusion:Non-mass enhancement was the most common performance of BPD with suspicious calcification in MRI.There was a significant difference in the distribution and internal enhancement of non-mass enhancement between the BPD with atypia and without atypia.BPD without atypia were often manifested as regional or multi-regional distribution and heterogenous enhancement.BPD with atypia were often manifested as linear distribution,heterogenous or homogenous enhancement.