动态增强磁共振成像在评估女性乳房乳头乳晕血供的应用

Application of dynamic contrast-enhanced MRI in the evaluation of blood supply to the nipple-areola complex of women

目的探究动态增强磁共振成像(DCE-MRI)用于评估女性乳房乳头乳晕血供特点的可行性,为乳房整形手术提供乳头乳晕的血供参考。方法从2012年3月至2019年10月华中科技大学同济医学院附属同济医院影像数据库中收集女性乳腺DCE-MRI图像资料,选择未发现肿物的正常乳房的DCE-MRI图像进行研究。在西门子工作站将患者乳腺DCE-MRI图像通过图像减影获取乳房血管图像,分别对轴位、冠状位和矢状位的最大密度投影(MIP)图像进行评估,结合三维MIP图像识别所有供应乳头乳晕的血管。乳头乳晕的血供被划分为内上、内侧、内下、外上、外侧、外下、中央、上方和下方9个象限,对各个象限血管进行统计和分析,并测量血管至乳房皮肤表面投影的最大距离。采用SPSS 19.0软件进行统计分析,通过卡方检验分别比较左侧与右侧乳房的乳头乳晕复合体(NAC)血供象限分布构成比。计算血管到皮肤距离的平均值、标准差及95%置信区间,通过方差分析比较各象限血管至皮肤距离的差异。P<0.05为差异具有统计学意义。结果共收集到245例患者490只女性乳房DCE-MRI图像,其中97例患者97只乳房发现有乳腺肿物,其余393只为正常乳房(97例单侧乳房、148例双侧乳房),将其作为研究对象。患者年龄23~72岁,平均43.7岁。393只乳房(左侧200只、右侧193只)共发现有637条(左侧311条、右侧326条)乳头乳晕供应血管。在637条血管中,内上象限269条(42.2%),外上180条 (28.3%),内侧57条(8.9%),下方37条(5.8%),中央30条(4.7%),内下25条(3.9%),外下25条(3.9%),上方11条(1.7%),外侧3条(0.5%)。卡方检验表明左侧乳房和右侧乳房在NAC血供象限分布构成比差异无统计学意义(χ2 =6.4,P=0.602)。除中央象限血管以外,所有血管到皮肤表面投影最大距离的平均值为0.91 cm, 95%置信区间为0.86~0.96 cm。方差分析表明各象限供血血管到皮肤投影的最大距离,差异有统计学意义(F=11.4,P<0.001)。结论 DCE-MRI可以清晰地显示乳头乳晕的血供来源。乳头乳晕血供主要来源于内上象限和外上象限的血管,血管在皮下约1 cm深度走行。

Objective The study was to explore the nipple-areola complex(NAC)blood supply model in Chinese breasts based on dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and to provide the blood supply knowledge for mammaplasty.Methods Breast DCE-MRI images of breasts without masses in 245 patients from March 2012 to October 2019 in Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology were included retrospectively.The breast vessels images were obtained by image subtraction in the Siemens workstation.Axial,coronal and sagittal maximum intensity projection(MIP)images were evaluated,and all vessels supplying the nipple-areola complex were identified by 3D MIP images.Blood supply to the NAC was classified into 9 zones,and vessels of each zone were counted and analyzed.The maximum distance from the vessel to the skin surface of the breast was measured.SPSS 19.0 software was used for statistical analysis.The chi-square test was used to check for significant differences in the distribution of zones between the left breasts and the right breasts.The mean,standard deviation and 95%confidence interval of the distance between vessels and skin were calculated.Using ANOVA to compare the distance between vessels and skin of zones.P<0.05 was statistically significant.Results There were 490 breasts in 245 DCE-MRI images,of which 97 breasts were found to have masses in 97 DCE-MRI images.The remaining 393 were normal breasts as study subjects.The patients’ages ranged from 23 to 72 years,with a mean of 43.7 years.637 source vessels(311 left,326 right)were identified in 393 breasts(200 left,193 right).Of the 637 vessels,269(42.2%)were in the superomedial zone and 180(28.3%)were in the superolateral zone.The proportions of vessels in zone medial(57,8.9%),inferior(37,5.8%),central(30,4.7%),inferomedial(25,3.9%),inferolateral(25,3.9%),superior(11,1.7%)and lateral(3,0.5%)were less than 10%,respectively.The chi-square test showed no significant difference in the distribution of zones(χ2=6.4,P=0.602)between the left breasts and the right breasts.Except for the central zone,the mean of maximum distance from the vessels to the skin surface was 0.91 cm,with a 95%confidence interval of 0.86 cm to 0.96 cm.Conclusions DCE-MRI can clearly show the blood supply to the NAC.Superomedial or superolateral source vessels supplying the NAC were predominant,and the vessels run at a subcutaneous depth of about 1 cm.