基于DCE-MRI的血流动力学分析对乳腺黏液癌与T_(2)高信号纤维腺瘤鉴别诊断的研究

Differentiation between Mucinous Carcinomas and Fibroadenomas with High T Signal Intensity on DCE-MRI Using Volume-Based Kinetic Analysis

目的探讨动态增强磁共振成像(DCE-MRI)血流动力学分析在乳腺黏液癌与T2高信号纤维腺瘤鉴别诊断中的应用价值。方法回顾性分析本院2017年2月至2019年7月病理确诊的24例乳腺黏液癌及31例T2高信号纤维腺瘤的临床及MRI检查资料。分析比较两者的发病年龄、病灶直径、形态、边缘、表观扩散系数(ADC)值、T2信号强度、延迟期强化方式;利用DynaCAD软件获得半定量血流动力学参数,比较病灶早期强化峰值、延迟期各曲线类型百分比。结果从一般情况及形态学分析,两组病灶直径、形态、边缘的差异具有统计学意义,年龄、ADC值、T2信号的差异无统计学意义;在半定量血流动力学特征中,乳腺黏液癌和T2高信号纤维腺瘤内平台型曲线所占百分比平均值分别为(18.23±15.23)%、(5.66±6.12)%,且二者的差异具有统计学意义(P=0.014)。结论MRI形态学特征及半定量血流动力学参数对鉴别乳腺黏液癌与T2高信号纤维腺瘤具有价值。

Objective To explore the diagnostic value of quantitative kinetic composition analysis in dynamic contrast-enhanced MRI(DCE-MRI)of the breast for the differential diagnosis of mucinous scarcinomas of breast(MCBs)from fibroadenomas(FAs)with high T2 signal intensity.Methods 24 patients with pathologically confirmed MCBs and 31 patients with pathologically confirmed FAs from 2018 to 2020 were enrolled,all the patients underwent breast MR examination.Two radiologists analyzed MR imaging retrospectively,included measurements of shape,size,margins,ADC value,T2 signal intensity and internal mass enhancement pattern.The maximum diameter,volume,and percentages of voxels within the lesion representing persistent,plateau,or washout kinetics were quantified using computer-assisted diagnosis software(DynaCAD Breast,Philips).Parameters above were compared between two groups of lesions using Manny-U test,univariate and multivariable analyses were performed to investigate the differentiation between MCBs and FAs.Results The mean volume of MCBs was significantly greater than that of FAs(P=0.025).The median rate of plateau enhancement in MCBs was(18.23±15.23)%,while in FAs with high T2 signal intensity was(5.66±6.12)%,statistical difference was found between two groups(P=0.014).Conclusion The percentages of plateau kinetic voxels,together with the size of masses may aid in differentiating MCBs from FAs with high T2 signal intensity.