3.0 T磁共振弥散加权成像及动态增强扫描对乳腺癌的诊断价值

Diagnostic value of 3.0 T magnetic resonance diffusion-weighted imaging and dynamic enhanced scanning in breast cancer

目的探讨3.0 T磁共振弥散加权成像及动态增强扫描对于乳腺癌的应用价值。方法选取保定市第二医院2016年12月至2019年12月,使用Siemens 3.0 T磁共振检出的总共188例患有210个乳腺肿瘤(136个恶性和74个良性)的患者,根据乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)分级以及弥散加权成像(diffusion weighted imaging,DWI)描述指标,在磁共振动态增强(dynamic contrast-enhanced,DCE)扫描和T2加权成像上标记肿块(n=182)和非肿块(n=28),同时使用BI-RADS描述指标中DCE、T2加权成像和表观扩散(弥散)系数(apparent diffusion coefficient,ADC)的特点,以ADC≤1.255×10-3 mm2/s作为标准区分良性和恶性病变的标准,与手术或穿刺活检病理结果进行对照,采用统计学方法分析得出结果。结果在模型1中,ADCmean(P<0.003)、DCE肿块边缘(P=0.002)和DCE平台型或流出型增强(P=0.001)与乳腺癌的诊断显著且独立相关。模型2确定ADCmean(P=0.001)、DCE肿块边缘(P=0.001)、早期快速强化(P=0.042)和DCE平台型或流出型增强(P=0.001)与乳腺癌诊断显著独立相关。T2加权成像变量未包含在最终模型中。结论使用3.0 T磁共振采用多通道乳腺专用线圈检查,其DCE和DWI定量和定性描述指标的模型可实现准确的乳腺癌诊断,联合应用可以显著提高乳腺癌的诊断准确率。且发现T2加权成像对乳腺癌的诊断没有显著贡献。

Objective To explore the application value of 3.0 T intensity magnetic resonance diffusion weighted imaging and dynamic enhanced scanning in breast cancer.Methods A total of 188 patients with 210 breast tumors(136 malignant and 74 benign)were selected from Baoding Second Hospital from December 2016 to December 2019 by using Siemens 3.0 T magnetic resonance.According to breast imaging reporting and data system(BI-RADS)grading and diffusion weighted imaging(DWI)description indexes,both mass(n=182)and non-mass(n=28)were labeled on dynamic Contrast-enhanced(DCE)scans and T_(2)-weighted imaging.Meanwhile,the characteristics of DCE,T2-weighted imaging and apparent diffusion coefficient(ADC)in BI-RADS description indicators were used to distinguish benign and malignant lesions,and the ADC cut-off value≤1.255×10-3 mm2/swas used as the standard.The results were compared with the pathological results of surgery or puncture biopsy and analyzed statistically.Results In model 1,ADCmean(P<0.003),DCE mass margin(P=0.002),and DCE plateau or outflow enhancement(P=0.001)were significantly and independently associated with the diagnosis of breast cancer.Model 2 determined that ADCmean(P=0.001),DCE mass margin(P=0.001),early rapid enhancement(P=0.042),and DCE plateau or outflow enhancement(P=0.001)were significantly independently associated with breast cancer diagnosis.T_(2)-weighted imaging variables were not included in the final model.Conclusion Using 3.0 T magnetic resonance and multichannel breast coil examination,the quantitative and qualitative descriptive index models in DCE and DWI can achieve accurate diagnosis of breast cancer,and the combined application can significantly improve the diagnostic accuracy of breast cancer.T_(2)-weighted imaging does not significantly contribute to the diagnosis of breast cancer.