MRI平均ADC值、rADC值在浆细胞性乳腺炎及乳腺癌鉴别中的应用

Application of MRI average ADC value and rADC value in differential diagnosis of plasma cell mastitis and breast cancer

目的探讨核磁共振成像(MRI)平均表观扩散系数(ADC)值、相对表现扩散系数(rADC)值在浆细胞性乳腺炎(PCM)及乳腺癌鉴别中的价值。方法回顾性选取2019年2月至2020年2月86例在保定市第一医院进行乳腺MRI检查的女性患者,患者入院后经病理学穿刺确诊PCM或乳腺癌,其中PCM组39例,乳腺癌组47例。两组患者均进行双乳MRI检查,比较同侧胸大肌、对侧正常乳腺腺体ADC值、rADC差异,在受试者工作特征(ROC)分析辅助下明确平均ADC值、rADC值诊断乳腺癌的价值,最后通过一致性分析平均ADC值、rADC值诊断乳腺癌的效能。结果两组同侧胸大肌ADC值、正常乳腺ADC值水平比较差异均无统计学意义(P>0.05),PCM组病灶平均ADC值、rADC1、rADC2分别为(1.16±0.08)×10^(-3)、(0.78±0.07)×10^(-3)、(0.61±0.11)×10^(-3) mm^(2)/s,显著高于正常体温组[(0.91±0.16)×10^(-3)、(0.57±0.15)×10^(-3)、(0.52±0.10)×10^(-3) mm^(2)/s],差异均有统计学意义(P<0.05)。经ROC分析证实,病灶平均ADC值、rADC1、rADC2均能用于乳腺癌的诊断,曲线下面积分别为0.886、0.889、0.833;联合诊断中以病灶平均ADC值≤1.078×10^(-3) mm^(2)/s、rADC1≤0.721×10^(-3) mm^(2)/s、rADC2≤0.609×10^(-3) mm^(2)/s为阳性,任一指标为阳性则判定为乳腺癌。经一致性分析证实,联合诊断中阳性43例,敏感度为0.915,特异度为0.949,准确率为0.930,阳性预测值为0.956,阴性预测值为0.902,Kappa=0.860。结论PCM与乳腺癌患者的病灶平均ADC值、rADC值存在明显差异,且通过ROC分析、一致性分析均证实ADC值、rADC值联合应用于PCM及乳腺癌鉴别具有更高的价值。

Objective To investigate the value of magnetic resonance imaging(MRI)average apparent diffusion coefficient(ADC)and relative diffusion coefficient(rADC)value in differential diagnosis of plasma cell mastitis(PCM)and breast cancer.Methods A total of 86 female patients who underwent breast MRI in Baoding City First Hospital From February 2019 to February 2020 were retrospectively selected,and diagnosed with PCM or breast cancer by pathology,including 39 cases in group PCM and 47 cases in breast cancer group.Two groups of patients underwent double breast examination.The value of rADC in diagnosis of breast cancer was analyzed.To clarify the value of the average ADC value and rADC value in diagnosing breast cancer,with the aid of receiver operating characteristic(ROC)analysis.Finally,the efficacy of breast cancer was diagnosed by consistent analysis of mean ADC and rADC values.Results There was no significant difference in ADC value of ipsilateral pectoralis major muscle and normal breast between the two groups,the differences were no statistically significant(P>0.05).The average ADC value,radc1 and radc2 of lesions in PCM group were(1.16±0.08)×10^(-3),(0.78±0.07)×10^(-3),(0.61±0.11)×10^(-3) mm^(2)/s,which were significantly higher than those in normal body temperature group[(0.91±0.16)×10^(-3),(0.57±0.15)×10^(-3),(0.52±0.10)×10^(-3) mm^(2)/s],the differences were statistically significant(P<0.05);ROC analysis showed that the average ADC value,rADC1 and rADC2 of the lesion were all used for the diagnosis of breast cancer.The area under the curve was 0.886,0.889 and 0.833 respectively;in combined diagnosis,the average ADC value of lesions was≤1.078×10^(-3) mm^(2)/s,rADC1≤0.721×10^(-3) mm^(2)/s,rADC2≤0.609×10^(-3) mm^(2)/s was positive,and any index positive was diagnosed as breast cancer.The consistency analysis confirmed that 43 cases were positive in the combined diagnosis,the sensitivity was 0.915,the specificity was 0.949,the accuracy was 0.930,the positive predictive value was 0.956,the negative predictive value was 0.902,Kappa=0.860.Conclusion The average ADC value and rADC value of PCM were significantly different from those of breast cancer patients,and ROC analysis and consistency analysis confirmed that the combination of ADC value and rADC value in PCM and breast cancer has higher value.