对比增强能谱乳腺X线摄影量化参数联合强化特点鉴别乳腺良、恶性肿块

Quantitative parameters combined with enhancement features of contrast-enhanced spectral mammography in distinguishing benign and malignant breast masses

目的观察不同时相对比增强能谱乳腺X线摄影(CESM)量化参数联合强化特点鉴别诊断乳腺良、恶性肿块的价值。方法前瞻性收集114例因单发乳腺肿块接受CESM患者,分别于注射对比剂后2~3 min(CESM早期,T_(1))、4~5 min(CESM中期,T_(2))及7~9 min(CESM晚期,T_(3))摄患侧头足(CC)位、首次内外斜(MLO)位及二次乳腺MLO位片;经处理获得相应减影图,测算病灶灰度值(LGV)、病灶与背景灰度值比值(LBR)、相邻2个时相病灶灰度值差(LGVD)及LBR变化率,根据2个相邻时相LGVD或LBR变化率评估病灶强化特点为上升型、平台型或流出型。以病理结果为金标准,采用受试者工作特征(ROC)曲线评价不同时相CESM量化参数联合强化特点鉴别诊断乳腺良、恶性肿块的效能。结果114例中,恶性84例(恶性组)、良性30例(良性组),组间LBR_(T1)及LGV_(T1)差异均有统计学意义(P均<0.05),其余参数差异均无统计学意义(P均>0.05)。LGV_(T1)+LGV_(T2)+强化特点_(T1-T2)及LGV_(T1)+LGV_(T2)+LGV_(T3)+强化特点_(T1-T2-T3)鉴别乳腺良、恶性肿块的敏感度分别为83.30%和91.60%,特异度分别为63.30%和53.30%;LBR_(T1)+LBR_(T2)+强化特点_(T1-T2)及LBR_(T1)+LBR_(T2)+LBR_(T3)+强化特点_(T1-T2-T3)的敏感度分别为80.90%和86.70%,特异度分别为73.30%和56.60%。结论不同时相CESM量化参数联合强化特点有助于鉴别乳腺良、恶性肿块。

Objective To observe the value of quantitative parameters combined with enhancement characteristics during different photography phases of contrast-enhanced spectral mammography(CESM)for differential diagnosis of benign and malignant breast masses.Methods Totally 114 patients with single breast mass who underwent CESM were prospectively collected.Cranio-caudal(CC)images,the first time mediolateral oblique(MLO)images and the second MLO of the affected side breast were acquired 2-3 min(early phase,T_(1)),4-5 min(middle phase,T_(2))and 7-9 min(delayed phase,T_(3))after contrast injection,respectively.Then the corresponding subtraction images were obtained,and the lesion's gray value(LGV),lesion to background grey value ratio(LBR),the change rate of lesion grey value difference(LGVD)and LBR of each 2 adjacent phases were measured and calculated.The enhancement characteristics of the lesion(elevated,steady and depressed)were assessed based on the change rate of LGVD or LBR of each 2 adjacent phases.Taken pathological results as the gold standards,receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficiency of CESM quantitative parameters combined with enhancement characteristics for differential diagnosis of benign and malignant breast masses.Results Among 114 patients,there were 30 cases of benign(benign group)and 84 of malignant lesion(malignant group).LGV_(T1) and LBR_(T1) were significantly different(both P<0.05),while there was no significant difference of the other parameters between groups(all P>0.05).The sensitivity of LGV_(T1)+LGV_(T2)+enhancement characteristics_(T1-T2) and LGV_(T1)+LGV_(T2)+LGV_(T3)+enhancement characteristics_(T1-T2-T3) for differential diagnosis of benign and malignant breast masses was 83.30%and 91.60%,with the specificity of 63.30%and 53.30%,respectively,while the sensitivity of LBR_(T1)+LBR_(T2)+enhancement characteristics_(T1-T2) and LBR_(T1)+LBR_(T2)+LBR_(T3)+enhancement characteristics_(T1-T2-T3) was 80.90%and 86.70%,and the specificity was 73.30%and 56.60%,respectively.Conclusion Quantitative parameters combined with enhancement characteristics in different phases of CESM could help to distinguish benign and malignant breast masses.