多模态MRI在乳腺非肿块性病变中的诊断价值

Diagnostic Value of Multimodal MRI in Breast Non-mass-like Lesions

目的探讨多模态MRI在乳腺非肿块样强化(non-mass-like enhancement,NMLE)病变中的诊断价值。方法选取71例恶性NMLE患者,计为恶性组;另选同时期60例良性NMLE患者作为对照,计为良性组(后经手术病理确认)。并对两组患者进行多模态MRI诊断,对比分析相关参数。结果恶性NMLE患者小叶节段样多于良性患者(P<0.05),病灶内部簇集样强化率高于良性NMLE(P<0.05);两组患者的时间-信号强度曲线(time-signal intensity curve,TIC)类型存在差异(P<0.05),Ⅲ型TIC为恶性患者的可能性更高,恶性患者表观扩散系数(apparent diffusion coefficient,ADC)值低于良性NMLE患者(P<0.05);体素内不相关运动扩散加权成像(intravoxel incoherent motionimaging-diffusion weighted imaging,IVIM-DWI)分析显示恶性NMLE患者容量转移常数(K^(trans))、速率常数(K_(ep))高于良性患者(P<0.05),血管外细胞外间隙容积比(V_(e))无差异(P>0.05);Logistic回归分析显示,ADC值、K^(trans)、K_(ep)是NMLE恶性的独立危险因素,NMLE病理诊断方程式:Log=-5.884-(0.712ADC值)+(1.023K_(ep))+(0.809K_(ep));受试者工作特征曲线(The receiver operating characteristic curve,ROC)结果显示,Hosemer-Lemeshow检验此模型对NMLE恶性的诊断曲线下面积(Area under curve,AUC)为0.953,敏感度、特异度分别为90.14%、88.33%。结论恶性NMLE患者的分布方式、内部强化特征、TIC类型均与良性NMLE患者存在一定差异,Ⅲ型TIC类型是判断NMLE恶性的独立危险因素,同时ADC值≤1.225 mm^(2)/s、K^(trans)>0.0831 min、K_(ep)>0.6309 min时,患者为恶性NMLE的可能性更高,多模态MRI有助于提高NMLE的临床诊断率。

Objective To investigate the diagnostic value of multimodal MRI in breast non-mass-like enhancement(NMLE)lesions.Methods 71 patients with malignant NMLE and 60 patients with benign NMLE confirmed by surgery and pathology were selected and defined as malignant group and benign group.All patients were diagnosed with multimodal MRI,and relevant parameters were comparatively analyzed.Results There were more lobular segmental patterns in the malignant group than in the benign group(P<0.05),and the rate of cluster enhancement inside the lesion was higher than that in the benign group(P<0.05).The time-signal intensity curve(TIC)was different in the 2 groups(P<0.05),and typeⅢTIC was more likely to belong to the malignant group.The apparent diffusion coefficient(ADC)value of the malignant group was lower than that of the benign group(P<0.05).Intravoxel incoherent motion imaging-diffusion weighted imaging(IVIM-DWI)showed that the volume transfer constant(K^(trans))and rate constant(K_(ep))of malignant group were higher than those of the benign group(P<0.05),but the volume fraction of extravascular extracellular space(V_(e))showed no difference(P>0.05).Logistic regression analysis showed that ADC value,K^(trans),and K_(ep) were independent risk factors for malignant NMLE.The pathological diagnosis equation of NMLE was as follows:Log=-5.884-(0.712 ADC value)+(1.023K_(ep))+(0.809K_(ep)).The receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC)of this model tested by Hosemer-Lemeshow in the diagnosis of malignant NMLE was 0.953.The sensitivity and specificity were 90.14%and 88.33%respectively.Conclusion The distribution pattern,internal enhancement characteristics,and TIC types of malignant NMLE are different from those of benign NMLE.TypeⅢTIC is an independent risk factor for malignant NMLE.ADC value≤1.225 mm^(2)/s,K^(trans)>0.0831min and Ke P>0.6309 min may indicate a high probability of malignant NMLE.Multimodal MRI can help improve the clinical diagnosis rate of NMLE.