体素内不相干运动模型对特发性肉芽肿性乳腺炎与浸润性导管癌的鉴别诊断价值

Value of intravoxel incoherent motion(IVIM) model in differential diagnosis of idiopathic granulomatous mastitis and invasive ductal carcinoma

目的 :探讨体素内不相干运动(IVIM)模型对段样非肿块强化的无脓肿特发性肉芽肿性乳腺炎(IGM)与浸润性导管癌(IDC)的鉴别诊断价值。方法:回顾性分析27例段样非肿块强化、无脓肿IGM患者(IGM组)和15例IDC患者(IDC组)的临床及影像资料。2组均行MRI多b值DWI及动态增强扫描。采用Fisher确切法、t检验比较2组年龄、月经状态、强化方式的差异,采用t检验、Mann-Whitney U检验筛选出IVIM模型参数单纯扩散系数(D值)、灌注分数(f值)、假性扩散系数(D*值)中的差异项,用二元logistic回归分析计算其与IDC组的危险系数,并绘制ROC曲线。结果:(1)2组年龄、月经状态差异均有统计学意义(均P<0.05),而强化方式差异无统计学意义(P=0.883)。(2)IGM组f值(0.401±0.167)低于IDC组(0.651±0.252)(P=0.003),IGM组D值(1.135±0.260)高于IDC组(0.592±0.141)(P=0.032);2组间D*值差异无统计学意义(P=0.289)。二元logistic线性回归分析显示,D值OR=2.115(95%CI 1.352~2.801)(P=0.013),绘制ROC曲线后,约登指数为0.547,敏感度为77.78%,特异度为76.92%,AUC=0.765(95%CI 0.592~0.891)(P=0.011)。结论:IVIM模型参数D值对段样非肿块强化的无脓肿形成IGM与IDC有鉴别诊断价值。

Objective:To explore the differential diagnosis value of intravoxel incoherent motion(IVIM) in segmental non-mass-enhanced and non-abscess idiopathic granulomatous mastitis(IGM) and invasive ductal carcinoma(IDC). Methods:The clinical and imaging data of 27 patients of segmental non-mass-enhanced and non-abscess IGM(IGM group) and 15 patients of IDC(IDC group)pathologically proven were retrospectively analyzed. All patients underwent multi-b-value DWI and MRI enhancement scan.Comparisons of age,menstrual state,enhancement pattern were made with Fisher’s exact test,chi-square test,and comparisons of IVIM parameters(D,D,f value) between them were made with t test or Mann-Whitney U test. Binary logistic regression was used to obtain the diagnostic parameter,and its ROC curve was analyzed to evaluate its diagnostic value. Results:(1)There were significant differences in age and menstrual state between the two groups(P<0.05),while the difference in enhancement pattern was not statistically significant(P= 0.883).(2)The f value of IGM group was 0.401±0.167,which was lower than that of the IDC group(0.651±0.252)(P= 0.003). The D value of IGM group was 1.135±0.260,which was higher than that of the IDC group(0.592±0.141)(P= 0.032). There was no significant difference in the Dvalue between two groups(P= 0.289). Binary logistic regression showed that OR of D value was 2.115(95%CI 1.352~2.801)(P= 0.013). ROC curve was drawn and showed that Youden index was 0.547,sensitivity was 77.78%,specificity was 76.92%,AUC was 0.765(95%CI 0.592~0.891)(P= 0.011).Conclusions:The parameter D value derived from the IVIM model can be used to distinguish IGM(without abscess) from IDC.