MRI弥散加权成像与彩色多普勒超声对良恶性乳腺病变的鉴别价值

Value of MRI diffusion weighted imaging and color Doppler ultrasound in the differential diagnosis of benign and malignant breast lesions

目的探讨MRI弥散加权成像(DWI)和彩色多普勒超声(CDUS)对良恶性乳腺病变的鉴别价值。方法收集81例乳腺病变患者的临床资料,所有患者均进行CDUS、MRI-DWI以及病理检查,采用受试者工作特征(ROC)曲线评价CDUS、MRI-DWI两种方式对良恶性乳腺病变的诊断效能。结果病理结果显示,81例乳腺病变患者中,乳腺癌41例,良性病变40例。MRI平扫示,恶性组乳腺病变的形态不规则、边缘不光整比例均明显高于良性组,差异均有统计学意义(P﹤0.01);MRI-DWI示,恶性组乳腺病变的DWI高信号比例明显高于良性组,表观扩散系数(ADC)值明显低于良性组,差异均有统计学意义(P﹤0.01)。二维超声示,恶性组乳腺病变的形态不规则、边界不清、内部回声不均匀、沙砾样钙化比例均高于良性组,差异均有统计学意义(P﹤0.05);彩色多普勒血流显像(CDFI)示,恶性组乳腺病变的Adler分级2~3级比例、动脉血流检出率及阻力指数(RI)均明显高于良性组,差异均有统计学意义(P﹤0.01)。ROC曲线分析结果显示,CDUS诊断乳腺恶性病变的RI最佳临界值为0.72,MRI-DWI诊断乳腺恶性病变的ADC值的最佳临界值为1.28×10^(-3)mm^(2)/s,CDUS、MRI-DWI诊断乳腺恶性病变的曲线下面积(AUC)分别为0.727(95%CI:0.615~0.820)、0.831(95%CI:0.730~0.905),MRI-DWI诊断方式的AUC大于CDUS。结论CDUS和MRI-DWI在良恶性乳腺病变的鉴别诊断中均有较高的价值,相较而言,MRIDWI诊断效能更高。

Objective To explore the value of MRI diffusion weighted imaging(MRI-DWI)and color Doppler ultra-sound(CDUS)in the differential diagnosis of benign and malignant breast lesions.Method The clinical data of 81 pa-tients with breast lesions were collected.All patients received CDUS,MRI-DWI and pathological examination,and the di-agnostic efficiency of CDUS and MRI-DWI in the differential diagnosis of benign and malignant breast lesions were eval-uated by receiver operating characteristic(ROC)curves.Result Pathological results showed that in the 81 patients with breast lesions,there were 41 cases with breast cancer and 40 cases with benign lesions.MRI plain scan showed that pro-portions of cases with irregular morphology and rough edge in malignant group were higher than those in benign group(P<0.01).MRI-DWI showed that the proportion of cases with DWI high signals in malignant group was higher and appar-ent diffusion coefficient(ADC)value lower than those in benign group(P<0.01).Two-dimensional ultrasound showed that proportion of cases with irregular morphology,unclear borders,uneven internal echo and grit-like calcification in ma-lignant group were higher than those in benign group(P<0.05).The color Doppler flow imaging(CDFI)showed that inci-dence of Adler grading at grade 2-3,detection rate of arterial blood flow and resistance index(RI)in malignant group were higher than those in benign group(P<0.01).The ROC curve analysis showed that the optimal cut-off value of RI by CDUS for identifying benign and malignant breast lesions was 0.72,the optimal cut-off value of ADC by MRI-DWI for identifying benign and malignant breast lesions was 1.28×10^(-3)mm^(2)/s.The area under the curve(AUC)of ROC of CDUS and MRI-DWI in diagnosing malignant breast lesions was 0.727(95%CI:0.615-0.820)and 0.831(95%CI:0.730-0.905)respectively,with greater AUC of MRI-DWI than that of CDUS.Conclusion The diagnostic value of both CDUS and MRI-DWI are significant in identifying benign and malignant breast lesions.Compared with CDUS,diagnostic efficiency of MRI-DWI is higher.