DWI联合DCE-MRI在乳腺肿块良恶性诊断中的效能

Efficacy of DWI combined with DCE-MRI in diagnosis of benign and malignant breast masses

目的:观察扩散加权成像(DWI)联合动态增强磁共振成像(DCE-MRI)在乳腺肿块良恶性诊断中的效能。方法:选取2020年4月至2022年4月该院收治的138例乳腺肿块患者进行前瞻性研究,所有患者均行DWI、DCE-MRI检查,以病理活检诊断结果作为金标准,比较DWI、DCE-MRI单项及联合检查在乳腺肿块良恶性诊断中的效能,以及诊断肿块良恶性的图像特征、内部强化方式。结果:病理学检查结果显示,138例乳腺肿块患者恶性84例,良性54例;DWI检查结果显示恶性63例,良性33例;DCE-MRI检查结果显示恶性64例,良性34例;DWI联合DCE-MRI检查结果为恶性80例,良性33例;DWI检查的灵敏度、特异度、准确度、阳性预测值、阴性预测值与DCE-MRI检查比较,差异均无统计学意义(P>0.05);DWI联合DCE-MRI检查诊断的灵敏度、准确度、阳性预测值均高于DWI、DCE-MRI单项检查,差异有统计学意义(P<0.05);DWI联合DCE-MRI检查诊断的特异度、阴性预测值与DWI、DCE-MRI单项检查比较,差异均无统计学意义(P>0.05);良性乳腺肿块分布特征中局灶、多区域、区域、节段占比与恶性乳腺肿块比较,差异均无统计学意义(P>0.05);良性乳腺肿块分布特征中弥漫占比高于恶性乳腺肿块,导管占比低于恶性乳腺肿块,差异均有统计学意义(P<0.05);良性乳腺肿块内部强化方式中网状、不均匀占比比较,差异均无统计学意义(P>0.05);良性乳腺肿块内部强化方式中斑点样占比高于恶性乳腺肿块,簇状占比低于恶性乳腺肿块,差异均有统计学意义(P<0.05)。结论:DWI联合DCE-MRI检查诊断乳腺肿块良恶性的效能高于DWI、DCE-MRI单项检查,且良性乳腺肿块弥漫占比、斑点样占比均高于恶性乳腺肿块,导管占比、簇状占比均低于恶性乳腺肿块。

Objective:To observe efficacy of diffusion weighted imaging(DWI)combined with dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in diagnosis of benign and malignant breast masses.Methods:A prospective study was conducted on 138 patients with breast masses admitted to the hospital from April 2020 to April 2022.All patients underwent DWI and DCE-MRI examinations.Using the diagnostic results of pathological biopsy as the gold standard,the efficacies of single DWI,single DCE-MRI and combined examination in the diagnosis of benign and malignant breast masses,as well as the image features and internal enhancement methods were compared.Results:The pathological examination showed that 84 cases were malignant and 54 cases were benign among the 138 patients with breast masses.DWI showed that 63 cases were malignant and 33 cases were benign.DCE-MRI showed that 64 cases were malignant and 34 cases were benign.DWI combined with DCE-MRI showed that 80 cases were malignant and 33 cases were benign.There were no significant differences in sensitivity,specificity,accuracy,positive predictive value and negative predictive value between DWI and DCE-MRI(P>0.05).The sensitivity,accuracy and positive predictive value of DWI combined with DCE-MRI were higher than those of single DWI and single DCE-MRI(P<0.05).There was no significant difference in the proportions of focal,multi-regional,regional and segmental distribution characteristics among the benign breast masses and the malignant breast masses(P>0.05).The proportion of diffuse lesions was higher than that of the malignant breast masses,the proportion of ductal lesions was lower than that of the malignant breast masses,and the differences were statistically significant(P<0.05).There were no significant differences in the proportions of reticular and inhomogeneous enhancement among the benign breast masses(P>0.05).Further,the proportion of spots in the internal enhancement of the benign breast masses was higher than that of the malignant breast masses,the proportion of clusters was lower than that of malignant breast masses,and the differences were statistically significant(P<0.05).Conclusions:The efficacy of DWI combined with DCE-MRI in the diagnosis of benign and malignant breast masses is higher than single DWI and single DCE-MRI.Moreover,the proportions of diffuse and spot benign breast masses are higher than those of the malignant breast masses,and the proportions of ductal and cluster lesions are lower than those of the malignant breast masses.