扩散峰度联合体素内不相干运动成像对乳腺良恶性病变的诊断价值

The value of diffusion kurtosis imaging combined with intravoxel incoherent motion in the differential diagnosis of benign and malignant breast lesions

目的探讨扩散峰度成像(DKI)联合体素内不相干运动成像(IVIM)对乳腺良恶性病变的诊断价值。方法回顾性分析济宁医学院附属医院经病理证实的乳腺肿块患者301例,良性组59例,恶性组242例,所有病例均行DKI及IVIM检查。分析两组间的MK、MD和D、D^(*)、f值;绘制受试者工作特征曲线(ROC)比较其诊断效能。结果良性组MD,D值高于恶性组,而MK,D^(*)值低于恶性组,差异有统计学意义(均P<0.05)。当MD≤2.60×10^(-3)mm^(2)/s,MK≥0.58,D≤0.79×10^(-3)mm^(2)/s,D^(*)≥30.2×10^(-3)mm^(2)/s时,诊断倾向于恶性病变,其中DKI的MD曲线下面积(AUC)最大,为0.815,特异度及准确度最高,分别为84.8%、81.4%。将MD、MK及D、D^(*)值联合,AUC为0.846,诊断效能均高于单一参数(Z=3.752,P<0.001;Z=6.235,P<0.001;Z=2.711,P=0.0271;Z=2.469,P=0.0135);敏感度为73.5%,特异度为81.6%,准确度为83.7%,亦高于单一参数。结论DKI联合IVIM可用于乳腺良恶性病变的预测,有利于患者术前精准治疗。

Objective To explore the diagnostic value of diffusion kurtosis imaging combined with intravoxel incoherent motion for discriminating benign and malignant breast lesions.Methods A total of 301 cases of patients with breast lesion confirmed by pathology were collected,including 59 cases in the benign group and 242 cases in the malignant group.DKI and IVIM scanning were performed in all patients.The mean diffusion rate(MD),mean kurtosis value(MK)and true diffusion coefficient(D),perfusion-related diffusion coefficient(D^(*)),perfusion fraction(f)were analyzed.The ROC was plotted to compare the diagnostic efficiency.Results The values of MD and D in benign group were higher than those in malignant group,while the values of MK,D^(*)were lower than that in malignant group(P<0.05).When MD≤2.60×10^(-3)mm^(2)/s,MK≥0.58,D≤0.79×10^(-3)mm^(2)/s,D^(*)≥30.2×10^(-3)mm^(2)/s,the diagnosis favors malignant lesions,with the MD of DKI had the largest AUC of 0.815.The specificity and accuracy were 84.8%and 81.4%,respectively.The AUC of MD+MK+D+D^(*)was 0.846 and the diagnostic efficacy was higher than the single parameter(Z=3.752,P<0.001;Z=6.235,P<0.001;Z=2.711,P=0.0271;Z=2.469,P=0.0135),the sensitivity,specificity and accuracy were 73.5%,81.6%,83.7%.Conclusion DKI combined with IVIM can be used in the prediction of benign and malignant breast lesions,which is conducive to the precise preoperative treatment of patients.