乳腺硬化性腺病的MRI影像表现及诊断价值

MRI Findings and Diagnostic Value of Sclerosing Adenosis of Breast

目的探讨乳腺硬化性腺病(SA)的MRI表现并分析MRI诊断SA的价值。方法回顾性分析31例手术病理证实为单纯SA及以SA为主伴其他良性病变的病例。观察MRI征象,并根据乳腺影像报告和数据系统(BI-RADS)进行分类,以BI-RADS分类≥4b诊断为恶性,计算误诊率、检出率。结果31例患者共40个SA病灶,3个单纯SA,余伴其他良性病变。乳腺SA在MRI中表现复杂:平扫T1WI多为等或低信号,T2WI以不均匀等或稍高信号为主,ADC值多高于1.1×10^(-3)mm^(2)/s,占60.0%(21/35),增强扫描非肿块样强化最多见,占52.5%(21/40),肿块样强化占25.0%(10/40),4个点状强化及5个阴性病灶,时间-信号强度曲线(TIC)以“流入型”多见,占48.6%(17/35);乳腺X线摄影、超声及MRI检查的误诊率分别为10.0%(4/40)、20.0%(8/40)和10.0%(4/40),检出率分别为72.5%(29/40)、92.5%(37/40)和87.5%(35/40)。结论MRI对乳腺SA的综合诊断能力优于超声及乳腺X线摄影,部分病变表现与导管原位癌相似,易造成误诊,最终应依靠病理检查。

Objective To investigate the MRI findings of breast sclerosing adenosis(SA)and analyze the value of MRI diagnosis of SA.Methods A retrospective analysis was performed on 31 cases of simple SA and SA with other benign lesions confirmed by surgical pathology.MRI features were observed and classified according to the Breast imaging Reporting and Data System(BI-RADS).Malignant tumors were diagnosed with BI-RADS≥4b,and misdiagnosis rate and detection rate were calculated.Results There were 40 SA lesions in 31 patients,including 3 simple SA lesions and other benign lesions.Breast SA has complex findings in MRI:T1WI mostly has equal or low signal.Uneven or slightly higher signal was dominant on T2WI.Non-mass enhancement was the most common on enhanced scan[52.5%(21/40)],and mass enhancement accounted for 25.0%(10/40).There were 4 points of enhancement and 5 negative lesions.The time-signal intensity curve(TIC)was mostly inflow type,accounting for 48.6%(17/35).The misdiagnosis rates of mammography,ultrasound and MRI were 10.0%(4/40),20.0%(8/40)and 10.0%(4/40),respectively,and the detection rates were 72.5%(29/40),92.5%(37/40)and 87.5%(35/40),respectively.Conclusion The comprehensive diagnostic ability of MRI in breast sclerosing adenosis is better than that of ultrasound and mammography,and some lesions are similar to ductal carcinoma in situ,which is easy to cause misdiagnosis,and ultimately should rely on pathological examination.