多模态定量磁共振成像对乳腺良恶性病变的诊断价值

The Value of Multimodal Magnetic Resonance Imaging in the Differential Diagnosis of Benign and Malignant Breast Lesions

目的探讨多模态磁共振成像(DWI+IVIM+DKI+DCE-MRI模型)对乳腺良恶性病变的诊断价值。方法回顾性分析经病理证实的乳腺肿块患者177例,良性组29例,恶性组148例,所有病例均行DWI、IVIM及DKI、DCE-MRI检查。分析两组间的临床病理资料、时间-信号强度曲线(TIC)和表观扩散系数(ADC)、真实扩散系数(D)、灌注相关扩散系数(D^(*))、灌注分数(f)、平均扩散峰度值(MK)、平均扩散率(MD)、容积转运常数(K^(trans))、血管外细胞外间隙容积分数(V_(e))、速率常数(K_(ep));绘制受试者工作特征曲线(ROC)比较其诊断效能。结果恶性组乳腺癌边界多欠清,TIC曲线多呈“平台型”或“流出型”,两组间差异有统计学意义(P<0.05)。良性组ADC,D,MD值高于恶性组,而D^(*),MK,K^(trans),K_(ep),V_(e)值低于恶性组,差异有统计学意义(P<0.05)。其中DKI的MD的曲线下面积(AUC)最大,为0.826。DWI模型的AUC为0.768,IVIM模型的AUC为0.821;DKI模型的AUC为0.871;DCE-MRI模型的AUC为0.791;四组定量模型的AUC差异不具有统计学意义(Z=0.045~1.618,P>0.05)。DKI模型的敏感度、特异度及准确率高于DWI及IVIM模型,但其准确率略低于DCE-MRI。将DKI模型、DCE-MRI模型联合后,AUC为0.946,诊断效能均高于单一模型(Z=2.197~3.600,P<0.05);敏感度为88.5%,特异度为96.6%,准确率为91.0%,均高于单一模型。结论DWI、IVIM、DKI、DCE-MRI均可用于乳腺良恶性病变的预测,联合DKI及DCE-MRI模型更有利于患者术前精准治疗。

Objective To explore the diagnostic value of multimodal magnetic resonance imaging(DWI+IVIM+DKI+DCE-MRI model)for benign and malignant breast lesions.Methods A total of 177 cases of patients with breast lesion confirmed by pathology were collected,including 29 cases in the benign group and 148 cases in the malignant group.DWI,IVIM,DKI and DCE-MRI scanning were performed in all patients.The clinicopathological characteristics,time signal intensity curve and true diffusion coefficient(D),perfusion-related diffusion coefficient(D^(*)),perfusion fraction(f),mean diffusion rate(MD),mean kurtosis value(MK),volume transfer constant(K^(trans)),extravascular extracellular space distribute volume per unit tissue volume(V_(e))and rate constant(K_(ep))were analyzed.The ROC was plotted to compare the diagnostic efficiency.Results In the malignant group,the boundary of breast cancer was mostly unclear,and the TIC curve was mostly plateau or washout type,which is significantly different from those of the benign group.The values of ADC,D and MD in benign group were lower than those in benign group,while the values of D^(*),MA,K^(trans),K_(ep),V_(e) were higher than that in malignant group(P<0.05).The MD value of DKI had the largest AUC of 0.826.The AUCs of the DWI,IVIM,DKI,DCE-MRI models were 0.768,0.821,0.871,0.791.The differences in AUCs between the four quantitative models were not statistically significant(Z=0.045 to 1.618,P>0.05).The sensitivity,specificity,and accuracy of the DKI models were higher than the DWI and IVIM models,but with a slightly lower accuracy than the DCE-MRI.Combining DKI and DCE-MRI model,the AUC was 0.946,and the diagnostic efficacy was higher than single model(Z=2.197-3.600,P<0.05).Conclusion DWI,IVIM,DKI,and DCE-MRI can all be used to discriminate benign and malignant breast lesions,and the combination of DKI and DCE-MRI model is more conducive to the precise preoperative treatment of patients.