研究DCE-MRI与超声弹性成像在乳腺BI-RADS 4级病变中的应用

Application of DCE-MRI and Ultrasound Elastography in the Diagnosis of BI-RADS 4 Types of Lesions

目的研究乳腺BI-RADS 4级病变诊断中动态增强磁共振成像(DCE-MRI)与超声弹性成像(UE)的应用价值。方法选取2020年6月至2022年6行手术治疗的102例乳腺BI-RADS 4级病变患者,术前均行DCE-MRI与UE检查。比较良性病灶、恶性病灶DCE-MRI定量参数、UE结果;以病理诊断结果为“金标准”,采用四格表法分析DCE-MRI、UE及两者联合诊断乳腺BI-RADS 4级病变的价值。结果102例乳腺BI-RADS 4级病变患者有123个病灶,病理诊断结果显示,良性病灶86个(69.92%),恶性病灶37个(30.08%)。与良性病灶比较,恶性病灶容量转移常数(Ktrans值)、速率常数(Kep值)、血管外细胞外间隙容积比(Ve值),弹性图评分≥4分构成比、弹性系数升高(P<0.05)。在37个经病理检查诊断为恶性的病灶中,DCE-MRI、UE、DCE-MRI联合UE诊断为恶性的分别有34个、33个、32个;在86个经病理检查诊断为良性的病灶中,DCE-MRI、UE、DCE-MRI联合UE诊断为恶性的分别有7个、9个、2个。DCEMRI诊断乳腺BI-RADS 4级病变的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为91.89%、91.86%、91.87%、82.93%、96.34%;UE诊断乳腺BI-RADS 4级病变的敏感度、特异度、准确度分别为89.19%、89.53%、89.43%;DCE-MRI联合UE诊断乳腺BI-RADS 4级病变的敏感度、特异度、准确度分别为86.49%、97.67%、94.31%。DCE-MRI联合UE诊断的特异度、准确度及阳性预测值均高于DCEMRI、UE单独诊断,但差异均无统计学意义(P值均>0.05)。结论DCE-MRI联合UE可有效鉴别乳腺BIRADS 4级病变良、恶性,以减少不必要的活检。

Objective To explore the application value of dynamic enhanced magnetic resonance imaging(DCE-MRI)and ultrasound elastography(UE)in the diagnosis of BI-RADS 4 types of lesions.Methods A total of 102 patients with BI-RADS 4 types of lesions who underwent 6 surgical treatments from June 2020 to 2022 were selected.All of them underwent DCE-MRI and UE examination before surgery.DCE-MRI quantitative parameters and UE results between benign and malignant lesions were compared.With pathological diagnosis as the"gold standard",the value of DCE-MRI,UE and their combination in the diagnosis of BI-RADS 4 types of lesions were analyzed by four-table method.Results There were 123 lesions in 102 patients with BI-RADS 4 types of lesions.The pathological diagnosis results showed that there were 86 benign lesions(69.92%)and 37 malignant lesions(30.08%).Compared with benign lesions,the volume transfer constant(Ktrans),rate constant(Kep),extravascular extracellular space-to-volume ratio(Ve)of malignant lesions,elastic chart score≥4 points,and elastic coefficient in malignant lesions were increased(P<0.05).Among the 37 lesions diagnosed as malignant by pathological examination,34,33 and 32 were diagnosed as malignant by DCE-MRI,UE,DCE-MRI combined with UE,respectively.Among the 86 lesions diagnosed as benign by pathological examination,7,9 and 2 were diagnosed as malignant by DCE-MRI,UE,DCE-MR combined with UE.The sensitivity,specificity,accuracy of DCE-MRI for the diagnosis of BI-RADS 4 types of lesions were 91.89%,91.86%,91.87%,respectively.The sensitivity,specificity,accuracy of UE in the diagnosis of BI-RADS 4 types of lesions were 89.19%,89.53%,89.43%,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of DCE-MRI combined with UE for the diagnosis of BI-RADS 4 types of lesions were 86.49%,97.67%,94.31%,94.12%and 94.38%,respectively.The specificity,accuracy and positive predictive value of DCE-MRI combined with UE were higher than those of DCE-MRI and UE alone,but there were no statistical significances(all P>0.05).Conclusion DCE-MRI combined with UE can improve the accuracy of benign and malignant differentiation of breast BI-RADS 4 lesions,so as to reduce unnecessary biopsies.