CESM病灶-背景实质信号增强比对乳腺疾病的诊断价值

Diagnostic value of CESM focus-background parenchymal signal enhancement ratio in breast diseases

目的:探讨对比增强能谱乳腺X线摄影(contrast-enhanced spectral mammography, CESM)病灶-背景实质信号增强比(LBSER)对乳腺良恶性病变的定量诊断价值。方法:回顾性分析我院临床可疑乳腺疾病112例患者临床资料,所有患者行手术病理或组织穿刺病理活检证实,且术前均行CESM检查。分析病灶的CESM影像学表现,并采用ROI定量分析方法,测量CESM图像病灶中央区及边缘区LBSER值,包括早期增强比及延迟增强比,比较乳腺恶性组与乳腺良性组间LBSER值的差异。采用受试者工作特征(ROC)曲线分析CESM及LBSER对乳腺良恶性病变的诊断效能。结果:112例患者中共117个乳腺病变,其中恶性52个(恶性组),良性65个(良性组),早期恶性病灶中央区、边缘区LBSER值明显高于良性病灶组,具有显著统计学意义(P均<0.001),延迟期恶性病灶中央区、边缘区LBSER值高于良性病灶组,具有统计学意义(P均<0.05)。CESM诊断敏感度、特异度、准确率分别为85.54%、80.00%、82.91%。以恶性病变早期中央区LBSER值的95%可信区间下限1.043作为鉴别诊断阈值,诊断敏感度、特异度、准确率分别为51.92%、86.15%、70.94%。CESM与LBSER联合诊断敏感度、特异度、准确率分别为90.38%、73.85%、81.20%。CESM、LBSER值及联合诊断鉴别乳腺良恶性病变的AUC值分别为0.833、0.690、0.821。结论:CESM检查中,乳腺恶性病变LBSER值明显高于乳腺良性病变,LBSER值可提供辅助乳腺疾病诊断信息,定量分析LBSER值数据有助于提高CESM检查鉴别乳腺良恶性病变的诊断效能。

Objective:To investigate the quantitative diagnostic value of contrast-enhanced energy spectrum mammography(CESM)focus-background parenchymal signal enhancement ratio(LBSER)in benign and malignant breast lesions.Methods:Retrospective analysis was performed on the clinical data of 112 patients with clinically suspected breast diseases in our hospital,all of whom were confirmed by surgical pathology or histopathologic biopsy,and CESM examination was performed before surgery.CESM imaging findings were analyzed,and ROI quantitative analysis was used to measure the LBSER values in the central and marginal areas of the lesions in CESM images,including early enhancement ratio and delayed enhancement ratio,to compare the difference in LBSER values between the malignant and benign breast groups.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of CESM and LBSER in benign and malignant breast lesions.Results:There were 117 breast lesions in 112 patients,of which 52 were malignant(malignant group)and 65 were benign(benign group).The LBSER values in the central and marginal areas of early malignant lesions were significantly higher than those in the benign lesion group,with statistical significance(all P<0.001).The LBSER values in the central and marginal areas of late malignant lesions were higher than those in the benign lesion group.There was statistical significance(all P<0.05).The sensitivity,specificity and accuracy of CESM diagnosis were 85.54%,80.00%and 82.91%,respectively.The lower limit of 95%confidence interval(CI)1.043 of the central LBSER value in the early stage of malignant lesions was used as the differential diagnosis threshold,and the diagnostic sensitivity,specificity and accuracy were 51.92%,86.15%and 70.94%,respectively.The sensitivity,specificity and accuracy of CESM combined with LBSER were 90.38%,73.85%and 81.20%,respectively.CESM,LBSER and AUC values of combined diagnosis were 0.833,0.690 and 0.821,respectively.Conclusion:In CESM examination,LBSER value of malignant breast lesions was significantly higher than that of benign breast lesions.LBSER value can provide auxiliary information for the diagnosis of breast diseases.Quantitative analysis of LBSER value data is helpful to improve the diagnostic efficiency of CESM examination in distinguishing benign and malignant breast lesions.