磁共振药代动力灌注扫描在鉴别段样强化肉芽肿性乳腺炎与浸润性导管癌中的价值研究

Value of MR pharmacokinetic perfusion scan in differential diagnosis between idiopathic granulomatous mastitis and invasive ductal carcinoma appearing as segmental distribution enhancement

目的 探讨基于压缩感知技术的磁共振药代动力灌注扫描对段样强化的特发性肉芽肿性乳腺炎(idiopathic granulomatous mastitis,IGM)与浸润性导管癌(invasive ductal carcinoma,IDC)的鉴别诊断价值。材料与方法 回顾性分析27例段样强化、无脓肿型IGM和15例IDC患者的临床及影像资料,均行磁共振药代动力灌注扫描。采用Fisher精确检验、t检验、χ^(2)检验比较两组月经状态、年龄、内部强化方式的差异,采用t检验、Mann Whitney U检验筛选出两组容积转运常数(volume transport constant,K^(trans))、速率常数(rate constant,K_(ep))、血管外细胞外间隙容积分数(extravascular extracellular volume fraction,Ve)值中的差异项,用二元logistic线性回归分析其与IDC的危险系数,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线。结果 两组年龄、月经状态差异均有统计学意义(P=0.001、0.003),而内部强化方式差异无统计学意义(P=0.883)。磁共振药代动力灌注扫描:IGM组K^(trans)值[(0.274±0.163)min^(-1)]低于IDC组[(0.451±0.257) min^(-1)],IGM组K_(ep)值[(0.618±0.245)min^(-1)]低于IDC组[(0.856±0.420) min^(-1)],且两组间K^(trans)及K_(ep)值的差异有统计学意义(P=0.013,0.012)。两组Ve值为IGM组(0.531±0.320)min^(-1)、IDC组(0.629±0.323)min^(-1),差异无统计学意义(P=0.182)。二元logistic线性回归:K^(trans)值的优势比(odds ratios,OR)=2.243[95%置信区间(confidence interval,CI):0.652~6.294](P=0.021),绘制ROC曲线显示,约登指数、敏感度、特异度分别为0.585、73.3%、85.2%,曲线下面积(area under the curve,AUC)=0.778 (95%CI:0.623~0.891)(P=0.001)。结论 基于压缩感知技术的磁共振药代动力灌注扫描所得K^(trans)值对以段样强化为表现的IGM、IDC有鉴别诊断价值。

Objective:To evaluate the differential diagnosis value of MR pharmacokinetic perfusion scan using compressed sense technique between idiopathic granulomatous mastitis(IGM)and invasive ductal carcinoma(IDC)appearing as non-mass enhancement with segmental distribution on MR.Material and Methods:A total of 42 non-mass enhanced breast lesions with segmental distribution on MR(IGM 27 cases,IDC 15 cases)were retrospectively analyzed.All cases were pathologically proved.Comparison of menstrual state,age,inner enhancement pattern,between two groups were made with Fisher's exact test,t test and Chi-square test.The t test and Mann Whitney U test were used to screen out the difference terms in the volume transfer constant(K^(trans)),rate constant(K_(ep)),extravascular space volume fraction and extracellular space volume fraction(Ve)between the two groups.Binary logistic linear regression was used to obtain the odds ratios(OR)of the parameter with significant difference and its receiver operating characteristic(ROC)curve was generated to evaluate the diagnostic value.Results:There were significant differences in age and menstrual state between two groups(P=0.001,0.003),while the difference in inner enhancement pattern was of no significant difference(P=0.883).MR pharmacokinetic perfusion scan:K^(trans)(IGM)was(0.274±0.163)min^(-1),which was lower than K^(trans)(IDC)(0.451±0.257)min^(-1).While K_(ep)(IGM)(0.618±0.245)min^(-1) was higher than K_(ep)(IDC)(0.856±0.420)min^(-1).Both differences of K^(trans) and K_(ep) between two groups were significant(P=0.013,0.012).The Ve for two groups were Ve(IGM)(0.531±0.320)min^(-1) and Ve(IDC)(0.629±0.323)min^(-1).There was no significant difference in Ve between them(P=0.182).The OR value for K^(trans) was 2.243[95%confidence interval(CI):0.652-6.294]in logistic linear regression(P=0.021).The Jordan index(0.585),sensitivity(73.3%),specificity(85.2%)and area under the curve(AUC)(0.778,95%CI:0.623-0.891)were obtained from the ROC for K^(trans)(P=0.001).Conclusions:The parameter K^(trans) derived from MR pharmacokinetic perfusion scan using compressed sense technique can be used to distinguish IGM from IDC,which appeare as non-mass enhancement with segmental distribution on MR.