动态增强磁共振成像扫描联合超声对乳腺良恶性疾病的诊断价值

Diagnostic value of dynamic enhanced MRI scan combined with ultrasound in benign and malignant breast diseases

目的探讨应用动态增强磁共振成像(DCE-MRI)扫描联合超声检查对乳腺疾病性质的诊断价值。方法回顾性收集我院2020年1月至2023年12月收治的75例乳腺疾病患者临床资料,所有患者均行DCE-MRI和超声检查,以病理结果作为“金标准”,计算不同检查方式诊断乳腺良恶性疾病的灵敏度、特异度、阳性预测值、阴性预测值和准确率,并应用Kappa检验评价不同检查方式诊断结果的一致性;采用受试者操作特性(ROC)曲线分析不同检查方式诊断乳腺良恶性疾病的曲线下面积(AUC)。比较DCE-MRI乳腺良恶性病变的边缘、形状、强化方式及时间-信号强度曲线(TIC)的差异。结果75例乳腺疾病患者,病理结果证实,共检出病灶82个,其中良性患者43例(46个病灶),恶性患者32例(36个病灶)。DCE-MRI联合超声诊断乳腺良恶性疾病的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为97.2%、95.6%、94.6%、97.8%和96.3%,均高于单一诊断(P<0.05);超声、DCE-MRI和二者联合诊断结果与病理结果的一致性分别为一般、中等和较好(Kappa=0.552、0.802和0.926)。经ROC曲线分析结果显示,二者联合诊断乳腺良恶性疾病的AUC为0.986,明显高于DCE-MRI和超声,差异均有统计学意义(P<0.05)。DCE-MRI良恶性乳腺疾病在病变边缘、形状、强化方式及TIC分型方面比较,差异均有统计学意义(P<0.05)。结论DCE-MRI和超声检查对乳腺疾病良恶性诊断均有一定的临床价值,但是二者联合检查诊断效能更高,能够为临床提供更加准确的参考依据,值得临床推广应用。

Objective To investigate the diagnostic value of applying Dynamic Enhanced MRI(DCE-MRI)scanning combined with ultrasonography on the nature of breast disease.Methods Retrospectively collect clinical data of 75 patients with breast diseases admitted to our hospital from January 2020 to December 2023,all patients underwent DCE-MRI and ultrasonography,and the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of different modalities for diagnosis of benign and malignant diseases of the breast were calculated using the pathologic results as the“gold standard”.The consistency of the diagnostic results of the different modalities was evaluated by applying the Kappa test.The area under the curve for the diagnosis of benign and malignant breast disease by different screening modalities was analyzed using subject operating characteristic(ROC)curves.Comparison of DCE-MRI breast benign and malignant lesions in terms of margins,shape,enhancement pattern,and time-signal intensity curves(TIC).Results Seventy-five patients with breast disease,as confirmed by pathologic results,had 82 lesions detected,including 43 benign patients(46 lesions)and 32 malignant patients(36 lesions).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of DCE-MRI combined ultrasound for diagnosis of benign and malignant breast diseases were 97.2%,95.6%,94.6%,97.8%and 96.3%,respectively,which were higher than that of a single diagnosis(P<0.05).The concordance between the diagnostic findings of ultrasound,DCE-MRI and the combination of the two with the pathologic findings was fair,moderate and good,respectively(Kappa=0.552,0.802 and 0.926).The results analyzed by ROC curve showed that the area of the curve(AUC)for the combined diagnosis of benign and malignant breast diseases by the two was 0.986,which was significantly higher than that of DCE-MRI and ultrasound,and the difference was statistically significant in all cases(P<0.05).DCE-MRI benign and malignant breast diseases were compared in terms of lesion margins,shape,mode of enhancement,and TIC typing,and the differences were statistically significant(P<0.05).Conclusion DCE-MRI and ultrasonography have certain clinical value in the diagnosis of benign and malignant breast diseases,but the combined examination of the two has higher diagnostic efficacy and can provide a more accurate reference basis for the clinic,which is worthy of clinical promotion and application.