乳腺良恶性肿瘤钆喷酸葡胺增强后不同时间点ADC值的评估

ADC evaluation after gadopentetate dimeglumine enhancement in breast tumors

目的探讨钆喷酸葡胺增强对乳腺病变表观扩散系数(ADC)值的影响,以及增强前及增强后3 min、13 min的ADC值在乳腺良恶性肿瘤中的鉴别效能。方法回顾性分析本院经病理证实的272个乳腺病灶增强前后肿瘤实质的ADC值,分别比较浸润性乳腺癌组、非浸润性乳腺癌组及良性肿瘤组间在增强后3 min、13 min与增强前的ADC值的差异,并绘制ROC曲线,分析其诊断效能。结果浸润性乳腺癌组增强前及增强后3 min的ADC值分别为(0.999±0.167)×10^(-3) mm^(2)/s、(0.934±0.165)×10^(-3) mm^(2)/s,差异有统计学意义(P<0.001),余病理类型增强前后ADC值差异均无统计学意义。增强前、增强后3 min区分肿瘤良恶性ADC值截断值分别为1.23×10^(-3)、1.31×10^(-3) mm^(2)/s,敏感度为92.3%、80.8%,特异度为96.3%、100%;增强前、增强后13 min区分肿瘤良恶性ADC值截断值分别为1.22×10^(-3)、1.30×10^(-3) mm^(2)/s,敏感度为95.7%、92.4%,特异度为91.3%、95.0%;增强前及增强后3 min、13 min的ADC值诊断乳腺病变良恶性的AUC均大于0.95。结论浸润性乳腺癌组增强后3 min ADC值有所下降,但不影响乳腺良恶性肿瘤的鉴别效能;在增强后3 min采集扩散加权成像序列有助于减少总检查时间。

Objective To investigate the effect of gadopentetate dimeglumine enhancement on the apparent diffusion coefficient(ADC)values and the diagnostic efficacy of ADC values in breast tumors.Methods The ADC values of 272 histologically confirmed breast tumors before and after contrast enhancement were retrospectively analyzed.The ADC values between benign,invasive,and non-invasive breast tumors before,at 3 minutes,and 13 minutes after enhancement were compared using receiver operating characteristic(ROC)curve analysis.Results The ADC values of invasive breast cancer were significantly greater(P<0.001)before[(0.999±0.167)×10^(-3) mm^(2)/s]than that at 3 minutes after[(0.934±0.165)×10^(-3) mm^(2)/s]contrast enhancement.There was no significant difference in ADC values between the other breast tumors before and after enhancement.The cut-off ADC values of 1.23×10^(-3) mm^(2)/s before enhancement had 92.3%sensitivity and 96.3%specificity for differentiating benign and malignant tumors compared to 80.8%sensitivity and 100%specificity at cut-off ADC value of 1.31×10^(-3) mm^(2)/s 3 minutes after enhancement.The cut-off ADC values of 1.22×10^(-3) mm^(2)/s before enhancement had 95.7%sensitivity and 91.3%specificity for differentiating benign and malignant tumors compared to 92.4%sensitivity and 95.0%specificity at cut-off ADC value of 1.30×10^(-3) mm^(2)/s 13 minutes after enhancement.The areas under the ROC curves were all greater than 0.95.Conclusion The ADC value of invasive breast cancer decreased at 3 minutes after enhancement without affecting the diagnostic efficacy of breast tumors.The acquisition of diffusion-weighted imaging sequence at 3 minutes instead of 13 minutes after enhancement can reduce the total examination time.