动态增强MRI鉴别乳腺导管内乳头状瘤与其他良性病变

Differential diagnosis of breast intraductal papilloma from other benign lesion with dynamic contrast-enhanced MRI

目的:分析MRI检查鉴别诊断乳腺导管内乳头状瘤(intraductal papilloma, IDP)与其他乳腺良性病变的价值。方法:回顾性分析296例女性病人,行乳腺MRI检查并经手术病理证实。均为单个病灶,其中96个IDP,其他良性病灶200个。病灶为MRI检查BI-RADS 4类及以上。使用Siemens Aera 1.5T后处理工作站获得时间信号强度曲线(time-signal intensity curve, TIC)及表观弥散系数(apparent diffusion coefficient, ADC)值,探讨其鉴别诊断价值。结果:IDP病人平均年龄(49.9±12.0)岁,其他良性病变病人平均年龄(41.2±11.8)岁。IDP和其他良性病变均以肿块型强化病灶和边缘光滑为主。IDP可见边缘毛刺,其他良性病变未见边缘毛刺。IDP以直径<1 cm为主,其他良性病变直径为1~5 cm(P<0.001)。IDP以均匀强化为主,位于乳晕后区者较其他良性病变更多见。其他良性病变146个肿块型强化病灶中,强化方式呈低信号分隔70个(47.9%)。其中纤维腺病64个[60.4%(64/106)],良性分叶状肿瘤3个[60.0%(3/5)]和脂肪瘤1个,以及腺病2个。非肿块型病灶中,IDP以节段分布(57.1%)为主,其他良性病变以局灶分布(44.4%)为主。IDP以流出型曲线(44.7%)为主,其他良性病变以上升型曲线(56.5%)为主。IDP较其他良性病变更多见导管扩张。IDP的ADC值为(1.15±0.19)×10-3 mm2/s,其他良性病变为(1.30±0.29)×10-3 mm2/s。两者鉴别的最佳区分阈值1.30×10-3mm2/s,灵敏度56.6%,特异度79.2%。准确率63.9%,曲线下面积0.710。结论:肿块大小、位置、强化方式,非肿块强化的分布,导管是否扩张,时间信号强度曲线,ADC值对于IDP与其他良性病变有鉴别诊断价值。

Objective To assess the value of magnetic resonance imaging(MRI)in differential diagnosis of breast intraductal papilloma(IDP)from other benign lesions.Methods A retrospective analysis of breast MRI was performed in 96 patients with IDP and 200 patients with other benign lesions of breast.The lesions were detected as MRI BI-RADS category 4 or higher.Time-signal intensity curve and apparent diffusion coefficient(ADC)were achieved from the 1.5 T Siemens Aera workstation and were used in differential diagnosis of breast lesions.Results The mean age was(49.9±12.0)years in IDP group and(41.2±11.8)years in other benign lesions group.The enhanced mass lesions with smooth margin were predominated in both groups.Spiculated margin was found in IDP group only.More lesions in IDP group had diameter less than 1 cm and the diameter of other benign lesions was 1-5 cm(P<0.001).The lesions in IDP group presented homogeneous enhancement and located in retroareolar region more than those in other benign group.There were 146 enhanced mass lesions in other benign group and 70(47.7%)lesions presented dark internal septations which included 64(60.4%)of 106 fibroadenoma,3(60.0%)of 5 benign phyllode tumors and 1 lipoma,2 adenoma disease.In non mass enhancement lesions,lesions in IDP group tended to appear segmental distribution 57.1%and lesions in other benign group appeared focal distribution 44.4%.Wash-out curve was 44.7%in IDP group and persistent curve was 56.5%in other benign group.Ductal dilation was seen more in IDP group than in other benign group.Mean ADC was[(1.15±0.19)×10-3 mm2/s vs(1.30±0.29)×10-3 mm2/s]in IDP group and other benign group respectively.The best discriminative value of ADC was(1.30×10-3 mm2/s)and area under the curve 0.710 with the sensitivity 56.5%,specificity 79.2%and accuracy 63.9%.Conclusions There are size,location and enhancement pattern of the mass,the distribution of non mass enhancement,ductal dilation,time-signal intensity curve and ADC values which have value in differential diagnosis of breast IDP from other benign lesions.