联合非增强磁共振STIR与扩散加权成像在乳腺癌诊断中的应用

Combined application no-contrast MR STIR and diffusion-weighted imaging in detecting breast cancer

目的评价联合非增强磁共振短TI翻转恢复序列(short TI inversion recovery,STIR)及扩散加权成像(diffusion weightedimaging,DWI)在乳腺癌诊断中的价值。方法回顾性研究复旦大学附属华山医院2009年至2009年2月收治的48例经术后病理证实的乳腺癌病例,所有病人在术前进行钼靶及MRI DWI(b:500、800、1000)及STIR扫描。联合DWI及STIR对乳腺癌进行诊断,分析诊断的敏感度及假阴性率。分析不同类型乳腺及DWI不同b值情况下的诊断敏感度。结果联合DWI及STIR诊断乳腺癌的敏感度为:91.7%,假阴性率为:8.3%。不同乳腺类型之间诊断敏感度差异无统计学意义(P=0.83>0.05)。不同b值:b值取500、800、1000时诊断敏感度在三者之间差异有统计学意义(x^2=6.5349,P=0.045<0.05)。结论联合非增强磁共振STIR及DWI诊断乳腺癌具有较大价值,为乳腺癌的筛查及随访提供了一种简便的方法。

Objective To evaluate the diagnostic capability of combined diffusion-weighted(DWI) and short TI inversion recovery(STIR) imaging to detect breast cancer.Methods Forty eight women patients with breast cancer confirmed by postoperative pathological examination between Septmber 2008 and February 2009 at Huashan Mospital of Fudan Oniversity.All cases were underwent mammography and MR imaging with combined DWI(b factor:50,800,1000)and STIR on pre-operation.Interpreted images were evaluated for sensitivity,false negative rate(FN),sensitivity by b value,and sensitivity by background density of the mammary gland.Results Of the 48 cases,44 were diagnosed as cancer by combined application DWI and STIR,the sensitivity was 91.7%(44/48);FN was 8.3%(4/48).Sensitivities by background density of mammary gland were:fatty/scattered fibroglandular tissue,84.6%(ll/13);heterogeneous fibroglandular tissue,92%(23/25);and mostly fibroglandular tissue,90%(9/10).No significant differences were observed(P=0.83>0.05).Sensitivities by various b value were:500,70.8%(34/48);800,85.4%(41/48);and 1000,91.7%(44/48),respectively.Significant differences were observed in sensitivity by various b value(x 2=6.5349,P=0.045<0.05).Conclusion Precise diagnosis of breast cancer is possible with combined DWI and STIR,even in non-contrast MR imaging,regardless of the background density of mammary gland.It is hoped that non-contrast MR imaging that combines DWI and STIR will become an established clinical screening method.