乳腺癌是女性最常见的恶性肿瘤,且发病率逐年增高,严重威胁女性生命健康,早诊断、早治疗对于提高乳腺癌患者的生存质量至关重要。常规的多序列乳腺MRI检查费用昂贵且扫描时间、图像后处理及医师阅片时间较长,限制了乳腺MRI在临床上的广...乳腺癌是女性最常见的恶性肿瘤,且发病率逐年增高,严重威胁女性生命健康,早诊断、早治疗对于提高乳腺癌患者的生存质量至关重要。常规的多序列乳腺MRI检查费用昂贵且扫描时间、图像后处理及医师阅片时间较长,限制了乳腺MRI在临床上的广泛应用。简化乳腺MRI(abbreviated breast MRI,AB-MRI)有望解决临床实际问题。AB-MRI方案更容易被患者接受,作为一种乳腺癌筛查方法前景可期。目前,术前应用AB-MRI评估乳腺癌疾病程度、新辅助化疗反应评估等方面的研究尚显不足,仍需要进行更大规模的前瞻性研究。本文从AB-MRI概念的提出、序列设计及临床应用等方面进行综述,包括不同风险人群乳腺癌的筛查、乳腺良恶性肿瘤鉴别、乳腺癌术前分期以及对新辅助化疗反应评估等多方面的临床应用,以帮助影像医师加强对AB-MRI方案的理解与应用,有助于提升我国乳腺癌的精准诊疗水平。展开更多
目的探讨弥散加权成像(diffusion-weighted MR imaging,DWI)联合动态对比增强磁共振成像(dynamic contrast-enhanced M R imaging,DCE M RI)对表现为非肿块样强化(none-mass enhancement,NM LE)的乳腺良恶性病变的诊断价值。方法回顾性...目的探讨弥散加权成像(diffusion-weighted MR imaging,DWI)联合动态对比增强磁共振成像(dynamic contrast-enhanced M R imaging,DCE M RI)对表现为非肿块样强化(none-mass enhancement,NM LE)的乳腺良恶性病变的诊断价值。方法回顾性分析49个乳腺NMLE病灶,比较良恶性组间强化分布、内部强化特征、动态曲线模式及表观弥散系数(apparent diffusion coefficient,ADC)值的差异有无统计学意义。绘制接受者操作特征曲线(receiver operating characteristic curve,ROC)评估ADC值的诊断效能、确定最佳诊断分界点。应用多因素分析探讨表现为NMLE的乳腺恶性病变的磁共振影像特征。结果良恶性组间病灶的内部强化特征、动态曲线模式的差异无统计学意义(P>0.05)。段样分布(P=0.01)、病灶内ADC值<1.2×10-3mm2/s(P<0.001)提示其为乳腺癌。段样分布的诊断灵敏度(sensitivity,Se)、特异度(specificity,Sp)、阳性预测值(positive predictive value,PPV)、阴性预测值(negative predictive value,NPV)分别为73.1%、87.0%、86.4%、74.1%。以ADC阈值为诊断标准,其Se、Sp、PPV、NPV分别为:84.6%、91.3%、91.7%、84.0%。当NMLE表现为段样分布且病灶内ADC值小于1.2×10-3mm2/s时强烈提示其为乳腺癌,PPV为92.9%。结论 DWI联合DCE M RI对于表现为NM LE的乳腺癌具有较高的诊断准确性。展开更多
目的回顾性比较研究乳腺专用磁共振成像(dedicated breast magnetic resonance imaging,DBMRI)、超声(ultrasound,US)及乳腺X线摄影(mammography,MG)3种检查方法对乳腺癌的诊断价值。方法搜集我院行手术治疗并于术前同时行DBMRI、MG及U...目的回顾性比较研究乳腺专用磁共振成像(dedicated breast magnetic resonance imaging,DBMRI)、超声(ultrasound,US)及乳腺X线摄影(mammography,MG)3种检查方法对乳腺癌的诊断价值。方法搜集我院行手术治疗并于术前同时行DBMRI、MG及US 3种检查的患者共612例,剔除36例于检查时已行新辅助化疗的患者,共576例患者纳入本研究,所有入组患者均以病理学结果作为金标准。数据分析与统计采用SPSS 13.0统计软件。以P<0.05为差异有统计学意义。结果 DBMR对乳腺癌病灶检出的敏感性为97.1%,高于MG(77.6%)(χ2=53.904,P=0.000)及US(91.0%)(χ2=10.370,P=0.001);MG对乳腺癌病灶检出的特异性为88.8%,高于DB-MR(82.8%)(χ2=3.925,P=0.048)及US(82.5%)(χ2=4.383,P=0.036)。对于导管内癌,DBMRI检出的敏感性为97.9%,高于US(77.8%)(χ2=29.445,P=0.000)及MG(71.1%)(χ2=9.680,P=0.002)。在致密型乳腺中,DBMRI诊断灵敏度高为96.0%,高于MG(66.7%)(χ2=35.806,P=0.000);US诊断敏感性为92.1%,高于MG(66.7%)(χ2=24.812,P=0.000)。在非致密型乳腺中,DBMR诊断敏感性为97.9%,高于MG(85%)(χ2=19.684,P=0.000)及US(90.4%)(χ2=19.684,P=0.002)。DBMRI、MG、US对伴钙化的乳腺癌检出的敏感性分别为98.3%、94.0%和94.8%。结论 DBMRI对乳腺癌的检出敏感性高,但特异性较低;对于导管内癌的诊断,DBMRI具有显著优势;在致密型乳腺乳腺癌的检出中,DBMRI与US均具有高敏感性,优于MG。展开更多
Objective： To compare the effectiveness of digital mammography and MRI in the detection and diagnosis of breast cancer and to assess the value of these modalities as well as the combination of the two. Methods： Sixt...Objective： To compare the effectiveness of digital mammography and MRI in the detection and diagnosis of breast cancer and to assess the value of these modalities as well as the combination of the two. Methods： Sixty-seven patients with surgery and pathology proved breast lesion （malignant, n = 32; benign, n = 46） underwent digital mammography and MRI, the pulse sequences included T1WI, T2WI, diffuse weighted imaging （DWI）, and dynamic contrast-enhanced MRI before surgery. Of the results of these two modalities, all lesions were classified into 5 groups according to BI-RADS classification, and the imaging findings were correlated to histopathology. The sensitivity and specificity of each modality as well as the combination of the two were calculated. Results： Of these 78 breasts lesions, The sensitivity was 78.13%% （25/32） for digital mammography and 93.75% （30/32） for MRI （P 〉 0.05）. The specificity was 73.91%% （34/46） and 89.13% （41/46） accordingly （P 〈 0.05）, both of them showed statistical difference. The sensitivity and specificity was 98.63% and 97.16% respectively as these two modalities were used in combination. Conclusion： Digital mammography in combination with MRI is helpful in the diagnosis of breast cancer, the sensitivity and specificity was enhanced when compared to that of single modality.展开更多
Objective:To study the diagnostic value of T2*-weighted first-pass perfusion imaging in breast tumors.Methods: We analyzed the magnetic resonance imaging(MRI)information along with the pathological and immunohistochem...Objective:To study the diagnostic value of T2*-weighted first-pass perfusion imaging in breast tumors.Methods: We analyzed the magnetic resonance imaging(MRI)information along with the pathological and immunohistochemistry re- sults.Magnetic resonance imaging was performed in 28 patients with breast tumor.The time to signal intensity curves were generated according to the T2*-weighted first-pass perfusion imaging.The curve’s maximal signal intensity drop rate and maximal signal intensity decrease time were analyzed and compared with the pathological diagnoses after surgery.Results: Malignant breast lesions showed higher maximal signal intensity drop rate(44.69%±17.07 vs.17.22%±7.49,P<0.001) than benign lesions,but there was no significant difference of maximal signal decrease time between those two lesions(23.94 s±4.92 vs.20.02 s±6.83,P>0.05).Conclusion:The T2*-weighted first-pass perfusion imaging has enough sensitivity and specificity in breast tumor diagnosis.展开更多
Objective Breast cancer is the most frequently diagnosed cancer in women. Accurate evaluation of the size and extent of the tumor is crucial in selecting a suitable surgical method for patients with breast cancer. Bot...Objective Breast cancer is the most frequently diagnosed cancer in women. Accurate evaluation of the size and extent of the tumor is crucial in selecting a suitable surgical method for patients with breast cancer. Both overestimation and underestimation have important adverse effects on patient care. This study aimed to evaluate the accuracy of breast magnetic resonance imaging(MRI) and ultrasound(US) examination for measuring the size and extent of early-stage breast neoplasms.Methods The longest diameter of breast tumors in patients with T_(1–2)N_(0–1)M_0 invasive breast cancer preparing for breast-conserving surgery(BCS) was measured preoperatively by using both MRI and US and their accuracy was compared with that of postoperative pathologic examination. If the diameter difference was within 2 mm, it was considered to be consistent with pathologic examination.Results A total of 36 patients were imaged using both MRI and US. The mean longest diameter of the tumors on MRI, US, and postoperative pathologic examination was 20.86 mm ± 4.09 mm(range: 11–27 mm), 16.14 mm ± 4.91 mm(range: 6–26 mm), and 18.36 mm ± 3.88 mm(range: 9–24 mm). US examination underestimated the size of the tumor compared to that determined using pathologic examination(t = 3.49, P < 0.01), while MRI overestimated it(t =-6.35, P < 0.01). The linear correlation coefficients between the image measurements and pathologic tumor size were r = 0.826(P < 0.01) for MRI and r = 0.645(P < 0.01) for US. The rate of consistency of MRI and US compared to that with pathologic examination was 88.89% and 80.65%, respectively, and there was no statistically significant difference between them(χ~2 = 0.80, P > 0.05).Conclusion MRI and US are both effective methods to assess the size of breast tumors, and they maintain good consistency with pathologic examination. MRI has a better correlation with pathology. However, we should be careful about the risk of inaccurate size estimation.展开更多
文摘乳腺癌是女性最常见的恶性肿瘤,且发病率逐年增高,严重威胁女性生命健康,早诊断、早治疗对于提高乳腺癌患者的生存质量至关重要。常规的多序列乳腺MRI检查费用昂贵且扫描时间、图像后处理及医师阅片时间较长,限制了乳腺MRI在临床上的广泛应用。简化乳腺MRI(abbreviated breast MRI,AB-MRI)有望解决临床实际问题。AB-MRI方案更容易被患者接受,作为一种乳腺癌筛查方法前景可期。目前,术前应用AB-MRI评估乳腺癌疾病程度、新辅助化疗反应评估等方面的研究尚显不足,仍需要进行更大规模的前瞻性研究。本文从AB-MRI概念的提出、序列设计及临床应用等方面进行综述,包括不同风险人群乳腺癌的筛查、乳腺良恶性肿瘤鉴别、乳腺癌术前分期以及对新辅助化疗反应评估等多方面的临床应用,以帮助影像医师加强对AB-MRI方案的理解与应用,有助于提升我国乳腺癌的精准诊疗水平。
文摘目的回顾性比较研究乳腺专用磁共振成像(dedicated breast magnetic resonance imaging,DBMRI)、超声(ultrasound,US)及乳腺X线摄影(mammography,MG)3种检查方法对乳腺癌的诊断价值。方法搜集我院行手术治疗并于术前同时行DBMRI、MG及US 3种检查的患者共612例,剔除36例于检查时已行新辅助化疗的患者,共576例患者纳入本研究,所有入组患者均以病理学结果作为金标准。数据分析与统计采用SPSS 13.0统计软件。以P<0.05为差异有统计学意义。结果 DBMR对乳腺癌病灶检出的敏感性为97.1%,高于MG(77.6%)(χ2=53.904,P=0.000)及US(91.0%)(χ2=10.370,P=0.001);MG对乳腺癌病灶检出的特异性为88.8%,高于DB-MR(82.8%)(χ2=3.925,P=0.048)及US(82.5%)(χ2=4.383,P=0.036)。对于导管内癌,DBMRI检出的敏感性为97.9%,高于US(77.8%)(χ2=29.445,P=0.000)及MG(71.1%)(χ2=9.680,P=0.002)。在致密型乳腺中,DBMRI诊断灵敏度高为96.0%,高于MG(66.7%)(χ2=35.806,P=0.000);US诊断敏感性为92.1%,高于MG(66.7%)(χ2=24.812,P=0.000)。在非致密型乳腺中,DBMR诊断敏感性为97.9%,高于MG(85%)(χ2=19.684,P=0.000)及US(90.4%)(χ2=19.684,P=0.002)。DBMRI、MG、US对伴钙化的乳腺癌检出的敏感性分别为98.3%、94.0%和94.8%。结论 DBMRI对乳腺癌的检出敏感性高,但特异性较低;对于导管内癌的诊断,DBMRI具有显著优势;在致密型乳腺乳腺癌的检出中,DBMRI与US均具有高敏感性,优于MG。
文摘Objective： To compare the effectiveness of digital mammography and MRI in the detection and diagnosis of breast cancer and to assess the value of these modalities as well as the combination of the two. Methods： Sixty-seven patients with surgery and pathology proved breast lesion （malignant, n = 32; benign, n = 46） underwent digital mammography and MRI, the pulse sequences included T1WI, T2WI, diffuse weighted imaging （DWI）, and dynamic contrast-enhanced MRI before surgery. Of the results of these two modalities, all lesions were classified into 5 groups according to BI-RADS classification, and the imaging findings were correlated to histopathology. The sensitivity and specificity of each modality as well as the combination of the two were calculated. Results： Of these 78 breasts lesions, The sensitivity was 78.13%% （25/32） for digital mammography and 93.75% （30/32） for MRI （P 〉 0.05）. The specificity was 73.91%% （34/46） and 89.13% （41/46） accordingly （P 〈 0.05）, both of them showed statistical difference. The sensitivity and specificity was 98.63% and 97.16% respectively as these two modalities were used in combination. Conclusion： Digital mammography in combination with MRI is helpful in the diagnosis of breast cancer, the sensitivity and specificity was enhanced when compared to that of single modality.
基金a grant from the Medicine Scientific Development Foun-dation of Nanjing(No.zkx05021).
文摘Objective:To study the diagnostic value of T2*-weighted first-pass perfusion imaging in breast tumors.Methods: We analyzed the magnetic resonance imaging(MRI)information along with the pathological and immunohistochemistry re- sults.Magnetic resonance imaging was performed in 28 patients with breast tumor.The time to signal intensity curves were generated according to the T2*-weighted first-pass perfusion imaging.The curve’s maximal signal intensity drop rate and maximal signal intensity decrease time were analyzed and compared with the pathological diagnoses after surgery.Results: Malignant breast lesions showed higher maximal signal intensity drop rate(44.69%±17.07 vs.17.22%±7.49,P<0.001) than benign lesions,but there was no significant difference of maximal signal decrease time between those two lesions(23.94 s±4.92 vs.20.02 s±6.83,P>0.05).Conclusion:The T2*-weighted first-pass perfusion imaging has enough sensitivity and specificity in breast tumor diagnosis.
文摘Objective Breast cancer is the most frequently diagnosed cancer in women. Accurate evaluation of the size and extent of the tumor is crucial in selecting a suitable surgical method for patients with breast cancer. Both overestimation and underestimation have important adverse effects on patient care. This study aimed to evaluate the accuracy of breast magnetic resonance imaging(MRI) and ultrasound(US) examination for measuring the size and extent of early-stage breast neoplasms.Methods The longest diameter of breast tumors in patients with T_(1–2)N_(0–1)M_0 invasive breast cancer preparing for breast-conserving surgery(BCS) was measured preoperatively by using both MRI and US and their accuracy was compared with that of postoperative pathologic examination. If the diameter difference was within 2 mm, it was considered to be consistent with pathologic examination.Results A total of 36 patients were imaged using both MRI and US. The mean longest diameter of the tumors on MRI, US, and postoperative pathologic examination was 20.86 mm ± 4.09 mm(range: 11–27 mm), 16.14 mm ± 4.91 mm(range: 6–26 mm), and 18.36 mm ± 3.88 mm(range: 9–24 mm). US examination underestimated the size of the tumor compared to that determined using pathologic examination(t = 3.49, P < 0.01), while MRI overestimated it(t =-6.35, P < 0.01). The linear correlation coefficients between the image measurements and pathologic tumor size were r = 0.826(P < 0.01) for MRI and r = 0.645(P < 0.01) for US. The rate of consistency of MRI and US compared to that with pathologic examination was 88.89% and 80.65%, respectively, and there was no statistically significant difference between them(χ~2 = 0.80, P > 0.05).Conclusion MRI and US are both effective methods to assess the size of breast tumors, and they maintain good consistency with pathologic examination. MRI has a better correlation with pathology. However, we should be careful about the risk of inaccurate size estimation.
