MR动态增强联合加权扩散在乳腺病变分级的应用可行性研究

蔡锋 许健恩 欧阳红斌

【摘要】 目的：探究MR動态增强联合加权扩散在乳腺病变分级的应用可行性。方法：选择本院2018年1月-2019年2月收治的80例乳腺病变患者作为研究对象，患者均行MR动态增强联合加权扩散及手术病理检查，以手术病理检查结果作为金标准，分析MR动态增强联合加权扩散对乳腺病变良、恶性，病变分级的诊断价值，并对比良、恶性乳腺病变的形态及强化特征、时间-信号强度曲线（TIC）、弥散系数（ADC值）。结果：MR动态增强联合加权扩散对乳腺病变良、恶性诊断的准确率为91.3%，敏感性为96.2%，特异性为88.9%，阳性预测值为80.6%，阴性预测值为98.0%;MR动态增强联合加权扩散对乳腺病变分级诊断的准确率为83.8%，敏感性为84.6%，特异性为83.3%。乳腺恶性病变患者的病灶不均匀强化率61.5%、病灶形态不规则率65.4%及边界不清晰率76.9%均显著高于良性病变患者20.4%、29.6%、22.2%，组间对比差异均有统计学意义（P<0.05）;乳腺良、恶性病变患者Ⅱ型TIC曲线比例19.2%、22.2%比较差异无统计学意义（P>0.05），乳腺恶性病变患者Ⅰ型TIC曲线比例15.4%显著低于良性病变患者66.7%，乳腺恶性病变患者Ⅲ型TIC曲线比例65.4%显著高于良性病变患者11.1%，乳腺恶性病变患者ADC值（0.9±0.3）mm2/s显著低于良性病变患者（1.4±0.6）mm2/s，组间对比差异均有统计学意义（P<0.05）。结论：对乳腺病变患者采用MR动态增强联合加权扩散进行诊断，不仅能有效鉴别出病变的良、恶性，且还能对病变分级进行准确诊断，从而能为后续临床治疗提供重要的依据。

【关键词】 MR动态增强; 加权扩散; 乳腺病变分级; 可行性

【Abstract】 Objective：To explore the feasibility of MR dynamic enhancement combined with weighted diffusion in the classification of breast lesions.Method：Eighty patients with breast lesions admitted to our hospital from January 2018 to February 2019 were enrolled.All patients underwent MR dynamic enhancement combined with weighted diffusion and surgical pathology.The results of surgical pathology were used as the gold standard.The value of MR dynamic enhanced combined weighted diffusion in the diagnosis of benign，malignant and graded lesions of breast lesions，and the morphology and enhancement characteristics of good and malignant breast lesions，time-signal intensity curve（TIC）and diffusion coefficient（ADC value）.Result：The accuracy of MR dynamic contrast-weighted diffusion in the diagnosis of benign and malignant breast lesions was 91.3%，sensitivity was 96.2%，specificity was 88.9%，positive predictive value was 80.6%，negative predictive value was 98.0%;MR dynamic enhancement，the accuracy of combined weighted diffusion for graded diagnosis of breast lesions was 83.8%，sensitivity was 84.6%，specificity was 83.3%.The lesion heterogeneity enhancement rate was 61.5% and lesion morphology irregularity rate was 65.4% in patients with breast malignant lesions and the border ambiguity rate was 76.9%，they were significantly higher than that of benign lesions 20.4%，29.6%，22.2% respectively（P<0.05）;in patients with benign and malignant breast lesions，there were no significant differences in the proportion of type Ⅱ TIC curves 19.2% and 22.2%（P>0.05）.The proportion of type Ⅰ TIC curve in patients with malignant breast lesions 15.4% was significantly lower than that in patients with benign lesions 66.7%.The proportion of type Ⅲ TIC curve in patients with lesions 65.4% was significantly higher than that in patients with benign lesions 11.1%.The ADC value of patients with malignant breast lesions（0.9±0.3）mm2/s was significantly lower than that of patients with benign lesions（1.4±0.6）mm2/s，the difference was statistically significant（P<0.05）.Conclusion：The diagnosis of breast lesions by MR dynamic enhancement combined with weighted diffusion can not only effectively identify the benign and malignant lesions，but also accurately diagnose the lesion classification，which can provide an important basis for subsequent clinical treatment.

【Key words】 MR dynamic enhancement; Weighted diffusion; Breast lesion classification; Feasibility

First-authors address：Guangdong Foshan Chancheng District Central Hospital Co.，Ltd.，Foshan 528031，China

doi：10.3969/j.issn.1674-4985.2019.16.013

乳腺癌是全球范围内女性最常见的恶性肿瘤之一，也是引起女性死亡的重要病因。随着我国经济的快速增长趋势，我国乳腺癌的增长速度及死亡率呈缓慢的上升趋势[1]。早发现、早诊断、早治疗是提高乳腺癌患者生存率与生活质量的关键[2]。磁共振成像（MR）具有任意平面成像、无辐射、软组织分辨力高等优势，近年来被广泛应用于乳腺疾病的筛查及定性诊断中，并且还被美国放射学院及乳腺影像学会乳腺癌影像学筛查临床实践指南推荐为乳腺癌高危人群的重要筛查手段[3]。……