多模态磁共振成像对乳腺良恶性肿瘤鉴别诊断的价值

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摘要目的：探讨3T磁共振不同序列单独及联合应用对乳腺良恶性肿瘤鉴别诊断的价值，通过ADC阈值来优化DCE-MRI与DWI的诊断效能。方法：回顾性分析经手术或穿刺活组织病理证实的573例608枚病灶的术前MRI图像资料，建立方程式将ADC阈值与BI-RADS分类结合，获得DCE-MRI联合DWI优化分级的方法，统计T1WI与T2WI，DWI，T1WI、T2WI联合DWI，DCE-MRI，DCE-MRI联合DWI优化分级五种方法及对良、恶性病变鉴别诊断的敏感度、特异度及准确度，绘制ROC曲线并分析曲线下面积（AUC）。结果：T1WI与T2WI，DWI，T1WI、T2WI联合DWI，DCE-MRI，DCE-MRI联合DWI优化分级五种方法诊断的敏感度、特异度分别为78.2%、66.2%，92.4%、78.4%，94.9%、79.7%，97.5%、67.6%，99.1%、81.1%。ROC AUC分别为0.783，0.846，0.909，0.923，0.939。结论：T1WI、T2WI联合DWI的敏感性较高，特异性较低，但在条件不允许进行增强检查时仍具有一定的临床应用价值。DCE-MRI联合DWI多参数分析方法的敏感性、特异性及AUC均最高，显著提高MRI检查对乳腺良恶性肿瘤的诊断价值。

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	刘学竞
	单嫣娜
	韩志江

关键词 ：乳腺肿瘤, 磁共振成像, 诊断, 鉴别

Abstract：Objective: To explore the value of different sequences of 3T magnetic resonance in the differential diagnosis of benign and malignant breast tumors. To optimize the diagnostic performance of DCE-MRI and DWI by the threshold ADC values. Methods: A retrospective analysis of preoperative MRI images of 573 cases with 608 histopathologically verified breast lesions by surgery or biopsy were conducted. A reading method that adapted ADC thresholds to the assigned BI-RADS classification was developed. Sensitivity, specificity, diagnostic accuracy and the area under the curve(AUC) were calculated. BI-RADS-adapted reading was compared with previously published reading methods such as T1WI and T2WI, DWI, T1WI, T2WI and DWI, DCE-MRI in the same population. Result: The sensitivities of T1WI and T2WI, DWI, T1WI, T2WI combined with DWI, DCE-MRI and DCE-MRI combined with DWI were 78.2%, 66.2%, 92.4%, 78.4% and 94.9% respectively. And the specificities were 79.7%, 97.5%, 67.6%, 99.1% and 81.1%, respectively. The AUC was 0.783, 0.846, 0.909, 0.923 and 0.399, respectively. Conclusion: Non-enhanced sequences of 3T magnetic resonance have high sensitivity and low specificity, but it still has some clinical significance when the patient cannot do the DCE-MRI. Multi-parametric breast 3T MRI with BI-RADS-adapted reading improves diagnostic accuracy.

Key words： Breast neoplasms Magnetic resonance imaging Diagnosis, differential

收稿日期: 2017-08-21

PACS:	Ｒ737.9
	Ｒ445.2

通讯作者: 单嫣娜，杭州市第一人民医院放射科，310006。E-mail：241452716@qq.com

作者简介: 刘学竞（1988-），女，河北石家庄人，医师。E-mail：834920013@qq.com

引用本文:

刘学竞，单嫣娜，韩志江. 多模态磁共振成像对乳腺良恶性肿瘤鉴别诊断的价值[J]. 中国临床医学影像杂志, 2018, 29(5): 320-323.
LIU Xue-jing, SHAN Yan-na, HAN Zhi-jiang. The value of multimode magnetic resonance imaging in differential diagnosis of benign and malignant breast tumors. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(5): 320-323.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2018/V29/I5/320

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