Abstract:Objective: To explore the efficacy and clinical value of multi-mode 3.0T MRI in the differential diagnosis of benign and malignant breast non-mass-like enhancement(NMLE) lesions. Methods: The data of 90 cases of breast NMLE lesions confirmed by operation and pathology and examined by 3.0T MRI were analyzed retrospectively. Among them, 31 cases were benign lesions(benign group) and 59 cases were malignant lesions(malignant group), all of them were female. Average age was 46.3±9.1. The distribution types, enhancement characteristics and time-intensity curve(TIC) on DCE-MRI were analyzed and compared between the two groups. The optimal threshold, diagnostic sensitivity and specificity of ADC were detected and determined on DWI. Results: ①Distribution type: dutcal type, segmental type, regional type and diffusive type, among which, the difference of segmental type distribution between the two groups was statistically significant(P<0.05), while the difference of the rest was not statistically significant(P>0.05);②Characteristic of enhanced lesions: the homogeneous, the heterogeneous, the clumped and the clustered ring. The clumped enhancement in the two groups had statistical significance(P<0.05), and the remaining variances were not statistically significant(P>0.05); ③The types of TIC in the two groups were not statistically significant(P>0.05); ④ADC value: The average ADC values of the two groups were (1.11±0.32)×10-3 mm2/s, (1.47±0.37)×10-3 mm2/s, and the difference was statistically significant(P<0.05), When the ADC value was less than or equal to 1.3×10-3 mm2/s, the sensitivity and specificity of diagnosing NMLE lesions as malignant lesions was 71.8% and 78.8% respectively. Conclusion: The application of DCE-MRI and ADC value measurement provides morphological and functional information that is helpful to distinguish benign and malignant breast NMLE lesions.
刘 靓,朱 丹,沈 晶,伍建林. 多模态MRI技术在乳腺非肿块性强化病变良恶性鉴别中的临床研究[J]. 中国临床医学影像杂志, 2020, 31(1): 15-19.
LIU Liang, ZHU Dan, SHEN Jing, WU Jian-lin. Clinical study of multi-mode MRI in differentiating benign and malignant breast non-mass-like enhancement lesions. JOURNAL OF CHINA MEDICAL IMAGING, 2020, 31(1): 15-19.
[1]American College of Radiology. Breast imaging reporting and data system atlas(BI-RADS atlas)[M]. Reston, VA: American College of Radiology, 2003: 8-62.
[2]中华医学会放射学分会乳腺专业委员会专家组. 乳腺磁共振检查及诊断规范专家共识[J]. 肿瘤影像学,2017,26(4):241-249.
[3]张丽,韩立新,曹惠霞,等. 磁共振扩散加权成像和VIBRANT动态增强在鉴别乳腺腺病与乳腺癌中的价值[J]. 临床放射学杂志,2017,36(3):342-346.
[4]周纯武,赵莉芸,李静. 磁共振成像在乳腺疾病的应用及进展[J]. 磁共振成像,2014,5(S1):56-61.
[5]许建荣. 乳腺MRI技术进展及面临的挑战[J]. 磁共振成像,2017,8(3):161-163.
[6]王增奎,杨栋梁,王春杰,等. 动态增强磁共振成像在乳腺非肿块性强化病变中的应用价值[J]. 中华乳腺病杂志,2017,11(1):33-38.
[7]李晶英,赵殿江. 乳腺MRI非肿块样强化病变的影像学诊断进展[J]. 中国医学影像学杂志,2018,26(7):547-551.
[8]Marcotte-Bloch C, Balu-Maestro C, Chamorey E, et al. MRI for the size assessment of pure ductal carcinoma in situ(DCIS): a prospective study of 33 patients[J]. Eur J Radiol, 2011, 77(3): 462-467.
[9]Liu H, Peng W. MRI morphological classification of ductal carcinoma in situ(DCIS) correlating with different biological behavior[J]. Eur J Radiol, 2012, 81(2): 214-217.
[10]Lehman CD. Magnetic resonance imaging in the evaluation of ductal carcinoma in situ[J]. J Natl Cancer Inst Monogr, 2010, 2010(41): 150-151.
[11]郑少燕,林黛英,曾向延,等. 非肿块型强化乳腺癌的MR诊断及鉴别诊断[J]. 影像诊断与介入放射学,2016,25(1):29-34.
[12]陈欣,赵暹,康华峰,等. MR非增强序列的联合应用对乳腺癌诊断价值的探讨[J]. 实用放射学杂志,2009,25(6):848-853.
[13]Ballesio L, Di Pastena F, Gig HS, et al. Non mass-like enhancement categories detected by breast MRI and histological findings[J]. Eur Rev Med Pharmacol Sci, 2014, 18(6): 910-917.
[14]郜莹莹,杨爱梅,彭杰,等. BI-RADS 4类非肿块乳腺癌与非肿块乳腺良性病变MRI动态增强特征及ADC值分析[J]. 临床放射学杂志,2018,37(7):1101-1105.
[15]谭红娜,苏懿,李瑞敏,等. 数据挖掘技术判定MRI乳腺非肿块样强化病灶的初步研究[J]. 中华放射学杂志,2009,43(5):455-459.
[16]Spick C, Bickel H, Pinker K, et al. Diffusion-weighted MRI of breast lesions: a prospective clinical investigation of the quantitative imaging biomarker characteristics of reproducibility, repeatability, and diagnostic accuracy[J]. NMR Biomed, 2016, 29(10): 1445-1453.
[17]张东坡,李优伟,郑作锋,等. 表观扩散系数对乳腺肿块样和非肿块样强化病变的诊断价值[J]. 放射学实践,2015,30(4):346-350.
[18]李晓,程流泉,刘梅,等. MRI、钼靶和超声对乳腺非肿块样强化病变诊断的对比研究[J]. 中国医学影像学杂志,2013,21(5):336-340.
[19]徐琳,汪登彬. MR扩散加权成像在鉴别乳腺非肿块样强化病变性质方面的价值,2014,29(4):454-456.
[20]Girardi V, Carbognin G, Camera L, et al. Inflammatory breast carcinoma and locally advanced breast carcinoma: characterisation with MR imaging[J]. Radiol Med, 201l, 116(1): 71-83.
[21]Dijkstra H, Dorrius MD, Wielema M, et al. Quantitative DWI implemented after DCE-MRI yields increased specificity for BIRADS 3 and 4 breast lesions[J]. Chin J Magn Reson Imag, 2016, 44(6): 1642-1649.
[22]Che SN, Cui XL, Li J, et al. The value of intravoxel incoherent motion model of diffusion weighted imaging in differentiating benign from malignant breast lesions[J]. Chin J Magn Reson Imag, 2015, 6(7): 506-512.
[23]柯承露,李静. IVIM及DKI在乳腺病变的临床研究进展[J]. 磁共振成像,2018,9(2):153-156.
[24]邹雪雪,秦东京,姜兴岳,等. DCE-MRI 联合IVIM-DWI鉴别诊断乳腺良恶性病变[J]. 中国医学影像技术,2016,32(4):534-538.