基于BI-RADS分类多参数乳腺MRI对肿块性病变的诊断效能研究

摘要

Objective To evaluate the diagnostic value of breast MRI BI - RADS classification in breast mass. Method Totally 194 cases with breast mass lesions was involved in this study. Positive predictive value (PPV) of the BI-RADS classification index, MRI examination (edge shape, boundary, and the internal enhancement), dynamic enhanced scan (TIC curve) and DWI was performed and recorded. Statistical analysis was conducted for identification of predictive significance. Result PPV of breast mass as BI-RADS 3, 4, and 5 were 0.114, 0.286, and 0.904, respectively. PPV of irregular shape, irregular margin, marginal enhancement was 0.780, 0.849, and 0.889, respectively. The PPV of Platform type and washout type were 0.613 and 0.833 respectively. PPV of ADC values ≤ 1.18×10-3mm2/s was as high as 0.901. Shape, Margin, andfeatures of enhancement did not match well with pathological results. TIC curve and ADC value matched satisfactorily with pathological results. Logistic regression analysis results showed that ADC values, irregular margin and TIC curve type were independent risk factors for diagnosis of malignant breast lesions, with (O^R)value as 1.041, 3.156, and 2.217, respectively. Conclusion BI-RADS may be able to predict malignancy of breast lesions. Margin, TIC curve and ADC values are independent risk factors for malignant breast lesions.%目的 评价乳腺MRI乳腺影像报告和数据系统(BI-RADS)分类各观察指标对肿块性乳腺病变的阳性预测价值(PPV)及诊断效能;探讨乳腺肿块性病变的动态增强磁共振(DCE-MRI)征象、功能磁共振成像(DWI-ADC)值联合应用对该类良、恶性病变诊断的价值.方法 回顾性分析194例乳腺肿块性病变,计算BI-RADS分类各指标的PPV,并分析MRI常规检查(形态、边界、边缘及内部强化方式)、动态增强扫描[时间-信号曲线(TIC)]和DWI结果:以病理结果为"金标准",分别得出PPV和Kappa值.结果 194例肿块性病变中,BI-RADS 3～5类PPV分别为0.114、0.286、0.904 ;依据MRI BI-RADS词汇形态学描述,形态不规则PPV 为0.780,边缘不规则/毛刺PPV为0.849,边缘强化PPV为0.889 ;TIC平台型和流出型PPV分别为0.613和0.833 ;ADC值≤1.18×10-3mm2/s PPV高达0.901.形状、病灶强化方式与病理结果吻合度较弱kappa值分别为0.410和0.386,边界与病理结果吻合度检验水平一般kappa值0.570.TIC曲线及ADC值与病理结果吻合度检验水平较高kappa值分别为0.735和0.823.Logistic回归分析结果表明ADC值、边缘及TIC类型对乳腺良、恶性病变的诊断能力较准确((O^R) =01.041,3.156和2.217),ADC值≤1.18×10-3mm2/s、边缘毛刺征、TICⅡ型和Ⅲ型为MRI诊断恶性乳腺肿块性病变的危险因素((O^R) =01.041,3.156和2.217).结论 运用BI-RADS词汇中的标准术语对乳腺MRI中肿块性病变特点进行严谨评估,对预测肿块性病变的恶性可能性有很大作用.边缘、TIC曲线及ADC值在乳腺良、恶性病变诊断中具有良好的诊断效能.