动态增强MRI鉴别乳腺良恶性肿瘤的效果及在病理分级中的作用

摘要

目的：考察动态增强核磁共振成像（ MRI）鉴别乳腺良恶性肿瘤的效果以及在病理分级中的应用。方法回顾性分析嘉兴市武警医院2009年1月至2012年1月收治乳腺肿瘤女性患者78例，年龄17～86岁，平均56．1±13．2岁，其中47例为手术病理诊断，31例为穿刺病理证实。并进行动态增强MRI，观察病灶形态学征象、计冷点Slope、热点Slope、冷点流出斜率和热点流出斜率。结果动态增强MRI对乳腺肿瘤良性病变和恶性病变均能100％显示。良恶性肿瘤在肿瘤形态、肿瘤边缘和均匀性方面有显著性差异（χ2值分别为2．357、3．838、2．532，均P＜0．01），恶性肿瘤主要表现为形态不规则、边缘不规则、回声不均匀。而良恶性肿瘤在肿瘤的边界和环形强化方面无显著性差异（χ2值分别为0．973、0．991，均P＞0．05），。热点Slope和热点流出斜率在不同级别浸润性导管癌之间无统计学差异（P＞0．05）。冷点Slope中病理Ⅱ级、Ⅲ级低于病理Ⅰ级（t＝2．14，P＜0．05；t＝11．0， P＜0．01），病理分级Ⅲ低于病理分级Ⅱ（t＝12．4，P＜0．01）。冷点流出斜率，病理Ⅱ级、Ⅲ级低于病理Ⅰ级（t＝3．9，P＜0．05；t＝6．6，P＜0．01），病理Ⅲ级低于病理分级Ⅱ（t＝3．7，P＜0．01）。结论动态增强MRI可有效辨别乳腺良性和恶性病变，并能在一定程度判断乳腺病变的病理分级。%Objective To investigate the use of dynamic contrast enhanced MRI in differentiating benign from malignant breast tumors and predicting the histologic grade for breast cancer patients .Methods A retrospective analysis was conducted on 78 cases of breast tumor patients admitted in Jiaxing Armed Police Hospital of Zhejiang Province during the period of January 2009 to January 2012 ( age rang 17-86 years, mean age 56.1 ±13.2), including 47 cases confirmed by surgery and pathology , and 31 cases confirmed by biopsy .They were treated with dynamic enhanced MRI , lesions morphological signs were observed , and cold spot , hot spot , cold outflow slope and hot outflow slope were calculated .Results Dynamic contrast enhanced MRI could detect 100% of benign and malignant breast tumor lesions .There were significant differences in tumor morphology , edge of the tumor and uniformity between benign and malignant breast tumors (χ2 value was 2.357, 3.838 and 2.532, respectively, all P<0.01), but there were no significant differences in the margin of tumor and ring-enhancement (χ2 value was 0.973 and 0.991, respectively, both P>0.05).Malignant tumors had the sonographic characteristics of irregular shape , irregular margin and non-homogeneous internal echoes .There were no significant differences in hot spot and hot outflow slope among different types of invasive ductal carcinoma (P>0.05), while cold spot was significantly decreased in carcinoma of grade Ⅱand gradeⅢcompared with grade Ⅰ(t=2.14,P<0.05;t=11.0,P<0.01), and cold spot was significantly decreased in carcinoma of grade Ⅲcompared with that of grade Ⅱ(t=12.4,P<0.01).Cold outflow slope was significantly decreased in carcinoma of grade Ⅱand grade Ⅲcompared with grade Ⅰ(t=3.9,P<0.05;t=6.6,P<0.01), and cold outflow slope was significantly decreased in carcinoma of grade III compared with grade II (t=3.7,P<0.01).Conclusion Dynamic contrast enhanced MRI can effectively distinguish benign from malignant breast lesions , and can determine the pathological grading of breast lesions to some extent .