Objective To explore the characterization of perfusion on parametric images in the differentiation of malignant and benign lesions of the breast with dynamic contrast-enhanced MR , and to evaluate the clinical value of parametric MR perfusion-weighted imaging.Methods MR imagines were obtained from 108 patients (111 lesions) in our hospital whose pathologies were confirmed by biopsy or surgery .All the patients underwent the MR scan combining the normal scan , Diffusion Weighted Image (DWI) and dynamic contrast-enhanced MRI (DCE-MRI).The time-signal intensity curve (TIC) was obtained.The parametric perfusion images of Washin, Washout, positive enhancement integral (PEI) and Combine (Washin and Washout) were derived with special software for breast evaluation in MRI workstation .The apparent diffusion coefficient ( ADC) values and the parame-ters of perfusion were measured respectively in lesions .Referring to the result of pathology , the receiver operator characteristic curve ( ROC) of the patients was used to definite the thresholds .Then, the area under the ROC curve ( AUC) of the ADC values , Washin, Washout, PEI, Combine parametric values were derived and compared .All the parameters above were analyzed to calcu-late the sensitivity and specificity respectively in breast cancer .Results The area under the ROC curve of the ADC values , Washin, Washout, PEI combined parameters were 0.887, 0.657, 0.896, 0.669, 0.710, respectively.As the threshold ADC=1.2 ×10-3 mm2/s, the sensitivity and specificity of the ADC were respectively 95.65%, 76.19%.There was a significant differ-ent between the malignant and benign lesions ( P <0.01).Moreover, the sensitivity and specificity of the Washin , Washout, PEI, the combined parameters were 98.6%, 91.3%, 76.8%, 95.7% and 47.6%, 78.6%, 59.5%, 52.4%, respectively. There were different between the malignant and benign lesions in all of the perfusion parameters ( P <0.05).Conclusion The MR perfusion on parametric images , especially Washout , have a high sensitivity for the differential diagnosis of malignant and be-nign lesions of the breast .It could provide valuable information in the differential diagnosis as an important role .%目的：探讨乳腺良恶性病变在磁共振动态增强灌注成像参数图中的特征，评估其在乳腺良恶性病变鉴别诊断中的价值。方法收集乳腺病变患者108例共111个病灶，联合采用乳腺普通平扫、扩散加权成像（ DWI ）及动态对比增强MR成像（ DCE －MRI）序列，绘制时间－信号强度曲线（ TIC），通过软件处理获得Washin、Washout、PEI及Combine等4种乳腺灌注伪彩参数图像，分别测定病灶的表观扩散系数（ ADC）值及各灌注参数值。参照病理结果，绘制ADC值及各灌注参数值的受试者工作特征曲线（ ROC），比较ADC值及各灌注参数图的ROC曲线下面积（ AUC）以及诊断乳腺癌的灵敏度和特异度。结果 ADC、Washin、Washout、PEI 及 Combine 灌注参数图 ROC 曲线下面积分别0．887，0．657，0．896，0．669，0．710。 ADC以1．2×10－3mm2／s为阈值，灵敏度和特异度分别为95．65％、76．19％，在良恶性病变的诊断差异有显著统计学意义（ P ＜0．01）；Washin、Washout、PEI及Combinec 参数图的灵敏度和特异度分别为98．6％，91．3％，76．8％，95．7％和47．6％，78．6％，59．5％，52．4％。各灌注参数值在良恶性病变的诊断差异均有统计学意义（ P ＜0．05）。结论磁共振动态增强灌注成像参数图特别是Washout图在乳腺良恶性病变的诊断中具有较高的应用价值，可为乳腺良恶性病变鉴别诊断提供重要的补充信息。
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