增强与非增强组合序列 MRI 对乳腺病变筛查的比较研究

摘要

目的：比较乳腺非增强组合序列与 MR 增强扫描（CE-MRI）对乳腺疾病的诊断价值，探讨非增强 MRI 序列作为常规乳腺筛查技术的可行性。方法：回顾性分析157例（良性92例，恶性65例）经病理证实的乳腺病变的 MRI 资料，计算 T1 WI ＆ DWI、FS T2 WI ＆ DWI 和 CE-MRI 三种方式诊断乳腺病变的检出率、敏感度、特异度、约登指数、阳性和阴性预测值，绘制受试者工作特征曲线（ROC），比较3种方式的诊断效能，并总结乳腺恶性病变在非增强组合序列上的特征。结果：T1 WI ＆ DWI、FS T2 WI ＆ DWI、CE-MRI 对乳腺病变的检出率分别为81．53％、89．17％和94．90％，三种方法间两两比较，差异均有统计学意义（P ＜0．0125）。三种方法对乳腺癌的检查率为95．38％（62／65）、96．92％（63／65）和96．92％（63／65），对肿块型乳腺癌为98．31％、98．31％和98．31％，三者间差异均无统计学意义（P ＞0．05）。FS T2 WI ＆DWI 诊断乳腺病变的敏感度、特异度、约登指数、阳性和阴性预测值分别为0．925、0．898、0．836、0．911和0．929，其 ROC的曲线下面积（AUC）为0．925，与 CE-MRI（0．929）间差异无统计学意义（P ＝0．914＞0．05）。FS T2 WI 和 DWI 上乳腺恶性病变的特征：①肿块型居多，边缘多不规则，伴或不伴毛刺；②FS T2 WI 上多呈稍高或混杂信号；③诊断恶性病变的ADC 阈值＝1．13×10－3 mm2／s。结论：FS T2 WI 结合 DWI 对乳腺疾病具有较高的诊断价值，可作为乳腺疾病筛查的 MRI技术。%Objectire:To compare the diagnostic value of combined non-enhanced MRI sequences in breast lesions with that of CE-MRI,and to explore the feasibility of combined non-enhanced MRI sequences as the routine MRI method for breast lesions screening.Methods:MRI findings of 157 patients with breast lesions (92 benign and 65 malignant lesions) proved by histopathology were retrospectively analyzed.Detection rate and sensitivity,specificity,Youden's index,positive and negative predictive value of T1 WI & DWI,FS-T2 WI & DWI and CE-MRI in diagnosis of breast lesions were analyzed and calculated.ROC curve were obtained and the diagnostic efficacy of the three methods were compared by Pearsonχ2 test. The characteristic findings of malignant breast lesions on FS-T2 WI and DWI were analyzed.Results:Detection rate of breast lesions by T1 WI & DWI,FS-T2 WI & DWI and CE-MRI were 81.53%,89.17% and 94.90%;The detecion rate for all or mass-type breast cancer by three methods was 95.38% (62/65 ),96.92% (63/65 ),96.92% (63/65 ),and 98.31%、98.31%,98.31%,there were no statistic differences among the three methods.Sensitivity,specificity,Youden′s index,posi-tive and negative predictive value of FS-T2 WI & DWI was 0.925,0.898,0.836,0.911 and 0.929,respectively,the AUC of ROC of FS T2 WI & DWI and CE-MRI was 0.925 and 0.929 respectively,with no statistic difference (P =0.914>0.05) .Characteristics of the malignant breast lesions on FS-T2 WI and DWI:①nodular or mass with irregular margin,with or without spiculation;②slightly high or mixed signal intensity on FS T2 WI;③ADC threshold for diagnosis of malignant le-sions was 1.13×10 -3 mm2/s.Conclusion:FS-T2 WI combined with DWI is of great value for diagnosis of breast lesions,and can be recommended as a feasible choice in breast screening.