探讨3.0TMRI动态增强联合扩散加权成像对乳腺疾病的诊断价值

Value of 3.0T dynamic contrast enhanced MRI combined with diffusion weighted imaging in the diagnosis of breast diseases

摘要:

目的：探讨3.0T磁共振动态增强扫描（dynamic contrast-enhanced magnetic resonance imaging，DCE-MRI）联合扩散加权成像（diffusion-weighted imaging，DWI）在乳腺良恶性病变鉴别诊断中的价值。方法：回顾性分析73例乳腺疾病患者（良性37个病灶、恶性42个病灶），活检前均行DCE-MRI及DWI（b=0.800s/mm2）。分析病变形态、边缘、曲线类型，统计比较Fischer评分、DWI及两者联合诊断乳腺疾病的敏感度、特异度、准确度、阴性似然比及阳性似然比。结果：良恶性病变的平均表观扩散系数（apparent diffusion coefficient，ADC）分别为（1.49±0.34）×10-3 mm2/s和（1.01±0.29）×10-3 mm2/s，根据受试者工作特性（re－ceiver operating characteristic，ROC）曲线确定ADC阈值为1.15×10-3 mm2/s，其诊断的敏感度、特异度、准确度、阴性似然比及阳性似然比分别约为83.3%（35/42）、83.8%（31/37）、83.5%（66/79）、0.199、5.142；单独行动态增强Fischer评分其诊断的敏感度、特异度、准确度、阴性似然比及阳性似然比分别约为97.6%（41/42）、78.4%（29/37）、88.6%（70/79）、0.031、4.519；两者联合其诊断的敏感度、特异度、准确度、阴性似然比及阳性似然比为92.9%（39/42）、91.9%（34/37）、92.4%（73/79）、0.077、11.469。结论：联合诊断方法较单一运用DCE-MRI或DWI在特异度、准确度、阴性似然比及阳性似然比等指标上诊断效能强，对乳腺疾病的定性诊断具有较高的价值。

Abstract:

Objective：To evaluate the differential diagnosis of 3.0T dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI） combined with diffusion weighted imaging（DWI） in the characterization of breast lesion. Methods：A total of 73 patients with breast diseases（37 benign lesions and 42 malignant lesions） were retrospectively analyzed. All lesions were examined with 3.0T DCE-MRI and DWI（b=0.800 s/mm2） before the histopathological demonstration. The lesion morphology，edge enhancement and curve pattern were analyzed using integral method and statistical method. The Fisher score，sensitivity，specificity，accuracy，positive likelihood ra－tio，and negative likelihood ratio of DWI and combined method in the diagnosis of breast lesions were compared. Results：The average apparent diffusion coefficient（ADC） of benign and malignant lesions were（1.49±0.34）×10-3 mm2/s and（1.01±0.29）×10-3 mm2/s.The threshold of ADC between benign and malignant lesions was 1.15×10-3 mm2/s by receiver operating characteristic curve. The sen－sitivity，specificity，accuracy and positive likelihood ratio，negative likelihood ratio of ADC were 83.3%，83.8%，83.5%，0.199，5.142.The sensitivity，specificity，accuracy and positive likelihood ratio，negative likelihood ratio of DCE-MRI were 97.6%，78.4%，88.6%，0.031，4.519. The sensitivity，specificity，accuracy，positive likelihood ratio and negative likelihood ratio of DCE-MRI combined with DWI were92.9%，91.9%，92.4%，0.077，11.469. Conclusion：DCE-MRI combined with DWI is of high diagnostic value as it has higher scores in sensitivity，specificity，accuracy，positive likelihood ratio and negative likelihood ratio in the diagnosis of breast diseases.