乳腺磁共振成像在非肿块强化病变的应用研究

发布时间：2018-05-09 01:16

本文选题：磁共振 + 乳腺　；参考：《广州医科大学》2017年硕士论文

【摘要】：目的近年来乳腺癌已超过宫颈癌成为女性恶性肿瘤发病率的第一位。临床触诊、乳腺X线摄影、超声都是乳腺病变的检查手段,对乳腺病变的诊断治疗及术后评估都具有重要作用。但临床触诊对病灶的大小及边界判断误差较大;乳腺X线摄影对乳腺内钙化较敏感,但对于致密型乳腺,受制于软组织分辨率较低,病灶往往显示欠佳或难以显示;超声的敏感度及特异度较低,对微小病变及多发病变难以定性。乳腺磁共振成像(magnetic resonance imaging,MRI)具有较高的空间及软组织分辨率,对病灶的敏感度高,在临床的诊断及术后评估方面逐步得到认可。MRI不仅可以对临床、乳腺X线摄影及超声检查发现的乳腺病变进一步评估,还因为其较高的敏感度,可以发现上述检查阴性的隐性乳腺癌。近来随着乳腺MRI检查的普及发现,非肿块强化病变是产生诊断假阳性率的主要原因。本研究通过回顾性分析经病理证实的非肿块强化病灶患者的MRI影像特征,探讨临床表现及MRI征象在非肿块强化病变良恶性诊断中的价值,从而进一步阐述BI-RADS MRI对乳腺非肿块强化病变的诊断及鉴别诊断价值。方法收集2015年10月至2016年10月期间行乳腺MRI检查且病灶表现为非肿块强化的女性患者234名的临床及MRI检查资料,发现病灶240处。所有患者均经病理证实。将所有患者分良恶性两组,分别对年龄,侧别,病灶形态特征,内部强化方式,最大径,MRI信号特征,时间信号强度曲线,DWI及ADC值进行统计对比,以P0.05被认为有统计学意义。再计算MRI对恶性病变检出率。所得数据用SPSS13.0统计软件包进行处理。结果良性病变组126人平均年龄38.67±0.87岁,恶性病变组109人平均年龄44.47±0.89岁。两组间发病年龄存在差异(P0.01),两组间在病灶形态特征,内部强化方式,最大径,时间信号强度曲线也存在差异,P值均0.01。而两组间在侧别,MRI信号特征,DWI表现及ADC值并没有显示出明显差异,且恶性组中导管原位癌及浸润性导管癌的ADC值也无统计学差异。分析MRI对恶性病变检出率,灵敏度=92.7%,特异度=84.6%,漏诊率=7.3%,误诊率=15.4%,阳性预测值=83.6%,阴性预测值=93.2%,诊断正确率=88.3%,Youden指数=77.3%,阳性试验似然比=6.02。病理上良性病变54.17%,以乳腺腺病最多见,占58.46%,其次为导管内乳头状瘤38.46%,肉芽肿性乳腺炎16.15%;恶性病变45.83%,以浸润性导管癌最多见,占50%,导管原位癌49.09%次之,另发现乳头状癌10例,乳腺黏液癌2例,浸润性小叶癌3例,均呈非肿块强化表现。结论乳腺非肿块强化型病变在良恶性的MRI表现具有一定特点。MRI对非肿块强化恶性病变的诊断有效性较高。非肿块强化良恶性病灶在发病年龄,病灶的形态特征,内部强化特征,最大径,TIC曲线类型方面的差别具有统计学意义。
[Abstract]:Objective in recent years, breast cancer has surpassed cervical cancer to become the first incidence of malignant tumors in women. Clinical palpation, mammography and ultrasound are important methods for the diagnosis, treatment and postoperative evaluation of breast lesions. But clinical palpation has a great error in judging the size and boundary of the lesion, mammography is sensitive to calcification in breast, but for dense breast, it is restricted by the low resolution of soft tissue, and the focus is often poor or difficult to display. The sensitivity and specificity of ultrasound are relatively low, and it is difficult to identify minor lesions and frequent diseases. Magnetic resonance imaging (MRI) of mammary gland has high spatial and soft tissue resolution and high sensitivity to lesions. It can be recognized gradually in clinical diagnosis and postoperative evaluation. Breast lesions were further evaluated by mammography and ultrasound, and recessive breast cancer with negative findings could be found because of its high sensitivity. Recently, with the popularization of breast MRI, non-tumor enhancement is the main cause of false positive diagnosis. The purpose of this study was to retrospectively analyze the features of MRI images in patients with non-tumor-enhanced lesions confirmed by pathology, and to explore the value of clinical manifestations and MRI signs in the diagnosis of benign and malignant lesions with non-tumor-enhanced lesions. The value of BI-RADS MRI in the diagnosis and differential diagnosis of breast non-enhancement lesions was further discussed. Methods from October 2015 to October 2016, the clinical and MRI data of 234 female patients who underwent breast MRI examination and whose lesions were non-mass enhancement were collected and 240 lesions were found. All patients were confirmed by pathology. All the patients were divided into benign and malignant groups, age, side, lesion morphology, internal enhancement mode, maximum diameter MRI signal characteristics, time signal intensity curve DWI and ADC value were statistically compared, P0.05 was considered to have statistical significance. The detection rate of malignant lesions by MRI was calculated. The data were processed by SPSS13.0 software package. Results the mean age of 126 patients with benign lesions and 109 patients with malignant lesions was 38.67 卤0.87 years old and 44.47 卤0.89 years old respectively. There were significant differences in the age of onset between the two groups (P 0.01), and there were also significant differences between the two groups (P < 0.01) in the lesion morphology, the internal enhancement mode, the maximum diameter, and the time signal intensity curve. However, there was no significant difference in DWI and ADC between the two groups, and the ADC values of ductal carcinoma in situ and invasive ductal carcinoma were not significantly different between the two groups. To analyze the detection rate of malignant lesions by MRI, the sensitivity was 92.7%, the specificity was 84.6%, the missed diagnosis rate was 7.3%, the misdiagnosis rate was 15.4%, the positive predictive value was 83.6%, the negative predictive value was 93.2%, the diagnostic accuracy rate was 88.3% and Youden index was 77.3%, the likelihood ratio of positive test was 6.02%. Pathologically, 54.17 benign lesions were found most frequently in breast adenopathy (58.46%), followed by intraductal papilloma (38.46), granulomatous mastitis (16.15%), malignant lesions (45.83%), invasive ductal carcinoma (50%), ductal carcinoma in situ (49.09%), and papillary carcinoma (10 cases). Two cases of breast mucinous carcinoma and 3 cases of invasive lobular carcinoma showed non-tumor enhancement. Conclusion enhanced breast lesions have some characteristics in benign and malignant MRI. MRI is more effective in the diagnosis of benign and malignant breast lesions. There were significant differences in the age of onset, the morphological features, the internal enhancement characteristics and the type of TIC curve of non-enhancement benign and malignant lesions.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9;R445.2

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