3.0T磁共振新技术联合钼靶对乳腺良恶性病变的研究

发布时间：2018-01-21 09:04

本文关键词： 乳腺疾病钼靶磁共振动态增强磁共振成像弥散加权成像磁共振波谱　出处：《遵义医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的:探讨乳腺钼靶、3.0T磁共振新技术(动态增强磁共振成像、弥散加权成像及磁共振波谱)及两者联合应用对乳腺良恶性病变诊断价值。方法:(1)收集2013年11月至2014年9月遵义医学院附属医院行乳腺钼靶及磁共振检查的女性患者61例,年龄23-77岁,平均年龄44.8岁。良性14例,恶性47例。所有病例行磁共振扫描及钼靶X线摄影。观察病变的形态表现、有无钙化、强化方式以及扩散加权成像(Diffusion weighted imaging,DWI),测量感兴趣区(Region of interest,ROI)的时间-信号强度曲线(Time-signal intensity curve,TIC)、ADC值、磁共振波谱(Magnetic resonance spectroscopy,MRS)有无胆碱峰。(2)分析磁共振新技术在乳腺良恶性病变的诊断灵敏度、特异度、符合率、阳性预测值以及阴性预测值;分析单独运用钼靶、磁共振及两种技术联合应用在乳腺良恶性病变的价值。采用SPSS 17.0统计软件包进行分析,计数资料进行卡方检验,p0.05认为差异有统计学意义。结果:(1)形态学表现诊断乳腺良、恶性病变的灵敏度61.1%,特异度为93%,符合率83.6%,阳性预测值78.6%,阴性预测值85.1%。采用卡方检验,χ2=1(p0.05),还不能认为病灶形态作为乳腺恶性病变的诊断具有统计学差异。(2)时间-信号强度曲线作为乳腺良、恶性病变的诊断标准,灵敏度为100%、特异度为88.7%、符合率90.1%,阳性预测值57.1%,阴性预测值100%。采用卡方检验,χ2=4.17(p0.05),可以认为以II型和III型曲线作为乳腺恶性病变的诊断具有统计学意义。(3)恶性病灶ADC值和对侧正常乳腺组织ADC值的ROC曲线下面积为0.988,以1.210×10-3mm2/s为鉴别乳腺良恶性病变的阈值,47例恶性病灶中有44例ADC值1.210×10-3mm2/s,灵敏度为95.6%、特异度为93.5%。(4)胆碱峰有无鉴别乳腺良恶性病变的灵敏度为70.2%,特异度为70.6%,符合率为75%,阳性预测值为97.1%,阴性预测值为17.6%。采用卡方检验,χ2=9.6,可以认为有无Cho峰出现,对诊断乳腺良、恶性病变有统计学差异。(5)三种磁共振新技术在乳腺良恶性疾病检出上,动态增强和DWI的敏感度及符合率分别为100%、90.1%和95.6%、86.9%,明显高于MRS的敏感度和符合率;而MRS在乳腺良恶性病变特异度上高于动态增强和DWI。(6)Kappa检验分析两名乳腺诊断医师运用钼靶X线摄影对乳腺良恶性病变的诊断一致性一般,而运用MRI诊断一致性好。(7)单独使用钼钯及MRI新技术诊断乳腺良恶性疾病的诊断符合率分别是45.9%、62.3%;两者联合运用诊断乳腺良恶性疾病的符合率为80.3%,为其两者联合运用诊断符合率均高于单独使用某一种检查(χ2=4.08,p0.05)。结论:磁共振检查对乳腺良恶性病变的诊断价值高于乳腺钼靶检查,磁共振动态增强、DWI技术对诊断乳腺癌的灵敏度较高,MRS的阳性预测值较高。乳腺钼靶联合磁共振检查明显提高乳腺良恶性病变术前诊断的符合率,为期早期诊断及预后提供理论依据。
[Abstract]:Objective: to investigate a new technique of dynamic contrast enhanced magnetic resonance (MRI) for mammary mammary mammography with 3.0 T magnetic resonance imaging (MRI). Diffusion weighted Imaging and Magnetic Resonance Spectroscopy) and their combination in the diagnosis of benign and malignant Breast lesions. Methods: 1). From November 2013 to September 2014, 61 female patients underwent mammography and magnetic resonance imaging (MRI) in affiliated Hospital of Zunyi Medical College. The age ranged from 23 to 77 years with an average age of 44.8 years. There were 14 benign cases and 47 malignant cases. All cases were examined by MRI and mammography. Enhancement and Diffusion weighted Imaging (DWI). Measure the time-signal intensity curve of the region of interest. Magnetic resonance spectroscopy, magnetic resonance spectroscopy (MRI). The sensitivity, specificity, coincidence rate, positive predictive value and negative predictive value of the new MRI technique in the diagnosis of benign and malignant breast lesions were analyzed. The value of using molybdenum target, magnetic resonance imaging and two kinds of techniques in benign and malignant breast lesions was analyzed by SPSS 17.0 statistical software package and chi-square test was used to count the data. Results the morphologic features of benign and malignant breast lesions were 61.1%, the specificity was 93.3%, and the coincidence rate was 83.6%. Positive predictive value was 78.6 and negative predictive value was 85.1. Chi-square test was used. It can not be considered that the shape of the lesion as the diagnosis of breast malignant lesions has statistical difference. 2) the time-signal intensity curve as the diagnostic criteria for benign and malignant breast lesions, the sensitivity is 100%. The specificity was 88.7. The coincidence rate was 90.1. The positive predictive value was 57.1 and the negative predictive value was 100. Chi-square test was used. It can be concluded that type II and III curves are statistically significant in the diagnosis of malignant breast lesions. The area under ROC curve of ADC value of malignant lesion and ADC value of contralateral normal breast tissue was 0.988. Using 1.210 脳 10 ~ (-3) mm ~ (-2) / s as the threshold for differentiating benign and malignant breast lesions, 44 of 47 malignant lesions had a ADC value of 1.210 脳 10 ~ (-3) mm ~ (2 / s). The sensitivity of choline peak was 70.2 and the specificity was 70.60.The coincidence rate was 75%. The positive predictive value was 97.1 and the negative predictive value was 17.6.The chi-square test showed that there was a Cho peak, which was good for the diagnosis of mammary gland. The sensitivity and coincidence rate of dynamic contrast enhancement and DWI in detecting benign and malignant breast diseases were 90.1% and 95.6% respectively. The sensitivity and coincidence rate of MRS were significantly higher than those of MRS. The specificity of MRS in benign and malignant breast lesions was higher than that in dynamic enhancement and DWI.6. The diagnosis of benign and malignant breast lesions by mammography by two mammographers by Kappa test was generally consistent. The diagnostic coincidence rates of MRI and MRI were 45.9% and 62.3%, respectively. The coincidence rate of the combined use of the two methods in the diagnosis of benign and malignant breast diseases was 80.3, and the diagnostic coincidence rate of the combined use of both was higher than that of a single examination (蠂 2 4.08). Conclusion: the value of MRI in the diagnosis of benign and malignant breast lesions is higher than that of mammography. The sensitivity of Mr dynamic contrast enhanced DWI in the diagnosis of breast cancer is higher than that of mammography. The positive predictive value of MRS was higher. Mammography combined with magnetic resonance imaging could significantly improve the coincidence rate of preoperative diagnosis of benign and malignant breast lesions and provide theoretical basis for early diagnosis and prognosis.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.2;R737.9

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