乳腺结构扭曲病变影像学研究

发布时间：2018-03-02 17:11

本文选题：乳腺结构扭曲　切入点：乳腺X线检查　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的1、分析乳腺X线及MRI检查对结构扭曲病变的影像学诊断价值;2、探讨乳腺X线及MRI两种检查方法临床诊断价值。材料与方法根据乳腺BI-RADS分类标准第四版,收集在我院行乳腺X线检查并诊断结果为单纯结构扭曲病灶的女性患者共49例,同时排除病灶影像学表现合并肿块、钙化等典型恶性征象病例,所有病例均未经任何手术、穿刺活检等治疗前行乳腺MRI检查。回顾性分析49例具备完整病理诊断结果患者的乳腺X线检查及乳腺MRI检查影像学表现。结果1、在49例乳腺结构扭曲病人中,病理诊断结果良性15例,恶性34例;2、乳腺X线检查对结构扭曲病灶的检出具有发现价值,乳腺结构扭曲病灶边缘特征差异具有统计学意义,其中良性结构扭曲边缘以模糊(53.3%)为主,而恶性病灶以星芒状(50.0%)较易出现,然而病灶最大长径及象限分布差异均无统计学意义(P0.05);3、乳腺DCE-MRI中良恶性结构扭曲病灶强化分布形式、内部增强特点有显著差异,且有统计学意义(P0.05),其中良性结构扭曲病灶较易出现区域样分布(46.7%)、均匀强化(53.3%),而恶性病变则以段样分布(35.3%)、簇状小环样强化(44.1%)为主。良性病灶边缘以光整或不规则为主,而恶性病灶边缘以不规则及毛刺为主,差别有统计学意义(P0.05),其敏感度为97.1%,特异度为40%,准确度为79.6%;4、TIC曲线中良性结构扭曲病变以持续型(I型)及平台型(II型)为主,恶性病灶以廓清型(III型)为主,差异具有统计学意义(P0.05);5、在DWI图像扫描时取b值取1000s/mm2,良恶性结构扭曲病灶的扩散敏感系数(ADC值)差别具有统计学意义(P0.05),采用ADC值=1.22×10-3 mm2/s作为诊断恶性结构扭曲病灶阈值点,其敏感度为70.6%,特异度为73.3%,准确度为71.4%。结论乳腺X线检查对结构扭曲病灶更具发现价值,其中边缘形态特征对诊断良恶性病灶意义较大,但乳腺结构扭曲病变的象限部位及病灶的大小对鉴别良恶性病灶不具有特异价值;MRI快速成像序列、DCE-MRI及DWI成像对结构扭曲病灶的临床诊断及鉴别诊断具有重要价值,其中ADC值更具诊断价值。
[Abstract]:Objective 1. To analyze the value of mammography and MRI in the imaging diagnosis of structural distortion. (2) to explore the clinical diagnostic value of mammography and MRI. A total of 49 female patients who underwent mammography in our hospital and were diagnosed as simply distorted lesions were included. The imaging findings of the lesions were excluded from typical malignant signs, such as mass, calcification, etc. All cases were not operated on. Mammography and mammary MRI imaging findings of 49 patients with complete pathological diagnosis were retrospectively analyzed. Results 1 among 49 patients with structural distortion of the mammary gland, The results of pathological diagnosis were benign in 15 cases and malignant in 34 cases. Mammography was valuable in the detection of structural distortion lesions, and the difference of the edge features of the lesions was statistically significant. Among them, the distortion margin of benign structure was fuzzy 53.3%, while the malignant lesion was 50.0%. However, there was no significant difference in the distribution of the largest length and quadrant of the lesion, and the enhanced distribution of benign and malignant lesions in breast DCE-MRI was not significant (P 0.05), but there was no significant difference in the distribution of the maximum length and quadrant of the lesion. There are significant differences in the characteristics of internal enhancement, There was significant difference in P0.05, in which 46.7% of the lesions with benign structures were more likely to be localized, and 53.3% of the lesions were evenly enhanced, while the malignant lesions were mainly distributed in the segmental form with 35.3% and 44.1% in clusters). The margin of benign lesions was smooth or irregular. The margin of malignant lesions was mainly irregular and burr, the difference was significant (P 0.05), the sensitivity was 97.1, the specificity was 40, and the accuracy was 79.6%. In the TIC curve, the benign structural distortion lesions were of type I) and the type of platform type II). The major malignant lesions were type III (clearance type). The difference was statistically significant (P < 0.05). The b value was taken at 1000 s / mm ~ (2) and the diffusive sensitivity coefficient of benign and malignant structure distortion lesions was obtained by using ADC value of 1.22 脳 10 ~ (-3) mm2/s as the threshold point for the diagnosis of malignant structure distortion lesions in DWI image scanning, and the diffusion-sensitivity coefficient of benign and malignant structures was 1.22 脳 10 ~ (-3) mm2/s. The sensitivity, specificity and accuracy of mammography were 70.6 and 73.3, respectively. Conclusion mammography is of great value in the diagnosis of benign and malignant lesions, especially in the diagnosis of benign and malignant lesions. However, the quadrant location and the size of the lesions are of no specific value in differentiating benign and malignant lesions. DCE-MRI and DWI imaging are of great value in the clinical diagnosis and differential diagnosis of structurally distorted lesions. The value of ADC is more valuable for diagnosis.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.8;R816.8;R445.2

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