多参数MRI的BI-RADS分类对乳腺病变的诊断效能

发布时间：2018-03-05 11:37

  本文选题：乳腺疾病　切入点：磁共振成像　出处：《中国医学影像学杂志》2015年03期 　论文类型：期刊论文

【摘要】：目的建立一种多参数乳腺MRI检查与诊断方式,与美国放射学院乳腺影像报告和数据系统(BI-RADS)分类对应,改进乳腺疾病的处理建议。资料与方法回顾分析278例乳腺疾病患者301个经病理证实的病灶,使用1 mm×1 mm×1 mm空间分辨率、120 s时间分辨率的动态增强扫描(DCE)序列和b=1000 s/mm2的扩散加权成像(DWI)序列进行扫描,将DCE显示早期病灶形态学恶性征象、时间-信号强度曲线(TIC)II型或III型、小于良恶性表观扩散系数(ADC)阈值的3个诊断因素各计1分,肿块和非肿块样强化病灶区别对待,积分≥2分诊断为BIRADS 5类,积分=1分诊断为BI-RADS 4类,积分1分诊断为BI-RADS 3类,其他特异性良性发现诊断为BI-RADS 2类,DCE和DWI无异常发现评价为BI-RADS1类,并与病理学的良性(B)-高危(HR)-恶性(M)病灶分级进行对照,评价其对病灶处理的建议。结果以HR作为恶性时(M+HR),得到的ROC曲线下面积为0.860;以HR作为良性时(B+HR),得到的ROC曲线下面积为0.876,两者很接近。经过ROC曲线优化,在病理上将HR作为良性、在MRI上将BI-RADS 5类作为恶性,获得敏感度为85.3%,特异度为86.8%,准确度为85.1%,高于其他组合。如果将病理上HR病灶的处理原则定义为局部切除或短期随访,则BI-RADS 5类对M+HR病灶(可切除病灶)阳性预测值为93.2%;BI-RADS 4类病灶对M+HR病灶的阳性预测值为46.9%,必须活检以决定局部切除或短期随访;BI-RADS 3类及以下对B+HR病灶的阳性预测值(随访观察)为90.4%。结论本研究建立了一个简单的诊断模型,动态增强显示的形态学特征、动态时间-信号强度曲线和DWIADC值取相同的权重进行BI-RADS分类,可以很好地预测乳腺病灶良性、高危和恶性特征,对指导乳腺疾病的处理方式有实用价值。
[Abstract]:Objective to establish a multi-parameter mammary gland MRI examination and diagnosis method, which corresponds to the classification of mammography report and data system (BI-RADS) of the American College of Radiology. Methods the data and methods A retrospective analysis of 301 pathologically proved lesions in 278 patients with breast disease was made. 1 mm 脳 1 mm 脳 1 mm 脳 1 mm spatial resolution dynamic enhanced scanning (DEC) sequence and diffusion weighted imaging (DWI) sequence of 1 mm 脳 1 mm 脳 1 mm 脳 1 mm ~ (-1) mm ~ (2) spatial resolution were used to scan the lesions. The DCE was used to display the malignant early lesions. The time-signal intensity curve was divided into two types: type II or type III. The three diagnostic factors less than the threshold value of the apparent diffusion coefficient of benign and malignant tumors were divided into three groups: 1 score, 1 grade, and 1 score, respectively. The tumor and non-tumor-like enhancement lesions were treated differently. The integral 鈮，

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