MRI平台型乳腺病灶的影像特点及DWI对其良恶性鉴别诊断价值的研究

发布时间：2018-03-24 14:34

本文选题：乳腺良恶性病变　切入点：磁共振成像　出处：《吉林大学》2014年硕士论文

【摘要】：目的：探讨MRI动态增强曲线呈平台型的乳腺病灶的磁共振影像特点及DWI-ADC值对其良恶性病灶的鉴别诊断价值。方法：研究搜集在乳腺MRI动态增强扫描中呈平台型曲线的患者，共60例患者68个病灶。所选患者均获得病理证实。搜集其相应的MRI平扫、增强影像、DWI影像及临床资料进行回顾性分析,对所有病灶的形态、边界、信号差异特点做一综合的影像学诊断，根据BI-RADS给予分级。通过后处理对照平台型的病灶位置选取感兴趣区域，测得相应的ADC值，分析ADC值鉴别诊断乳腺良恶性病灶的敏感性、特异性、阳性似然比、阴性似然比及准确率。结果：病理结果显示本组乳腺癌共35例患者36个病灶，占52.9%（36/68），乳腺良性病变共25例患者32个病灶，占47.1%（32/68）。所有乳腺病灶在常规T1WI、T2WI平扫图像上分别呈等低信号、高信号。良性病灶多呈类圆形（81.3%，26/32），边界多清楚（87.5%，28/32），多呈均匀性强化方式（78.1%，25/32）；恶性病灶多呈分叶状（69.4%，，25/36），边界多不清（72.2%，26/36），多呈不均匀性强化（44.4%，16/36）。本研究良性组乳腺病灶的DCE-TIC早期强化率平均值为（78.68±17.02）%，恶性组为（114.40±22.29）%，良性组早期强化率明显低于恶性组（P=0.000）。TIC早期强化率界值为98.1%时，灵敏度、特异度、阳性似然比、阴性似然比分别为77.1%、84.9%、5.09、0.27。乳腺病灶恶性组ADC值均值为（1.05±0.13）×10-3mm2/s，良性组ADC值为（1.37±0.31）×10-3mm2/s。良性肿瘤组的ADC值明显高于乳腺恶性肿瘤组（P=0.000）。乳腺良恶性病变的ADC界值定为1.33×10-3mm2/s时，灵敏度、特异度、阳性似然比、阴性似然比分别为92.6%、82.9%、5.42、0.09。以ADC界值为诊断标准，诊断良恶性病变的符合率高达88.2%。结论：乳腺病灶在DCE-TIC呈平台型时，需综合MRI的影像特点及DWI-ADC值的测量。当b值取0、1000s/mm2时ADC值以1.33×10-3mm2/s为诊断界值，其乳腺良恶性肿瘤的诊断灵敏度、诊断符合率均提高。
[Abstract]:Objective:. To study the characteristics of Mr imaging of breast lesions with dynamic enhanced MRI curve and the value of DWI-ADC value in differential diagnosis of benign and malignant lesions. Methods:. A total of 68 lesions were collected from 60 patients with plateau curve in dynamic enhanced scanning of breast MRI. All the selected patients were confirmed by pathology, and their corresponding MRI plain scans were collected. Contrast-enhanced DWI images and clinical data were retrospectively analyzed to make a comprehensive imaging diagnosis of the shape, boundary and signal difference of all lesions. According to the classification of BI-RADS, the region of interest was selected from the location of the lesions of platform type after treatment, and the corresponding ADC value was measured. The sensitivity, specificity, positive likelihood ratio of ADC value in differential diagnosis of benign and malignant breast lesions were analyzed. Negative likelihood ratio and accuracy. Results:. The pathological results showed that there were 36 lesions in 35 cases of breast cancer (52.9%), 32 lesions in 25 cases (47.1% / 68%) of benign breast lesions. High signal intensity. The benign lesions are mostly round 81.33 / 26 / 32, the boundaries are more clear 87.555 / 28 / 32, more homogeneous enhancement is 78.1 / 2532; the malignant lesions are mostly lobular 69.426 / 36, the boundaries are more than 72.226 / 36, and most of them are heterogeneous enhancement: 44.4% / 16 / 36. In this study, the early stage of DCE-TIC in the benign group was strong. The average enhancement rate was 78.68 卤17.02 and 114.40 卤22.29 in the malignant group. The early enhancement rate in the benign group was significantly lower than that in the malignant group. Sensitivity, specificity, positive likelihood ratio, The negative likelihood ratio was 77.1 / 84.9 / 5.09 / 0.27.The mean value of ADC was 1.05 卤0.13) 脳 10 ~ (-3) mm ~ (2 / s) in malignant breast lesions group and 1.37 卤0.31 脳 10 ~ (-3) mm ~ (2 / s) in benign tumor group. The ADC value in benign tumor group was significantly higher than that in breast cancer group (P _ (0.000)). When the ADC threshold of benign and malignant breast lesions was 1.33 脳 10-3mm2/s, the sensitivity, specificity and specificity of benign and malignant lesions were significantly higher than those of benign tumor group. The positive likelihood ratio and the negative likelihood ratio were 92. 6% and 82. 9% respectively. According to the diagnostic criteria of ADC, the coincidence rate of diagnosis of benign and malignant lesions was up to 88. 2%. Conclusion:. The imaging characteristics of MRI and the measurement of DWI-ADC value should be integrated when the breast lesions are flat type in DCE-TIC. When b value is 0 ~ 1000s / mm ~ 2, the diagnostic threshold value of ADC value is 1.33 脳 10-3mm2/s, the diagnostic sensitivity and diagnostic coincidence rate of benign and malignant breast tumors are improved.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R737.9

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