乳腺不对称密度病变的影像学研究

发布时间：2018-07-18 09:29

【摘要】：研究目的探讨MRI动态增强及扩散加权序列对BI_RADS_X提出的乳腺不对称密度病灶的良恶性诊断价值并与乳腺X线摄影诊断不对称密度病灶良恶性对照，探讨两种影像学方法的临床应用价值。材料与方法依据乳腺BI_RADS分类标准第四版在X线摄影中发现不对称密度病灶的患者，其中42例女性患者为不伴有不规则肿块、恶性钙化、结构扭曲等典型恶性征象的单纯不对称密度病变，未经任何治疗行乳腺MRI动态增强及扩散加权序列（DWI）扫描，，由高年资诊断医生根据BI_RADS_X及BI_RADS_MRI分类标准分别对其进行征象分析并分类，以术后病理或穿刺活检为金标准，回顾分析其X线及MRI影像学征象并进行对照分析。结果1.病理诊断良性不对称密度病变18例，恶性不对称密度病变24例；2.X线摄影中良恶性不对称密度病变的象限位置、病灶大小及边缘形态差异均无统计学意义（P0.05），X线摄影对不对称密度恶性病变的具有发现价值，但其灵敏度为0%；3.MR检查不对称密度病变强化的分布形式和内部增强情况对鉴别病变良恶性有意义（P0.05）；段样分布(54.2%)、簇状小环样强化(55%)较易出现在恶性不对称病变中，丛样分布(55.6%)、区域性强化(50%)则更易出现在良性病变中。边缘形态恶性病变以不规则或毛刺征象为主，良性不对称病变以规则及不规则为主，其差异具有统计学意义，其不对称密度病变的诊断灵敏度为92%，特异度为50%，准确度为74%；4. MRI动态增强曲线恶性不对称密度病变以III型曲线为主，良性病变以I型曲线为主，差异具有统计学意义，TIC曲线对不对称密度病变的诊断灵敏度为92%，特异度为67%，准确度为81%；5. MRI扩散加权成像（DWI）扫描时取敏感因子（b值）=1000s/mm2测定ADC值、良恶性病变间差异有统计学意义。采用ADC值可信区间的95%（1.23×10-3mm2/s）作为诊断恶性不对称密度病变的上限阈值点，其灵敏度为83%，特异度为83%，准确度为83%。结论乳腺X线摄影对不对称密度病灶具有临床发现价值，对于良恶性鉴别灵敏度低、价值有限；MRI动态增强扫描及扩散加权成像检查对不对称密度病变的定性及鉴别诊断具有临床诊断价值。
[Abstract]:Objective to investigate the value of dynamic contrast enhanced MRI and diffusion weighted sequence in the diagnosis of benign and malignant lesions with asymmetric density of mammary gland proposed by Birads X, and to compare them with those of mammography in the diagnosis of benign and malignant lesions with asymmetric density. To explore the clinical application value of two imaging methods. Materials and methods according to the fourth edition of Birads classification standard of mammary gland, patients with asymmetric density lesions were found in X-ray radiography, 42 of whom were without irregular mass and malignant calcification. Simple asymmetric density lesions with typical malignant signs, such as structural distortion, were examined by dynamic enhanced and diffusion-weighted sequence (DWI) without any treatment. According to the classification standard of BI _ S _ RADSX and BI _ S _ RADS MRI, the senior diagnostics analyzed the signs and classified them respectively. The X-ray and MRI imaging signs were analyzed retrospectively and compared with the golden standard of postoperative pathology or puncture biopsy. Result 1. 18 cases of benign asymmetric density lesions and 24 cases of malignant asymmetric density lesions were diagnosed by pathology. 2. The quadrant position of benign and malignant asymmetric density lesions in radiography. There was no significant difference in the size and edge morphology of the lesions (P0.05) X-ray radiography was of value in the detection of malignant lesions with asymmetric density, but the sensitivity was 0. 3. The distribution and internal enhancement of asymmetric density lesions were significant in differentiating benign and malignant lesions (P0.05), segmental distribution (54.2%) and cluster small ring enhancement (55%) were more likely to appear in malignant asymmetric lesions. Cluster distribution (55.6%) and regional enhancement (50%) were more likely to occur in benign lesions. The main signs of malignant lesions were irregular or prickly, and the benign asymmetrical lesions were regular and irregular. The difference was statistically significant. The diagnostic sensitivity, specificity and accuracy of asymmetric density lesions were 92 and 50, respectively, and the accuracy was 74. 4%. The dynamic contrast-enhanced curve of MRI was mainly type III curve for malignant asymmetric density lesions, while the type I curve for benign lesions. The difference was statistically significant. The diagnostic sensitivity, specificity and accuracy of TIC curve for asymmetric density lesions were 922 and 67, respectively. The ADC values were measured with sensitivity factor (b) and 1000 s / mm2 in diffusion weighted imaging (DWI). The difference between benign and malignant lesions was statistically significant. 95% (1.23 脳 10-3mm2/s) of the confidence interval of ADC value was used as the upper threshold point for the diagnosis of malignant asymmetric density lesions. The sensitivity was 83%, the specificity was 83%, and the accuracy was 83%. Conclusion mammography has clinical value in the diagnosis of asymmetric density lesions and has low sensitivity and limited value in differentiating benign and malignant lesions. Dynamic contrast-enhanced MRI and diffusion-weighted imaging are of clinical value in the qualitative and differential diagnosis of asymmetric density lesions.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.9;R730.44

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