目的：探讨DWI-MRI联合X线钼靶检查在良恶性乳腺病变鉴别诊断中的应用价值，并和病理检查结果相对照。方法：回顾性分析我院72例经病理学检查证实的乳腺良恶性病灶，所有病例均完成乳腺X线钼靶检查、MRI常规（T1增强、STIR、T2加权）及DWI检查，并测量ADC值。以病理结果为金标准，利用χ2检验或Fisher精确概率检验比较单独应用MRI及MRI联合X线钼靶检查对乳腺病灶的诊断敏感度、特异度及总符合率；根据病理结果将病灶分成良、恶性两组分别测量其平均ADC值，采用独立样本t检验（正态分布）或非参数检验（非正态资料）比较两组ADC均值有无差别，并绘制受试者工作特性曲线（ROC曲线）。结果：72例病例经病理证实21例为良性，51例为恶性。单独应用MRI诊断的敏感度、特异度、符合率分别为91.8%、78.3%、88.2%；MRI联合X线钼靶检查诊断的敏感度、特异度、总符合率分别为94%、81.8%、92.1%；经χ2检验，后者诊断效率高于前者（χ2=15.967，P<0.05）。测得良性组ADC均值（单位：×10-3 mm2/s）约为1.374±0.309，恶性组约为0.871±0.149，两组ADC均值间比较存在统计学差异（t=4.903，P<0.05），最佳ADC截断阈值为1.243×10-3 mm2/s，对应的敏感度为81%，特异度为95.5%，总符合率为90.2%。结论：DWI-MRI及其量化参数ADC值联合乳腺X线钼靶检查，能有效融合两种技术的优势，提高乳腺良恶性病变诊断的准确性，可在乳腺癌术前鉴别诊断中作为常规应用加以推广，以有效减少活检假阳性率。
Abstract
Objective: To investigate the diagnostic value of DWI-MRI combined with mammography in detecting and characterizing benign and malignant breast lesions, having histological findings as the reference standard. Methods: Seventy-two patients with histologically proven breast lesions were retrospectively analyzed in this study, with all patients underwent mammography, MRI routine scan(T1 contrast enhancement, STIR, T2 weighted), and DWI. The ADC values of the lesions were measured on the ADC maps. Taking histological findings as the reference standard, the diagnostic accuracy, sensitivity and specificity of MRI examinations alone and MRI combined with X-ray mammography were calculated and compared with chi-square test or Fisher exact test. According to the pathology results, the 72 lesions were divided into benign and malignant groups, and ADCs of both groups were compared using the 2-tailed student t test or Mann-Whitney U test, with ROC analysis performed. Results: Seventy-two patients included 21 benign cases and 51 malignant ones tested by histological results. The sensitivities, specificities and accurate rates of the sole MRI examination and MRI combined with digital mammography X-ray were 91.8%, 78.3%, 88.2% and 94%, 81.8%, 92.1% respectively, through the chi-square test the latter data were higher than the former ones(χ2=15.967, P<0.05). The mean ADC value(in ×10-3 mm2/s) of the benign group(1.374±0.309) was significantly higher than that of the malignant group(0.871±0.149) (t=4.903, P<0.05), and the optimal cut-off ADC of 1.243 yielded a sensitivity of 81%, a specificity of 95.5%, and total coincidence rate of 90.2%. Conclusion: The fused application of DWI-MRI sequences ADC values in combination with X-ray mammography, can effectively improve the accuracy of diagnosis on breast lesions. It could be used as a routine application without using contrast agents in the diagnosis of breast cancer before operation, so as to decrease negative biopsy rates.
关键词
乳腺疾病 /
磁共振成像 /
放射摄影术
Key words
Breast diseases /
Magnetic resonance imaging /
Radiography
中图分类号：
Ｒ655.8
Ｒ445.2
Ｒ814.41
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参考文献
[1]Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. Ca Cancer J Clin, 2016, 66(2): 115-132.
[2]Caumo F, Zorzi M, Brunelli S, et al. Digital Breast Tomosynthesis with Synthesized Two-Dimensional Images versus Full-Field Digital Mammography for Population Screening: Outcomes from the Verona Screening Program[J]. Radiology, 2018, 287(1): 37-46.
[3]Vinnicombe S. How I report breast magnetic resonance imaging studies for breast cancer staging and screening[J]. Cancer Imaging, 2016, 16(1): 17.
[4]Strobel K, Schrading S, Hansen NL, et al. Assessment of BI-RADS category 4 lesions detected with screening mammography and screening US: utility of MR imaging[J]. Radiology, 2015, 274(2): 343-351.
[5]Mcdonald ES, Hammersley JA, Chou SH, et al. Performance of DWI as a Rapid Unenhanced Technique for Detecting Mammographically Occult Breast Cancer in Elevated-Risk Women With Dense Breasts[J]. AJR, 2016, 207(1): 205-216.
[6]Bickelhaupt S, Tesdorff J, Laun FB, et al. Independent value of image fusion in unenhanced breast MRI using diffusion-weighted and morphological T2-weighted images for lesion characterization in patients with recently detected BI-RADS 4/5 x-ray mammography findings[J]. Eur Radiol, 2017, 27(2): 562-569.
[7]Zuckerman SP, Conant EF, Keller BM, et al. Implementation of Synthesized Two-dimensional Mammography in a Population-based Digital Breast Tomosynthesis Screening Program[J]. Radiology, 2016, 281(30): 730-736.
[8]李志，钱明理，汪登斌，等. 乳腺专用磁共振成像、乳腺X线摄影及超声检查对乳腺癌诊断价值的对照研究[J]. 临床放射学杂志，2012，31（6）：794-799.
[9]Rafferty EA, Durand MA, Conant EF, et al. Breast Cancer Screening Using Tomosynthesis and Digital Mammography in Dense and Nondense Breasts[J]. JAMA, 2016, 315(16): 1784-1786.
[10]张丽，韩立新，曹惠霞，等. 3.0T磁共振扩散加权成像和VIBRANT动态增强在鉴别乳腺腺病与乳腺癌中的价值[J]. 临床放射学杂志，2017，36（3）：342-346.
[11]Cipolla V, Guerrieri D, Bonito G, et al. Effects of contrast-enhancement on diffusion weighted imaging and apparent diffusion coefficient measurements in 3-T magnetic resonance imaging of breast lesions[J]. Acta Radiol, 2018, 59(8): 902-908.
[12]Telegrafo M, Rella L, Stabile Ianora AA, et al. Unenhanced breast MRI(STIR, T2-weighted TSE, DWIBS): An accurate and alternative strategy for detecting and differentiating breast lesions[J]. Magn Reson Imag, 2015, 33(8): 951-955.
[13]曾仲刚，李雪霞，李刚，等. 多模态MRI技术诊断乳腺单发良恶性结节的Logistic分析[J]. 中国临床医学影像杂志，2018，29（6）：395-399.
[14]Bokacheva L, Kaplan JB, Giri DD, et al. Intravoxel incoherent motion diffusion-weighted MRI at 3.0T differentiates malignant breast lesions from benign lesions and breast parenchyma[J]. J Magn Reson Imaging, 2014, 40(4): 813-823.
[15]Bogner W, Gruber S, Pinker K, et al. Diffusion-weighted MR for differentiation of breast lesions at 3.0T: how does selection of diffusion protocols affect diagnosis?[J]. Radiology, 2009, 253(2): 341-351.
[16]Altay C, Balci P, Altay S, et al. Diffusion-weighted MR imaging: role in the differential diagnosis of breast lesions[J]. JBR-BTR, 2014, 97(4): 211-216.
[17]Cabuk G, Nass Duce M, Ozgür A, et al. The diagnostic value of diffusion-weighted imaging and the apparent diffusion coefficient values in the differentiation of benign and malignant breast lesions[J]. J Med Imaging Radiat Oncol, 2015, 59(2): 141-148.
[18]Thomassin-Naggara I, De Bazelaire C, Chopier J, et al. Diffusion-weighted MR imaging of the breast: advantages and pitfalls[J]. Eur J Radiol, 2013, 82(3): 435-443.
[19]Rao AA, Feneis J, Lalonde C, et al. A Pictorial Review of Changes in the BI-RADS Fifth Edition[J]. Radiographics, 2016, 36(3): 623-639.
[20]Millet I, Pages E, Hoa D, et al. Pearls and pitfalls in breast MRI[J]. Br J Radiol, 2012, 85(1011): 197-207.
[21]汪登斌. 重视乳腺多模态影像学技术的应用研究[J]. 放射学实践，2015，30（11）：1070-1071.
