摘要
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χ^2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χ^2检验,后者诊断效率高于前者(χ^2=15.967,P<0.05)。测得良性组ADC均值(单位:×10^-3 mm^2/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。
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: Seventytwo 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 chisquare 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(χ^2=15.967, P<0.05). The mean ADC value(in ×10^-3 mm^2/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.
作者
唐晓雯
赵玉年
庄姗
尹娜
TANG Xiao-wen;ZHAO Yu-nian;ZHUANG Shan;YIN Na(Department of Radiology,Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research &The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)
出处
《中国临床医学影像杂志》
CAS
2019年第8期548-552,共5页
Journal of China Clinic Medical Imaging
关键词
乳腺疾病
磁共振成像
放射摄影术
Breast diseases
Magnetic resonance imaging
Radiography
