乳腺导管原位癌的MRI表现及与病理分级的关系

背景与目的：乳腺导管原位癌(ductal carcinoma in situ，DCIS)的组织学分级是其预后的一个重要因素，高核级有较高的浸润趋势，且术后复发率高。本研究旨在评估DCIS的MRI表现及与病理学分级关系。方法：回顾性分析94例经病理证实为DCIS的MRI表现，分析其MRI形态学及动态增强表现，进一步讨论MRI特点与组织学核级别间的相关性。结果：94例患者中检出97个DCIS病灶，非肿块样强化病灶49个，其中节段样强化29个(59.18%)；肿块样强化48个。动态增强表现：包括Ⅰ型曲线20个，Ⅱ型曲线50个，Ⅲ型曲线27个。BIRADS：BI-RADS 4A类22个，BI-RADS 4B类19个，BI-RADS 4C类29个，BI-RADS 5类27个。与组织病理学关系：HNGDCIS病变范围较non-HNG DCIS广(非肿块样强化：P=0.01；肿块样强化：P=0.03)，而不同核级别DCIS的MRI形态学间差异无统计学意义(P>0.05)，HNG DCIS时间信号强度曲线更易出现流出型(P=0.01)，BI-RADS显示HNGDCIS更易被判定为BI-RADS 4C类及BI-RADS 5类(P=0.02)。结论：非肿块样强化DCIS以段样分布常见，结合形态学、血流动力学及BI-RADS分类，可较全面评价DCIS组织学核级别程度，对临床具有重要的指导意义。

The MRI of ductal carcinoma in situ with pathology grade

Background and purpose: Histological grade of DCIS is an important factor in the prognosis,high nuclear grade have higher infiltration trend and recurrence rate. This study aimed to evaluate the dynamic and morphological MRI charactristics of ductal carcinoma in situ (DCIS) of the breast, then analyze its relations with nuclear grade. Methods: Of the 94 patients, 97 lesions were proved DCIS by pathology. The morphology, maximum size, time- intensity curve of lesion were recorded or measured. Statistic was performed to identify MR imaging features that optimally discriminated HNG from non-HNG DCIS. Results: There were 49 non mass-like enhancement lesions, and 48 masses enhancement lesions. Among 49 non mass-like lesions, 29 were segmental enhancement (59.18%). Dynamic enhanced performance: 50 exhibited plateau curves and 27 were washout curves. BI-RADS categories: 22 BI-RADS 4A, 19 BI-RADS 4B, 29 BI-RADS 4C, and 27 BI-RADS 5. HNG lesions exhibited larger mean maximum lesion size (non-mass-like enhancement: P=0.01; mass: P=0.03), time- intensity curve was variable to approach significance (P=0.01), and BI-RADS can help to discriminate the nuclear grade (P=0.02). There were no differences in lesion morphology (P>0.05). Conclusion: The preliminary findings suggest that DCE MR imaging features may aid in identifying patients with high risk DCIS.