DCE-MRI联合IVIM-DWI鉴别诊断乳腺良恶性病变

目的 探讨动态增强MRI(DCE-MRI)联合体素内不相干运动DWI(IVIM-DWI)鉴别诊断乳腺良恶性病变的价值.方法 收集因乳腺病变接受DCE-MRI及IVIM-DWI检查的患者87例,经术后病理证实共93个病灶,其中良性病灶42个(良性组),恶性病灶51个(恶性组).对两组的DCE-MRI参数(病变形态、强化特点、峰值时间、最大增强斜率和TIC类型)及IVIM-DWI参数(f、D和D^*值)进行比较.采用多因素Logistic回归分析确定DCE-MRI、IVIM-DWI及二者联合鉴别诊断乳腺良恶性病变的独立影响因素.以病理诊断结果为金标准,绘制ROC曲线,并计算曲线下面积(AUC).结果 DCE-MRI、IVIM-DWI及二者联合诊断乳腺良恶性病变,纳入Logistic回归方程的独立影响因素分别为形态、TIC类型,D值,形态、TIC类型及D值.DCE-MRI、IVIM-DWI及二者联合鉴别诊断乳腺良恶性病变的敏感度、特异度、准确率分别为78.43%、71.43%、75.27%,70.59%、66.67%、68.82%,84.31%、78.57%、81.72%.3种方法的AUC分别为0.75、0.69、0.81.结论 DCE-MRI联合IVIM-DWI可提高鉴别诊断乳腺良恶性病变的效能.

Combination of DCE-MRI and IVIM-DWI in differential diagnosis of benign and malignant breast lesions

Objective To explore the value of dynamic contrast-enhanced MRI (DCE-MRI) combined with intravoxel incoherent motion DWI (IVIM-DWI) in differential diagnosis of benign and malignant breast lesions. Methods Totally 87 patients underwent DCE-MRI and IVIM-DWI were involved. Ninety-three lesions were confirmed by pathology, of which 42 lesions were benign (benign group) and 51 were malignant (malignant group). DCE-MRI parameters (shape, enhancement characteristic, time to peak, maximum slope of increase and time signal intensity curve pattern) and IVIM-DWI parameters (f, D and D^* value) were compared between two groups. Multivariate Logistic regression was adopted to identify independent factors for differential diagnosis of benign and malignant breast lesions by DCE-MRI, IVIM-DWI, combination of DCE-MRI and IVIM-DWI. Taking the results of pathological diagnosis as golden standard, ROC curve was drawn, and the area under curve (AUC) was calculated. Results In differential diagnosis of benign and malignant breast lesions, the independent factors adopted in the logistic regression equation of DCE-MRI were shape and TIC type, when of IVIM-DWI was D value, of combination of DCE-MRI and IVIM-DWI were shape, TIC type and D value, respectively. The sensitivity, specificity and accuracy of DCE-MRI, IVIM-DWI, combination of DCE-MRI and IVIM-DWI were 78.43%, 71.43%, 75.27%; 70.59%, 66.67%, 68.82%; 84.31%, 78.57%, 81.72%, respectively. AUC of the three methods were 0.75, 0.69 and 0.81, respectively. Conclusion Combination of DCE-MRI and IVIM-DWI could improve the performance of differential diagnosis of benign and malignant breast lesions.