3.0 T磁共振动态增强联合扩散加权成像IVIM模型对乳腺良恶性疾病的诊断价值

目的 探讨动态增强磁共振成像联合体素内不相干运动模型对乳腺良、恶性病变鉴别诊断价值。 方法 回顾性分析温州医科大学附属第二医院2016年10月-2017年9月经病理证实的60例乳腺疾病患者临床资料,患者均行常规MRI成像、动态增强成像及体素内不相干运动模型(IVIM-DWI,b=0~1 200 s/mm2)检查。观察指标:病变形态、强化方式、时间-信号曲线、IVIM模型相关参数值,分析上述观察指标在乳腺良、恶性病变当中的鉴别诊断价值。 结果 在形态学上,乳腺癌多表现为边界模糊,伴分叶或毛刺,片状不均匀强化等特点,差异有统计学意义。在动态增强上,乳腺癌多表现为廓清型曲线(Ⅲ型),乳腺良性病多呈流入型(Ⅰ型)或平台型(Ⅱ型),差异有统计学意义。在IVIM相关参数值上:D值、f值和ADC值在乳腺良、恶性组间差异有统计学意义(t值分别为3.301、-5.247、3.899,均P<0.05);D*值差异无统计学意义(t=0.454,P>0.05)。ROC曲线示D值诊断效能最大(AUC=0.873),联合D值和f值的AUC可达到0.941。 结论 动态增强磁共振成像联合IVlM模型相关参数值有助于提高乳腺良恶性病变的鉴别诊断价值,并呈现出较高的诊断效能。 

Role of dynamic contrast-enhancement combined with intravoxel incoherent motion diffusion-weighted MRI at 3.0T in differentiating benign from malignant breast lesions

Objective To evaluate dynamic contrast-enhancement combined with intravoxel incoherent motion (IVIM) diffusion-weighted (DW) MRI for differentiating benign from malignant breast lesions. Methods The clinical data of 60 cases of breast diseases confirmed by pathology in our hospital from October, 2016 to September, 2017 were retrospectively analyzed (benign:25 cases, malignant:35 cases). Conventional MRI, dynamic contrast enhancement and IVIM-DWI (b=0-1 200 s/mm2) examination were performed in all patients. Lesion morphology, enhancement pattern, time signal curve and the relevant parameters of IVIM model were analyzed to evaluate the differential diagnostic value between breast benign and malignant lesions respectively. Results The irregular margin with or without spiculation and heterogeneous enhancement were mostly seen in breast cancer (P=0.003, 0.004, respectively). TIC type Ⅲ was mostly seen in breast cancer, TIC type Ⅰ and Ⅱ were mostly seen in breast benign (χ2=19.272, P<0.01). Except D* value, there were statistically significant differences among the IVIM related parameters (t=3.301, -5.247, 3.899, all P<0.05). ROC analysis showed that the AUC of D value was 0.873 which was the highest one. AUC was increased to 0.941 by combining D with f value for diagnosis. Conclusion Magnetic resonance dynamic contrast enhancement combined with IVIM model related parameter values can improve the value of differentiating benign from malignant breast lesions, and shows a higher diagnostic efficiency.