本文選題：磁共振 + 乳腺�。� 參考：《廣州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的近年來(lái)乳腺癌已超過(guò)宮頸癌成為女性惡性腫瘤發(fā)病率的第一位。臨床觸診、乳腺X線攝影、超聲都是乳腺病變的檢查手段,對(duì)乳腺病變的診斷治療及術(shù)后評(píng)估都具有重要作用。但臨床觸診對(duì)病灶的大小及邊界判斷誤差較大;乳腺X線攝影對(duì)乳腺內(nèi)鈣化較敏感,但對(duì)于致密型乳腺,受制于軟組織分辨率較低,病灶往往顯示欠佳或難以顯示;超聲的敏感度及特異度較低,對(duì)微小病變及多發(fā)病變難以定性。乳腺磁共振成像(magnetic resonance imaging,MRI)具有較高的空間及軟組織分辨率,對(duì)病灶的敏感度高,在臨床的診斷及術(shù)后評(píng)估方面逐步得到認(rèn)可。MRI不僅可以對(duì)臨床、乳腺X線攝影及超聲檢查發(fā)現(xiàn)的乳腺病變進(jìn)一步評(píng)估,還因?yàn)槠漭^高的敏感度,可以發(fā)現(xiàn)上述檢查陰性的隱性乳腺癌。近來(lái)隨著乳腺M(fèi)RI檢查的普及發(fā)現(xiàn),非腫塊強(qiáng)化病變是產(chǎn)生診斷假陽(yáng)性率的主要原因。本研究通過(guò)回顧性分析經(jīng)病理證實(shí)的非腫塊強(qiáng)化病灶患者的MRI影像特征,探討臨床表現(xiàn)及MRI征象在非腫塊強(qiáng)化病變良惡性診斷中的價(jià)值,從而進(jìn)一步闡述BI-RADS MRI對(duì)乳腺非腫塊強(qiáng)化病變的診斷及鑒別診斷價(jià)值。方法收集2015年10月至2016年10月期間行乳腺M(fèi)RI檢查且病灶表現(xiàn)為非腫塊強(qiáng)化的女性患者234名的臨床及MRI檢查資料,發(fā)現(xiàn)病灶240處。所有患者均經(jīng)病理證實(shí)。將所有患者分良惡性兩組,分別對(duì)年齡,側(cè)別,病灶形態(tài)特征,內(nèi)部強(qiáng)化方式,最大徑,MRI信號(hào)特征,時(shí)間信號(hào)強(qiáng)度曲線,DWI及ADC值進(jìn)行統(tǒng)計(jì)對(duì)比,以P0.05被認(rèn)為有統(tǒng)計(jì)學(xué)意義。再計(jì)算MRI對(duì)惡性病變檢出率。所得數(shù)據(jù)用SPSS13.0統(tǒng)計(jì)軟件包進(jìn)行處理。結(jié)果良性病變組126人平均年齡38.67±0.87歲,惡性病變組109人平均年齡44.47±0.89歲。兩組間發(fā)病年齡存在差異(P0.01),兩組間在病灶形態(tài)特征,內(nèi)部強(qiáng)化方式,最大徑,時(shí)間信號(hào)強(qiáng)度曲線也存在差異,P值均0.01。而兩組間在側(cè)別,MRI信號(hào)特征,DWI表現(xiàn)及ADC值并沒(méi)有顯示出明顯差異,且惡性組中導(dǎo)管原位癌及浸潤(rùn)性導(dǎo)管癌的ADC值也無(wú)統(tǒng)計(jì)學(xué)差異。分析MRI對(duì)惡性病變檢出率,靈敏度=92.7%,特異度=84.6%,漏診率=7.3%,誤診率=15.4%,陽(yáng)性預(yù)測(cè)值=83.6%,陰性預(yù)測(cè)值=93.2%,診斷正確率=88.3%,Youden指數(shù)=77.3%,陽(yáng)性試驗(yàn)似然比=6.02。病理上良性病變54.17%,以乳腺腺病最多見(jiàn),占58.46%,其次為導(dǎo)管內(nèi)乳頭狀瘤38.46%,肉芽腫性乳腺炎16.15%;惡性病變45.83%,以浸潤(rùn)性導(dǎo)管癌最多見(jiàn),占50%,導(dǎo)管原位癌49.09%次之,另發(fā)現(xiàn)乳頭狀癌10例,乳腺黏液癌2例,浸潤(rùn)性小葉癌3例,均呈非腫塊強(qiáng)化表現(xiàn)。結(jié)論乳腺非腫塊強(qiáng)化型病變?cè)诹紣盒缘腗RI表現(xiàn)具有一定特點(diǎn)。MRI對(duì)非腫塊強(qiáng)化惡性病變的診斷有效性較高。非腫塊強(qiáng)化良惡性病灶在發(fā)病年齡,病灶的形態(tài)特征,內(nèi)部強(qiáng)化特征,最大徑,TIC曲線類型方面的差別具有統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective in recent years, breast cancer has surpassed cervical cancer to become the first incidence of malignant tumors in women. Clinical palpation, mammography and ultrasound are important methods for the diagnosis, treatment and postoperative evaluation of breast lesions. But clinical palpation has a great error in judging the size and boundary of the lesion, mammography is sensitive to calcification in breast, but for dense breast, it is restricted by the low resolution of soft tissue, and the focus is often poor or difficult to display. The sensitivity and specificity of ultrasound are relatively low, and it is difficult to identify minor lesions and frequent diseases. Magnetic resonance imaging (MRI) of mammary gland has high spatial and soft tissue resolution and high sensitivity to lesions. It can be recognized gradually in clinical diagnosis and postoperative evaluation. Breast lesions were further evaluated by mammography and ultrasound, and recessive breast cancer with negative findings could be found because of its high sensitivity. Recently, with the popularization of breast MRI, non-tumor enhancement is the main cause of false positive diagnosis. The purpose of this study was to retrospectively analyze the features of MRI images in patients with non-tumor-enhanced lesions confirmed by pathology, and to explore the value of clinical manifestations and MRI signs in the diagnosis of benign and malignant lesions with non-tumor-enhanced lesions. The value of BI-RADS MRI in the diagnosis and differential diagnosis of breast non-enhancement lesions was further discussed. Methods from October 2015 to October 2016, the clinical and MRI data of 234 female patients who underwent breast MRI examination and whose lesions were non-mass enhancement were collected and 240 lesions were found. All patients were confirmed by pathology. All the patients were divided into benign and malignant groups, age, side, lesion morphology, internal enhancement mode, maximum diameter MRI signal characteristics, time signal intensity curve DWI and ADC value were statistically compared, P0.05 was considered to have statistical significance. The detection rate of malignant lesions by MRI was calculated. The data were processed by SPSS13.0 software package. Results the mean age of 126 patients with benign lesions and 109 patients with malignant lesions was 38.67 鹵0.87 years old and 44.47 鹵0.89 years old respectively. There were significant differences in the age of onset between the two groups (P 0.01), and there were also significant differences between the two groups (P < 0.01) in the lesion morphology, the internal enhancement mode, the maximum diameter, and the time signal intensity curve. However, there was no significant difference in DWI and ADC between the two groups, and the ADC values of ductal carcinoma in situ and invasive ductal carcinoma were not significantly different between the two groups. To analyze the detection rate of malignant lesions by MRI, the sensitivity was 92.7%, the specificity was 84.6%, the missed diagnosis rate was 7.3%, the misdiagnosis rate was 15.4%, the positive predictive value was 83.6%, the negative predictive value was 93.2%, the diagnostic accuracy rate was 88.3% and Youden index was 77.3%, the likelihood ratio of positive test was 6.02%. Pathologically, 54.17 benign lesions were found most frequently in breast adenopathy (58.46%), followed by intraductal papilloma (38.46), granulomatous mastitis (16.15%), malignant lesions (45.83%), invasive ductal carcinoma (50%), ductal carcinoma in situ (49.09%), and papillary carcinoma (10 cases). Two cases of breast mucinous carcinoma and 3 cases of invasive lobular carcinoma showed non-tumor enhancement. Conclusion enhanced breast lesions have some characteristics in benign and malignant MRI. MRI is more effective in the diagnosis of benign and malignant breast lesions. There were significant differences in the age of onset, the morphological features, the internal enhancement characteristics and the type of TIC curve of non-enhancement benign and malignant lesions.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9;R445.2

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