本文關鍵詞： 乳腺疾病 鉬靶 磁共振 動態(tài)增強磁共振成像 彌散加權成像 磁共振波譜　出處：《遵義醫(yī)學院》2015年碩士論文　論文類型：學位論文

【摘要】：目的:探討乳腺鉬靶、3.0T磁共振新技術(動態(tài)增強磁共振成像、彌散加權成像及磁共振波譜)及兩者聯(lián)合應用對乳腺良惡性病變診斷價值。方法:(1)收集2013年11月至2014年9月遵義醫(yī)學院附屬醫(yī)院行乳腺鉬靶及磁共振檢查的女性患者61例,年齡23-77歲,平均年齡44.8歲。良性14例,惡性47例。所有病例行磁共振掃描及鉬靶X線攝影。觀察病變的形態(tài)表現(xiàn)、有無鈣化、強化方式以及擴散加權成像(Diffusion weighted imaging,DWI),測量感興趣區(qū)(Region of interest,ROI)的時間-信號強度曲線(Time-signal intensity curve,TIC)、ADC值、磁共振波譜(Magnetic resonance spectroscopy,MRS)有無膽堿峰。(2)分析磁共振新技術在乳腺良惡性病變的診斷靈敏度、特異度、符合率、陽性預測值以及陰性預測值;分析單獨運用鉬靶、磁共振及兩種技術聯(lián)合應用在乳腺良惡性病變的價值。采用SPSS 17.0統(tǒng)計軟件包進行分析,計數(shù)資料進行卡方檢驗,p0.05認為差異有統(tǒng)計學意義。結果:(1)形態(tài)學表現(xiàn)診斷乳腺良、惡性病變的靈敏度61.1%,特異度為93%,符合率83.6%,陽性預測值78.6%,陰性預測值85.1%。采用卡方檢驗,χ2=1(p0.05),還不能認為病灶形態(tài)作為乳腺惡性病變的診斷具有統(tǒng)計學差異。(2)時間-信號強度曲線作為乳腺良、惡性病變的診斷標準,靈敏度為100%、特異度為88.7%、符合率90.1%,陽性預測值57.1%,陰性預測值100%。采用卡方檢驗,χ2=4.17(p0.05),可以認為以II型和III型曲線作為乳腺惡性病變的診斷具有統(tǒng)計學意義。(3)惡性病灶ADC值和對側正常乳腺組織ADC值的ROC曲線下面積為0.988,以1.210×10-3mm2/s為鑒別乳腺良惡性病變的閾值,47例惡性病灶中有44例ADC值1.210×10-3mm2/s,靈敏度為95.6%、特異度為93.5%。(4)膽堿峰有無鑒別乳腺良惡性病變的靈敏度為70.2%,特異度為70.6%,符合率為75%,陽性預測值為97.1%,陰性預測值為17.6%。采用卡方檢驗,χ2=9.6,可以認為有無Cho峰出現(xiàn),對診斷乳腺良、惡性病變有統(tǒng)計學差異。(5)三種磁共振新技術在乳腺良惡性疾病檢出上,動態(tài)增強和DWI的敏感度及符合率分別為100%、90.1%和95.6%、86.9%,明顯高于MRS的敏感度和符合率;而MRS在乳腺良惡性病變特異度上高于動態(tài)增強和DWI。(6)Kappa檢驗分析兩名乳腺診斷醫(yī)師運用鉬靶X線攝影對乳腺良惡性病變的診斷一致性一般,而運用MRI診斷一致性好。(7)單獨使用鉬鈀及MRI新技術診斷乳腺良惡性疾病的診斷符合率分別是45.9%、62.3%;兩者聯(lián)合運用診斷乳腺良惡性疾病的符合率為80.3%,為其兩者聯(lián)合運用診斷符合率均高于單獨使用某一種檢查(χ2=4.08,p0.05)。結論:磁共振檢查對乳腺良惡性病變的診斷價值高于乳腺鉬靶檢查,磁共振動態(tài)增強、DWI技術對診斷乳腺癌的靈敏度較高,MRS的陽性預測值較高。乳腺鉬靶聯(lián)合磁共振檢查明顯提高乳腺良惡性病變術前診斷的符合率,為期早期診斷及預后提供理論依據(jù)。
[Abstract]:Objective: to investigate a new technique of dynamic contrast enhanced magnetic resonance (MRI) for mammary mammary mammography with 3.0 T magnetic resonance imaging (MRI). Diffusion weighted Imaging and Magnetic Resonance Spectroscopy) and their combination in the diagnosis of benign and malignant Breast lesions. Methods: 1). From November 2013 to September 2014, 61 female patients underwent mammography and magnetic resonance imaging (MRI) in affiliated Hospital of Zunyi Medical College. The age ranged from 23 to 77 years with an average age of 44.8 years. There were 14 benign cases and 47 malignant cases. All cases were examined by MRI and mammography. Enhancement and Diffusion weighted Imaging (DWI). Measure the time-signal intensity curve of the region of interest. Magnetic resonance spectroscopy, magnetic resonance spectroscopy (MRI). The sensitivity, specificity, coincidence rate, positive predictive value and negative predictive value of the new MRI technique in the diagnosis of benign and malignant breast lesions were analyzed. The value of using molybdenum target, magnetic resonance imaging and two kinds of techniques in benign and malignant breast lesions was analyzed by SPSS 17.0 statistical software package and chi-square test was used to count the data. Results the morphologic features of benign and malignant breast lesions were 61.1%, the specificity was 93.3%, and the coincidence rate was 83.6%. Positive predictive value was 78.6 and negative predictive value was 85.1. Chi-square test was used. It can not be considered that the shape of the lesion as the diagnosis of breast malignant lesions has statistical difference. 2) the time-signal intensity curve as the diagnostic criteria for benign and malignant breast lesions, the sensitivity is 100%. The specificity was 88.7. The coincidence rate was 90.1. The positive predictive value was 57.1 and the negative predictive value was 100. Chi-square test was used. It can be concluded that type II and III curves are statistically significant in the diagnosis of malignant breast lesions. The area under ROC curve of ADC value of malignant lesion and ADC value of contralateral normal breast tissue was 0.988. Using 1.210 脳 10 ~ (-3) mm ~ (-2) / s as the threshold for differentiating benign and malignant breast lesions, 44 of 47 malignant lesions had a ADC value of 1.210 脳 10 ~ (-3) mm ~ (2 / s). The sensitivity of choline peak was 70.2 and the specificity was 70.60.The coincidence rate was 75%. The positive predictive value was 97.1 and the negative predictive value was 17.6.The chi-square test showed that there was a Cho peak, which was good for the diagnosis of mammary gland. The sensitivity and coincidence rate of dynamic contrast enhancement and DWI in detecting benign and malignant breast diseases were 90.1% and 95.6% respectively. The sensitivity and coincidence rate of MRS were significantly higher than those of MRS. The specificity of MRS in benign and malignant breast lesions was higher than that in dynamic enhancement and DWI.6. The diagnosis of benign and malignant breast lesions by mammography by two mammographers by Kappa test was generally consistent. The diagnostic coincidence rates of MRI and MRI were 45.9% and 62.3%, respectively. The coincidence rate of the combined use of the two methods in the diagnosis of benign and malignant breast diseases was 80.3, and the diagnostic coincidence rate of the combined use of both was higher than that of a single examination (蠂 2 4.08). Conclusion: the value of MRI in the diagnosis of benign and malignant breast lesions is higher than that of mammography. The sensitivity of Mr dynamic contrast enhanced DWI in the diagnosis of breast cancer is higher than that of mammography. The positive predictive value of MRS was higher. Mammography combined with magnetic resonance imaging could significantly improve the coincidence rate of preoperative diagnosis of benign and malignant breast lesions and provide theoretical basis for early diagnosis and prognosis.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R445.2;R737.9

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