本文選題：乳腺良惡性病變　切入點：磁共振成像　出處：《吉林大學(xué)》2014年碩士論文

【摘要】：目的： 探討MRI動態(tài)增強曲線呈平臺型的乳腺病灶的磁共振影像特點及DWI-ADC值對其良惡性病灶的鑒別診斷價值。 方法： 研究搜集在乳腺MRI動態(tài)增強掃描中呈平臺型曲線的患者，共60例患者68個病灶。所選患者均獲得病理證實。搜集其相應(yīng)的MRI平掃、增強影像、DWI影像及臨床資料進行回顧性分析,對所有病灶的形態(tài)、邊界、信號差異特點做一綜合的影像學(xué)診斷，根據(jù)BI-RADS給予分級。通過后處理對照平臺型的病灶位置選取感興趣區(qū)域，測得相應(yīng)的ADC值，分析ADC值鑒別診斷乳腺良惡性病灶的敏感性、特異性、陽性似然比、陰性似然比及準確率。 結(jié)果： 病理結(jié)果顯示本組乳腺癌共35例患者36個病灶，占52.9%（36/68），乳腺良性病變共25例患者32個病灶，占47.1%（32/68）。所有乳腺病灶在常規(guī)T1WI、T2WI平掃圖像上分別呈等低信號、高信號。良性病灶多呈類圓形（81.3%，26/32），邊界多清楚（87.5%，28/32），多呈均勻性強化方式（78.1%，25/32）；惡性病灶多呈分葉狀（69.4%，，25/36），邊界多不清（72.2%，26/36），多呈不均勻性強化（44.4%，16/36）。本研究良性組乳腺病灶的DCE-TIC早期強化率平均值為（78.68±17.02）%，惡性組為（114.40±22.29）%，良性組早期強化率明顯低于惡性組（P=0.000）。TIC早期強化率界值為98.1%時，靈敏度、特異度、陽性似然比、陰性似然比分別為77.1%、84.9%、5.09、0.27。乳腺病灶惡性組ADC值均值為（1.05±0.13）×10-3mm2/s，良性組ADC值為（1.37±0.31）×10-3mm2/s。良性腫瘤組的ADC值明顯高于乳腺惡性腫瘤組（P=0.000）。乳腺良惡性病變的ADC界值定為1.33×10-3mm2/s時，靈敏度、特異度、陽性似然比、陰性似然比分別為92.6%、82.9%、5.42、0.09。以ADC界值為診斷標準，診斷良惡性病變的符合率高達88.2%。 結(jié)論： 乳腺病灶在DCE-TIC呈平臺型時，需綜合MRI的影像特點及DWI-ADC值的測量。當(dāng)b值取0、1000s/mm2時ADC值以1.33×10-3mm2/s為診斷界值，其乳腺良惡性腫瘤的診斷靈敏度、診斷符合率均提高。
[Abstract]:Objective:. To study the characteristics of Mr imaging of breast lesions with dynamic enhanced MRI curve and the value of DWI-ADC value in differential diagnosis of benign and malignant lesions. Methods:. A total of 68 lesions were collected from 60 patients with plateau curve in dynamic enhanced scanning of breast MRI. All the selected patients were confirmed by pathology, and their corresponding MRI plain scans were collected. Contrast-enhanced DWI images and clinical data were retrospectively analyzed to make a comprehensive imaging diagnosis of the shape, boundary and signal difference of all lesions. According to the classification of BI-RADS, the region of interest was selected from the location of the lesions of platform type after treatment, and the corresponding ADC value was measured. The sensitivity, specificity, positive likelihood ratio of ADC value in differential diagnosis of benign and malignant breast lesions were analyzed. Negative likelihood ratio and accuracy. Results:. The pathological results showed that there were 36 lesions in 35 cases of breast cancer (52.9%), 32 lesions in 25 cases (47.1% / 68%) of benign breast lesions. High signal intensity. The benign lesions are mostly round 81.33 / 26 / 32, the boundaries are more clear 87.555 / 28 / 32, more homogeneous enhancement is 78.1 / 2532; the malignant lesions are mostly lobular 69.426 / 36, the boundaries are more than 72.226 / 36, and most of them are heterogeneous enhancement: 44.4% / 16 / 36. In this study, the early stage of DCE-TIC in the benign group was strong. The average enhancement rate was 78.68 鹵17.02 and 114.40 鹵22.29 in the malignant group. The early enhancement rate in the benign group was significantly lower than that in the malignant group. Sensitivity, specificity, positive likelihood ratio, The negative likelihood ratio was 77.1 / 84.9 / 5.09 / 0.27.The mean value of ADC was 1.05 鹵0.13) 脳 10 ~ (-3) mm ~ (2 / s) in malignant breast lesions group and 1.37 鹵0.31 脳 10 ~ (-3) mm ~ (2 / s) in benign tumor group. The ADC value in benign tumor group was significantly higher than that in breast cancer group (P _ (0.000)). When the ADC threshold of benign and malignant breast lesions was 1.33 脳 10-3mm2/s, the sensitivity, specificity and specificity of benign and malignant lesions were significantly higher than those of benign tumor group. The positive likelihood ratio and the negative likelihood ratio were 92. 6% and 82. 9% respectively. According to the diagnostic criteria of ADC, the coincidence rate of diagnosis of benign and malignant lesions was up to 88. 2%. Conclusion:. The imaging characteristics of MRI and the measurement of DWI-ADC value should be integrated when the breast lesions are flat type in DCE-TIC. When b value is 0 ~ 1000s / mm ~ 2, the diagnostic threshold value of ADC value is 1.33 脳 10-3mm2/s, the diagnostic sensitivity and diagnostic coincidence rate of benign and malignant breast tumors are improved.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.2;R737.9

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