【摘要】：目的探討3.0T磁共振動態(tài)增強掃描(Dynamic contrast-enhancedmagnetic resonance imaging, DCE-MRI)聯(lián)合擴散加權(quán)成像（Diffusion-weighted imaging, DWI）在乳腺疾病中的診斷價值。 材料與方法應(yīng)用8通道乳腺專用相控陣表面線圈，采用GE SignaHDx3.0T超導(dǎo)核磁共振掃描儀進行檢查研究：①搜集2012年3月-2013年3月于我院就診的乳腺疾病患者73例，共79個病灶，均為女性，均獲得手術(shù)或病理結(jié)果證實。②所有患者依次行3.0T DWI橫斷面掃描、DCE-MRI掃描。行磁共振檢查之前，，每位患者均簽署知情同意書。分析所有病變形態(tài)、邊緣情況、TIC類型，統(tǒng)計比較分別采用DCE-MRI中的Fischer評分、DWI中ADC閾值及兩種掃描方式不同評分方法聯(lián)合診斷乳腺良、惡性疾病的敏感度、特異度、準確度、陰性似然比及陽性似然比。 結(jié)果 1良、惡性病變的平均表觀擴散系數(shù)（Apparent diffusioncoefficient， ADC）分別為(1.49±0.340)×10-3mm2/s和(1.01±0.277)×10-3mm2/s。 2根據(jù)受試者工作特性（Receiver operating characteristic, ROC）曲線確定ADC閾值為1.15×10-3mm2/s，其診斷的敏感度83.3%（35/42）、特異度83.8%（31/37）、準確度83.5%（66/79）、陰性似然比0.199、陽性似然比5.142。 3動態(tài)增強Fischer評分其敏感度為97.6%（41/42）、特異度為78.4%（29/37）、準確度為88.6%（70/79）、陰性似然比0.031、陽性似然比為4.519。 4兩者掃描方式聯(lián)合診斷的敏感度為92.9%（39/42）、特異度為91.9%（34/37）、準確度為92.4%（73/79）、陰性似然比為0.077、陽性似然比為11.469。 結(jié)論聯(lián)合診斷方法較單一運用DCE-MRI或DWI在敏感度、特異度、準確度、陰性似然比及陽性似然比等指標上診斷效能強,在乳腺疾病診斷及鑒別診斷中具有較高的臨床應(yīng)用價值。
[Abstract]:Objective to evaluate the diagnostic value of 3.0T dynamic enhanced MRI (Dynamic contrast-enhancedmagnetic resonance imaging, DCE-MRI) combined with diffusion weighted imaging (Diffusion-weighted imaging, DWI) in breast diseases. Materials and methods the surface coil of 8-channel phasor array was used for the examination and study. The results were as follows: (1) 73 patients with breast diseases from March 2012 to March 2013, with 79 lesions, were collected from March 2012 to March 2013 in our hospital. All the patients were female and were confirmed by operation or pathology. 2 all patients underwent 3.0T DWI cross-sectional scan and DCE-MRI scan in turn. Prior to the MRI, each patient signed an informed consent. The sensitivity and specificity of Fischer score in DCE-MRI, ADC threshold in DWI and two different scanning methods in the diagnosis of benign and malignant diseases of breast were analyzed and compared with each other by analyzing the morphology, edge and TIC types of the lesions, and statistically comparing the sensitivity and specificity of the two scoring methods in the diagnosis of benign and malignant diseases of the breast. Accuracy, negative likelihood ratio and positive likelihood ratio. Results 1 the average apparent diffusion coefficient (Apparent diffusioncoefficient, ADC) of benign and malignant lesions was (1.49 鹵0.340) 脳 10-3mm2/s and (1.01 鹵0.277) 脳 10 脳 10 脳 3 mm ~ 2 vs (1.01 鹵0.277) 脳 10 ~ (3) mm ~ (2) respectively. 2According to the (Receiver operating characteristic, ROC) curve, the threshold of ADC was determined to be 1.15 脳 10-3mm2 / s. The sensitivity, specificity and accuracy of ADC were 83.3% (35 / 42), 83.8% (31 / 37) and 83.5% (66 / 79), respectively, and the sensitivity, specificity and accuracy were 83.3%, 83.8% and 63.5%, respectively. The negative likelihood ratio is 0.199 and the positive likelihood ratio is 5.142. 3The sensitivity, specificity, accuracy, negative likelihood ratio and positive likelihood ratio of dynamic enhanced Fischer score were 97.6% (41 / 42), 78.4% (29 / 37), 88.6% (70 / 79), 0.031 and 4.519, respectively. 4the sensitivity, specificity, accuracy, negative likelihood ratio and positive likelihood ratio were 92.9% (39 / 42), 91.9% (34 / 37), 92.4% (73 / 79), 0.077 and 11.469 respectively. Conclusion the combined diagnostic method is more effective than DCE-MRI or DWI alone in sensitivity, specificity, accuracy, negative likelihood ratio and positive likelihood ratio. It has high clinical application value in the diagnosis and differential diagnosis of breast diseases.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.2

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