【摘要】：一、目的： (1)分析MRI BI-RADS分類中哪些術(shù)語與乳腺癌有關(guān),進(jìn)一步評估BI-RADS分類在乳腺良惡性病變中的診斷價值。 (2)通過分析DWI上乳腺良惡性病變的SI值、ADC值及BI-RADS分類和ADC值結(jié)合后乳腺良惡性病變的BI-RADS分類的調(diào)整,探討DWI對乳腺良惡性病變的診斷價值,以及BI-RADS分類和DWI結(jié)合能否提高3.0T磁共振的診斷性能。 (3)通過測量浸潤性導(dǎo)管癌的ADC值,并與病理結(jié)果對照,探討DWI評價浸潤性導(dǎo)管癌組織學(xué)分級的價值。 二、材料與方法： 1、研究對象 (1)第一部分及第二部分：采用同一組病例。收集山東大學(xué)省立醫(yī)院在2012年5月至2013年12月期間,因鉬靶、B超或臨床查體發(fā)現(xiàn)乳腺病變而行MRI檢查以進(jìn)一步明確診斷的患者89例,其中26例因放化療(11例)、或沒有病理證實(15)被排除,最后63例納入研究�；颊吣挲g范圍27-71歲,平均年齡43.78±10.20歲。所有病灶行MRI檢查后,均經(jīng)穿刺活檢或手術(shù)病理證實。 (2)第三部分：收集山東大學(xué)省立醫(yī)院在2012年5月至2013年12月期間,因鉬靶、B超或臨床查體發(fā)現(xiàn)乳腺病變而行MRI檢查以進(jìn)一步明確診斷的患者89例,其中53例因放化療(11例)、沒有病理證實(15例)、良性病變(22)、其他類型惡性腫瘤(5例)被排除,最后36例納入研究�；颊吣挲g范圍27-71歲,平均年齡44.50±10.73歲。所有病灶行MRI檢查后,均經(jīng)穿刺活檢或手術(shù)病理證實。 2、掃描方法 所有檢查采用西門子3.OT磁共振成像儀(Magnetom verio, SIEMENS, Germany),乳腺專用8通道表面線圈�；颊吒┡P位,雙側(cè)乳腺同時掃描。檢查時間為月經(jīng)前的7-14天。掃描序列包括T1WI-TSE、T2WI-壓脂、DWI及3DFLASH DYN T1WI加脂肪抑制序列。DWI選取b值0s/mm2及800s/mm2。 3、圖像分析分析方法 (1)第一部分：兩位醫(yī)師在工作站上,根據(jù)BI-RADS分類對病灶的大小、形態(tài)學(xué)、血流動力學(xué)特征進(jìn)行評估,并對病灶進(jìn)行BI-RADS分類總體評估,計算診斷的敏感性、特異性及準(zhǔn)確性。所有結(jié)果與病理結(jié)果對照。 (2)第二部分： DWI圖像：目測評價：DWI圖像上,乳腺腫塊的信號強(qiáng)度分為等信號、略高信號及高信號。 SI值：在DWI圖上,選擇病灶最大徑線層面為感興趣區(qū)(Region of interest,ROI)層面,測量三次取其平均值。 ADC值測量：所有乳腺病變和正常乳腺的ADC值的測量在Siemens syngo工作站進(jìn)行,利用工作站軟件生成黑白ADC圖,選取病灶最大徑線層面為感興趣區(qū)(Region of interest, ROI)層面,測量三次取其平均值。 BI-RADS分類與DWI結(jié)合：根據(jù)Pinker等人的研究方法,1-5類病灶根據(jù)相應(yīng)的ADC閾值重新調(diào)整BI-RADS分類,并計算診斷的敏感性、特異性及準(zhǔn)確性。 (3)第三部分： 病灶大�。涸诠ぷ髡旧蠝y量所有病灶的最大直徑,測量三次取平均值。以2cm為界限,把病灶分為2組,記錄個數(shù),并與病理學(xué)相對照。 ADC值的測量：所有浸潤性導(dǎo)管癌的ADC值的測量在Siemens syngo工作站進(jìn)行,利用工作站軟件生成黑白ADC圖,選取病灶最大徑線層面為感興趣區(qū)(Region of interest, ROI)層面,測量三次取其平均值。 4、組織病理學(xué) 第三部分病例均為浸潤性導(dǎo)管癌,組織病理學(xué)評估采用Nottingham改良的Bloom-Richardson分級系統(tǒng),分為I級、Ⅱ級及Ⅲ級。 5、統(tǒng)計學(xué)分析 統(tǒng)計學(xué)分析采用SPSS17.0軟件進(jìn)行,數(shù)據(jù)測量結(jié)果以平均值士標(biāo)準(zhǔn)差(X士s)的形式表達(dá)。顯著性水準(zhǔn)均采用0.05(雙側(cè)),P0.05被認(rèn)為有統(tǒng)計學(xué)意義,P0.001有顯著統(tǒng)計學(xué)意義。 第一部分：對乳腺良惡性病變的大小進(jìn)行獨(dú)立樣本的t檢驗。計數(shù)資料經(jīng)χ2檢驗比較良惡性病灶間差異。計數(shù)資料如不符合χ2檢驗條件,采用Fisher's確切概率法。以病理結(jié)果為金標(biāo)準(zhǔn),計算BI-RADS分類診斷乳腺癌的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值及準(zhǔn)確性。 第二部分：對乳腺良惡性病變SI值進(jìn)行獨(dú)立樣本的t檢驗。乳腺良性、惡性病變及正常腺體的ADC值均符合正態(tài)分布且方差齊性,行單因素方差分析(One-Way ANONA)均數(shù)之間的兩兩比較采用LSD檢驗。以惡性病變ADC值95%可信區(qū)間的上限值為良惡性判斷閾值,計算相應(yīng)的敏感性、特異性及準(zhǔn)確性。采用ROC曲線分析評價ADC值診斷乳腺惡性腫瘤的最佳界點(diǎn)及診斷的敏感性、特異性及準(zhǔn)確性。MRI BI-RADS分類與DWI結(jié)合后,以病理結(jié)果為金標(biāo)準(zhǔn),以BI-RADS分類Ⅳ～Ⅴ為惡性病變,Ⅱ～Ⅲ為良性病變,計算這時3.0T磁共振診斷乳腺癌的靈敏性、特異性、陽性預(yù)測值、陰性預(yù)測值及準(zhǔn)確性。 第三部分：Ⅰ級、Ⅱ級、Ⅲ級乳腺浸潤性導(dǎo)管癌的ADC值均符合正態(tài)分布且方差齊性,行單因素方差分析(One-Way ANONA)。均數(shù)之間的兩兩比較采用LSD檢驗。低侵襲及高侵襲性乳腺癌ADC均值比較用t檢驗。采用ROC曲線分析評價ADC值診斷低侵襲乳腺癌的最佳界點(diǎn)和相應(yīng)診斷的敏感性、特異性及準(zhǔn)確性。 三、結(jié)果 第一部分：惡性腫瘤中形態(tài)不規(guī)則占87.80%,邊緣不規(guī)則或毛刺分別為46.30%、43.90%,早期快速強(qiáng)化為90.20%,不均質(zhì)強(qiáng)化為60.98%,Ⅱ型及Ⅲ型曲線各為48.78%、51.20%。良性腫瘤中,圓形或卵圓形腫塊各為40.9%、36.3%,邊緣清晰為77.27%,均質(zhì)強(qiáng)化為59.09%。早期緩慢強(qiáng)化、低信號暗分隔、Ⅰ曲線僅見于良性腫瘤。邊緣強(qiáng)化的病灶約93.33%為惡性腫瘤,Ⅲ型曲線的病灶中惡性腫瘤為90.20%。BI-RADS分類診斷乳腺癌的靈敏性、特異性、陽性預(yù)測值、陰性預(yù)測值及準(zhǔn)確性分別為97.56%、77.27%、88.89%、94.44%、90.47%。 第二部分：惡性腫瘤、良性腫瘤及正常腺體的平均ADC值分別為(0.98±0.13)×10-3mm2/s、(1.40±0.16)×10-3mm2/s、(1.69±0.34)×10-3mm2/s。三者的ADC均值呈升高的趨勢,且有顯著性差異(F=88.31,p0.001,one-way ANOVA檢驗)。以ROC曲線分析所得1.218×10-3mm2/s為診斷閾值,診斷的敏感性、特異性和準(zhǔn)確率分別為97.56%、81.82%、92.06%。BI-RADS分類與DWI結(jié)合后,診斷的敏感性、特異性和準(zhǔn)確性分別為97.56%、86.36%、93.65%。 第三部分：組織學(xué)分級Ⅰ級、Ⅱ級及Ⅲ級病灶的ADC均值分別為(1.116±0.113)×10-3mm2/s、(0.955±0.047)×10-3mm2/s、(0.826±0.579)×10-3mm2/s,呈明顯降低趨勢(F=37.662,p0.001,one-way ANOVA檢驗)。低侵襲性乳腺癌的ADC均值是(1.116士0.113)×10-3mm2/s,較高侵襲性乳腺癌的ADC均值是(0.912±0.080)×10-mm2/s。 四、結(jié)論 1、ACR BI-RAD分類中腫塊形態(tài)不規(guī)則、邊緣不規(guī)則或呈毛刺、不均質(zhì)強(qiáng)化或邊緣強(qiáng)化,早期快速強(qiáng)化、Ⅱ型及Ⅲ型曲線均提示惡性腫瘤。BI-RADS分類對乳腺良惡性病變有鑒別診斷價值,其診斷乳腺癌的靈敏性、特異性及準(zhǔn)確性分別為97.56%、77.27%、90.47%。 2、惡性腫瘤的ADC值低于良性腫瘤和正常腺體,DWI能鑒別乳腺良惡性腫瘤。BI-RADS分類與DWI結(jié)合后,診斷的敏感性、特異性和準(zhǔn)確性分別為97.56%、86.36%、93.65%,特異性和準(zhǔn)確性均提高。 3、ADC值與浸潤性導(dǎo)管癌的組織學(xué)分級密切相關(guān),較低的ADC值具有較高的組織學(xué)分級。ADC值可作為預(yù)后參數(shù),DWI能評價浸潤性導(dǎo)管癌的侵襲性。
[Abstract]:I. Purpose: (1) Analysis of which terms in the MRI BI-RADS classification are associated with breast cancer and further assess the diagnostic value of the BI-RADS classification in benign and malignant breast lesions Value. (2) The value of DWI in the diagnosis of benign and malignant lesions of the breast was discussed by analyzing the SI value, the ADC value and the BI-RADS classification and the ADC value of the breast benign and malignant lesions on the DWI, and whether the BI-RADS classification and the DWI combination could improve the diagnosis of 3.0T magnetic resonance. Fracture performance. (3) By measuring the ADC value of the invasive ductal carcinoma and comparing with the pathological findings, the histological structure of the invasive ductal carcinoma was discussed by DWI. The value of the classification. II. Material and Party Method:1. The first part of the study object (1) and the first part and the second part Part two: The same group of cases was used. During the period from May 2012 to December 2013, the provincial level of Shandong University was collected. In the period from May 2012 to December 2013,89 cases of the patients with breast lesions were found to be further clearly diagnosed by the MRI examination of the breast lesions,26 of which were due to radiotherapy and chemotherapy (11 cases), or did not The pathological confirmation (15) was ruled out In addition, the last 63 cases were included in the study. The patient's age ranged from 27 to 71 years, with an average age of 4 3.78 to 10.20 years of age. All lesions were examined by MRI, both of which were (2) The third part: collected from May 2012 to December 2013, the third part: collected 89 cases of patients with breast lesions by MRI in the period from May 2012 to December 2013 for the purpose of further definite diagnosis. Of the 53 cases (11 cases), there was no pathological confirmation (15 cases), benign lesion (22), and other type of malignant tumor (5 cases). Excluded, the last 36 cases were included in the study. The patient's age ranged from 27 to 71 years, with an average of years The age was 44.50 to 10.73 years. After all the lesions were examined by MRI, All of them were biopsy. Or the pathology of the operation confirmed.2. All the examinations of the scanning method were Siemens 3. OT magnetic resonance imager (Magnetom verio, SIEMENS, Ger). Germany),8-channel surface for breast Coils. Patient's prone position, bilateral breast at the same time Scan. The examination time is 7-14 days before menstruation. The scan sequence includes T1WI-TSE, T2WI-fat, DWI and 3DFL ASH DYN T1WI plus fat suppression sequence. DWI selection b鍊，

本文編號：2500255