【作者】 王岸飞；

【导师】 张焱；

【作者基本信息】 郑州大学 ， 影像医学与核医学， 2011， 硕士

【摘要】 背景和目的乳腺癌是女性最常见的恶性肿瘤,也是第二大癌症死因[1]。乳腺癌在美国的发病率为女性发病率中居首位,而中国是乳腺癌发病率增长速度最快的疾病之一,据中国抗癌协会公布的统计数字表明,中国近年来的乳癌发病率正以每年3%的速度递增[2],其中乳腺小叶癌的增加与激素使用有较大关系,与激素的替代治疗和体外受精时卵巢的过度刺激等方面有很大的关系[3]。目前中国的乳腺癌不仅成为城市中死亡率增长最快的恶性肿瘤,而且在发病年龄也呈年轻化。虽然目前乳腺癌发生率逐渐提高,但乳腺癌患者的生存时间和生存率相对于其他癌症较好,特别是导管原位癌的治愈率>95%,因此乳腺癌的早期检出和诊断具有重要意义。磁共振(magnetic resonance imaging MRI)在乳腺癌的诊断和评价中占重要地位。特别是高场强MRI,其优越的软组织分辨率及丰富的检查手段：磁共振动态增强扫描(dynamic contrast-enhanced magnetic resonance imaging, DCE-MRI)、扩散加权成像(diffusion weighted imaging, DWI)、灌注成像(perfusion weighted image PWI)、氢质子磁共振波谱(1H magnetic resonance spectroscopy,1H-MRS)等,可以很好地了解乳腺癌的形态学特征、血液动力学特点、组织生化物质含量的变化、组织的功能状态等,使MRI结合分子生物学在细胞和分子水平检测疾病特征成为可能和现实。资料与方法收集2010年2月至2011年2月期间乳腺良恶性病例104例,良性病变41例,恶性病变63例,所有病例均在郑州大学第一附属院行MRI检查并经手术病理证实,对其进行MRI特征总结分析。全部病例均为女性,最小年龄25岁,最大年龄86岁,平均年龄47.4岁。41例良性病人中,25例纤维腺瘤,5例乳腺腺病,6例导管内乳头状瘤,5例慢性炎症。63例恶性病变中,浸润性导管癌52例,导管内癌7例,小叶原位癌2例,肌纤维母细胞肉瘤1例,鳞状细胞癌1例,其中15例伴有腋窝淋巴结转移。MRI检查在术前1周内进行,使用德国西门子公司生产的Trio Tim 3.0T高场磁共振扫描仪,乳腺专用双穴相控阵表面线圈。依次行T1加权像(T1 weighted image T1WI).压脂T2加权像(T2 weighted image T2WI)、弥散加权成像(DWI)、动态增强。所有图像均在Syngo工作站处理,由两名有经验的医师(至少一名副主任医师)对104例乳腺癌患者的影像资料进行详细分析,分别记录动态增强时间信号强度曲线(Time-signal intensity curve TIC)类型、早期强化率(early-phase enhancement rate EPER)、达峰时间(peak to time)、表观扩散系数(apparent diffusion coefficient,ADC)、Washin、Washout、MIPt、PEI、TTP等指标。应用SPSS17.0统计分析软件对数据进行分析,乳腺良恶性病变病变在灌注伪彩图测得参数Washin、Washout、TTP、MIPt、PEI及动态增强参数ACD值、EPER之间的比较用独立样本T检验,正态、方差齐时用t检验；正态、方差不齐时用校正t检验；良恶性病变时间-信号强度曲线类型分布及TTP的分部采用x2检验及秩和检验。均以P<0.05为有统计学意义。结果乳腺良恶性病例104例,良性病变41例,恶性病变63例,所有病例均在郑州大学第一附属院行MRI检查并经手术病理证实,对其进行MRI特征总结分析。全部病例均为女性,最小年龄25岁,最大年龄86岁,平均年龄47.4岁。41例良性病灶中Ⅰ型曲线20例,约为48.78%,63例恶性病灶中Ⅲ型和Ⅱ型曲线分别为32、27例,约占49.21%和44.45%,恶性病灶呈Ⅰ型曲线仅6.35%。参考Fischer评分法,诊断敏感性、特异性分别为92.1%,73.2%。乳腺良恶性差异具有统计学意义。63个恶性病灶中,病例在ADC图中均为低信号,最大的ADC值为1.541×10-3mm2/s,最小ADC值为0.528×10-3mm2/s,平均值为1.013±0.208×10-3mm2/s。41良性病变中最大的ADC值为2.054×10-3mm2/s,最小ADC值为1.048×10-3mm2/s,平均值为1.458±0.249×10-3mm2/s。以ADC=I.112×10-3 mm2/s为临界值,敏感性为82.35%,特异性为62.5%。乳腺良恶性差异具有统计学意义。63个恶性病灶中,最快1分20秒达到强化峰值,最慢5分50秒达到强化峰值。平均达峰时间210±58秒。41良性病变中最快2分20秒达到强化峰值,最慢5分50秒达到强化峰值。平均达峰时间376±138秒。乳腺良恶性差异具有统计学意义。63例恶性病灶中,1分钟时最大强化率277.5%,最小强化率70.9%,平均强化率137.5±47.5%。良性病灶中,1分钟时最大强化率212.6%,最小强化率18.6%,平均强化率88.1±49.5%。乳腺良恶性差异具有统计学意义。乳腺灌注伪彩图：恶性病变Washin、Washout、TTP、MlPt、PEI值分别为733.49±30.73、-17.29±4.83、225.18±11.11、525.57±14.67、1387.67±58.51;良性病变Washin、Washout、TTP、MlPt、PEI值分别为80.23±41.69、57.83±9.49、449.19±88.87、458.40±23.65、1093.69±73.46两组差异具有统计学意义结论1、乳腺良恶性病变的时间-信号强化曲线和ADC值差异具有统计学意义,乳腺良恶性病变灌注参数值、TTP、EPER值差异具有统计学意义。2、乳腺DCE-MRI、DWI检查对乳腺良恶性病变的诊断及鉴别诊断有较大的价值,而乳腺PWI为乳腺良恶性病变的诊断及鉴别诊断提供了一种新的方法,并对乳腺良恶性病变的诊断及鉴别诊断有一定的价值更多还原

【Abstract】 Background and purposeBreast cancer, the most common malignancy of women, is the second largest cause of cancer death. Breast cancer incidence is one of the fastest growing in China, the statistic data from China Anti-Cancer Association show that the incidence of breast cancer in recent being at an annual rate of increase of 3%with a trend of younger age. Survey data show that although incidence of breast cancer increased gradually, the survival time of patients with breast cancer and better survival rate compared to other cancers especially ductal carcinoma in situ of the cure rate 95%, so the early detection and diagnosis play a very important role in the prognosis. Breast MRI (magnetic resonance imaging MRI) examination, especially, high field MRI with its superior soft tissue resolution and rich examination of means:dynamic contrast-enhanced magnetic resonance imaging, DCE-MRI; diffusion weighted imaging, DWI; perfusion weighted image PWI;1H magnetic resonance spectroscopy, 1H-MRS, etc. We can have a good understanding of the morphological characteristics of breast cancer, hemodynamic characteristics, the tissue biochemical changes in material content, the organization’s functional status by these means which realize that MRI combined with molecular biology at the cellular and molecular level detectio of possible disease characteristics.Therefore, MRI is very important in breast cancer diagnosis and evaluation.MRI accounts for an important position in the diagnosis and evaluation of breast cancer. Especially high-field MRI, the superior soft tissue resolution and rich examination of means:dynamic contrast-enhanced magnetic resonance scanning (DCE-MRI), diffusion-weighted imaging (DWI), perfusion Imaging (PWI), proton magnetic resonance spectroscopy (1H-MRS), could be a very good understanding of breast cancer’s morphological and hemodynamic characteristics, changes in chemical and biological substances, the functional status of organization, so it is possible and realistic to detect the disease characteristics with MRI at the cellular and molecular level. After breast cancer can also be used to track other aspects of observation.Materials and methods104 cases of breast cancer collected during the period February 2010 to February 2011, all cases MRI examination were performed in the line of First Affiliated Hospital of Zhengzhou University, and confirmed by surgery and pathology.All patients were female, age range 25 to 86, with an average age of 45.7 years.41 cases of benign patients,25 fibroadenomas, five breast adenosis, intraductal papilloma 6,5 cases of chronic inflammation,63 cases of malignant lesions, invasive ductal carcinoma in 52 cases,7 cases of intraductal carcinoma, lobular carcinoma in situ in 2 cases,1 case of mucinous adenocarcinoma,1 case of cribriform carcinoma, squamous cell carcinoma in 1 case,15 cases with axillary lymph node metastases.MRI examination within 1 week before surgery carried out, using the Siemens Magnetom Trio Tim 3.OT MRI device and a proprietary phase array breast surface coils. Followed by T1-weighted imaging (T1WI), inversion recovery T2-weighted images (T2WI), diffusion-weighted imaging (DWI), dynamic contrast-enhanced and delayed scans. All images are in Syngo Mmw workstation dealt with by two experienced physicians (at least one deputy director of the physician) independent of the 104 cases of breast cancer patients to conduct a detailed analysis of image data, respectively, recorded rim enhancement, speculate, the type of time-intensity curve (TIC), the early-phase enhancement ratio (EPER), peak to time, apparent diffusion coefficient (apparent diffusion coefficient, ADC) value,Washin, Washout, MIPt、 PEI,TTPand other indicators.Using SPSS 17.0 statistical analysis software analyses the parameters of benign and malignant breast lesions.ResultsOf the 104 cases of benign and malignant cases,41 are of benign and malignant ones are 63. All cases had MRI examination and confirmed by surgery and pathology and MRI features analyzed in the First Affiliated Hospital of Zhengzhou University. All patients were female and the youngest 25 years old, maximum age 86 years, the average age of 47.4 years.41cases of benign lesions,Ⅰ-type curve in 20 cases, approximately 48.78%, and 63 malignant cases,30 cases of typeⅢcurve,Ⅱ-type curve in 7 cases, accounting for 49.21%,44.45%,Ⅰ-type curve only 6.35%. Reference Fischer scoring, diagnostic sensitivity and specificity were 92.1%,73.2%. 63 malignant lesions, mucinous adenocarcinoma in 1 patient showed high signal intensity on ADC map, the other cases were of low signal. The maximum ADC value isl.541×10-3mm2/s, the minimum is 0.528×10-3mm2/s, an average of 1.013±0.208×10-3mm2/s.41 benign lesions the largest ADC value of 2.054×10-3mm2/s, the minimum ADC value is 1.048×10-3 mm2/s, an average of 1.458±0.249×10-3 mm2/s. To ADC=1.112×10-3mm2/s for the critical value, the sensitivity was 82.35%, a specificity of 62.5%.In the 63 malignant lesions, the fastest one takes 1 minute 20 seconds to reach peak enhancement, the slowest one takes five minutes 50 seconds. The average time to peak is 210±58 seconds.41 benign lesions in the fastest 2 minutes and 20 seconds to reach peak enhancement, the slowest five minutes 50 seconds to reach peak enhancement. The average time to the peak is 376±138 seconds. Benign and malignant breast bear statistically significant difference. Malignant lesions, one-minute maximum enhancement ratio is 277.5%,70.9%minimum enhancement ratio, the average rate of 137.5±47.5%enhancement. Benign lesions, one-minute maximum enhancement rate of 212.6%,18.6%minimum enhancement ratio, the average rate is 88.1±49.5%enhancement. Benign and malignant breast show statistically significant differences. Pseudo-color pictures of breast infusion:Malignant lesions Washin, Washout, TTP, MIPt, PEI values were 733.49±30.73,-17.29±4.83,225.18±11.11,525.57±14.67,1387.67±58.51; Benign Washin, Washout, TTP, MIPT, PEI values were 80.23±41.69,57.83±9.49,449.19±88.87,458.40±23.65,1093.69±73.46 a statistically significant difference between two groups.Conclusion1、DCE-MRI,ADC and Perfusion parameters of MRI were a significant differences between the benign and malignant breast lesions2、DCE-MRI, DWI examination of benign and malignant breast lesions have important value for the diagnosis and differential diagnosis.Perfusion-weighted imaging of the breast could provide valuable information in the differential diagnosis and may has important value for the diagnosis and differential diagnosis of benign and malignant breast lesions更多还原