【作者】 陈艳丽；

【导师】 张秀梅；

【作者基本信息】 吉林大学 ， 临床医学， 2010， 硕士

【摘要】 本研究旨在探讨磁共振动态增强成像和扩散加权成像在乳腺良恶性病变鉴别诊断方面的最新进展及临床应用价值。共收集21例患者,23个病灶,皆是临床触诊发现乳腺单侧或双侧肿块,X线钼靶摄影或B超怀疑恶性的病例,进行MRI动态增强成像(DCE-MRI)和扩散加权成像(DWI)扫描。得出如下结论:(1)MRI动态增强在对乳腺良恶性疾病的鉴别中,形态不规则,边缘模糊、有毛刺,边界不清,充填型环形强化,Ⅲ型曲线是典型乳腺癌的影像表现;而形态为圆形或类圆形,边缘清晰光滑,均匀强化或无强化,Ⅰ型曲线对乳腺良性病变有诊断意义。(2)在扩散加权成像中,乳腺良恶性病变的ADC诊断阈值为1.20×10-3mm2/s,ADC≤1.20×10-3mm2/s为恶性,ADC>1.20×10-3mm2/s为良性。ADC值鉴别良恶性病变敏感性、特异性和准确性较高,而且不需增强,可作为一项常规检查序列。(3)MRI动态增强成像和扩散加权成像相结合对乳腺良恶性病变的正确诊断和鉴别诊断具有重要价值,能为临床乳腺疾病的术前明确诊断提供更有价值、更丰富的信息。更多还原

【Abstract】 Breast lesions is the world’s women frequently-occurring disease, common diseases. With the rapid economic development, people lifestyle changes, breast cancer incidence and mortality rates increase with years, and seriously endanger women’s health, so early detection, early diagnosis and early treatment are key to reducing breast cancer mortality.Recently, MRI technology in the detection and diagnosis of breast cancer showed great advantages, particularly in DCE-MRI and DWI applications, to further improve the early diagnosis of breast cancer. This study is the application of DCE-MRI and DWI to a group of breast lesion evaluation, designed to explore the DCE-MRI and DWI in the diagnosis of benign and malignant breast lesions and differential diagnosis of the value and progress.All tumors were treated by dynamic contrast enhanced MRI (3D-FLASH sequence) and diffusion-weighted (EPI sequence) scan.This group 21 female patients were collected, which were found in clinical palpation with unilateral or bilateral breast lumps and X ray mammography or b-mode ultrasonic suspected malignancy. There were 23 lesions, including 15 malignant lesions and 8 benign lesions. All cases underwent surgical resection or biopsy, and confirmed by pathology. Pathological findings as follows: malignant lesions have 12 infitrating ductal carcinoma cases, 2 infitrating lobular carcinoma cases; 1 Lymphoma case. Benign lesions included 5 Fibroadenoma cases, 1 intraductal papilloma case, 1 Plasma cell mastitis case, 1 Breast adenosis.All lesions were accorded to morphological characteristics of lesions, strengthen means, early enhanced rate, time-signal intensity curve and the ADC values to determine the nature of the lesion. Regarded pathologic results as the gold standard, DCE-MRI and DWI differential diagnosis of the nature of breast lesions assessed.Through this group analysis of 23 lesions obtained the following results: Based on the MRI scan, differentiating benign and malignant breast lesions after injection of contrast agent were meaningful, especially in filling annular enhancement, the higher specificity in the diagnosis of breast cancer; Increased rate of early DCE-MRI of breast differential diagnosis of benign and malignant lesions was no significant difference, p>0.05; TIC to reflect the number of the blood supply of tumors, it has some value for benign and malignant differentiation, but TIC in the characterization of breast disease and classification have significant overlap, it is not an independent diagnostic breast benign lesions, malignant; In the DWI, the ADC value by the sensitivity of benign and malignant lesions, specificity and accuracy are high. Thus summarized as follows: (1) DCE-MRI of the breast in the differential diagnosis of benign and malignant disease, irregular shape, edge blur, burr, the border is unclear, filling-type ring enhancement,Ⅲ-type curve is typical of imaging findings of breast cancer; The shape is round or oval, sharp edges, smooth, homogeneous enhancement or no enhancement,Ⅰ-type curve of benign breast lesions diagnosis. (2) DWI in breast diagnosis of benign and malignant lesions of the ADC threshold value was 1.20×10-3 mm2/s, ADC≤1.20×10-3 mm2/s was malignant lesions, ADC>1.20×10-3 mm2/s was benign lesions. ADC values of benign and malignant lesions of the sensitivity, specificity, and accuracy is high, and without enhancement, can be used as a routine examination sequence.⑶DCE-MRI and DWI combined benign and malignant lesions of breast diagnosis and differential diagnosis had great value, it provided more valuable and more abundant information for clinical breast for preoperative diagnosis of disease.DCE-MRI scanning is a dynamic point of view from the blood of breast lesions of the nature of their disease imaging method. Lesions more clearly show the shape, scope and violations of the surrounding tissue, is substantially improved breast disease diagnosis and differential diagnosis accuracy. DWI is a functional imaging, easy to operate, check the time is short, without contrast agent, in patients with no pain, measurement of ADC values of evaluating the effect is a fast and easy to approach, ADC values of benign and malignant tumors have a clear identification of value, can become a routine examination. By MRI diffusion-weighted imaging and dynamic contrast-enhanced imaging in benign and malignant breast lesions on performance can improve the accuracy of diagnosis for the clinical basis.更多还原