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目的探讨基于体素内不相干运动(IVIM)的扩散加权成像(DWI)对乳腺肿块病灶的诊断价值。方法前瞻性纳入术前行MRI检查且动态对比增强(DCE)表现为乳腺肿块的患者78例(87个病灶),分为良性组(n=29)与恶性组(n=58)。通过单、双指数模型分别获得表观扩散系数(ADC)、单纯水分子扩散系数(D)、灌注相关的扩散系数(D*)和灌注分数(f)参数值。采用独立样本t检验分析组间各参数差异。绘制受试者工作特征曲线(ROC),分析各参数对乳腺肿块病灶的诊断效能。结果恶性组ADC、D低于良性组(P<0.001),恶性组D*高于良性组(P=0.04)。恶性组与良性组间f无明显差异(P>0.05)。以病理为金标准,ADC、D、D*值诊断乳腺恶性肿块病灶的曲线下面积(AUC)分别为0.88、0.92、0.62,D与ADC间差异有统计学意义(P=0.03)。ADC、D、D*分别以1.19×10~(-3)mm~2/s、1.05×10~(-3)mm~2/s、7.55×10~(-3)mm~2/s为诊断阈值,敏感度分别为86.2%、89.7%、89.7%,特异度分别为89.7%、93.1%、37.9%,准确率分别为87.4%、89.7%、55.2%。结论 IVIM参数D对乳腺肿块病灶的诊断效能优于ADC,具有较高的敏感度和特异度,D*诊断效能一般,f诊断价值有限。
Objective To investigate the diagnostic value of diffusion-weighted imaging (DWI) based on the non-coherent motion of the voxel (IVIM) in lesions of breast masses. METHODS: A total of 78 patients (87 lesions) with breast masses undergoing dynamic contrast enhanced MRI (DCE) were prospectively enrolled in this study. The patients were divided into benign group (n = 29) and malignant group (n = 58). Apparent diffusion coefficient (ADC), diffusion coefficient of pure water (D), perfusion-related diffusion coefficient (D *) and perfusion fraction (f) were obtained by single and double exponential model respectively. Independent samples t-test analysis of differences between the parameters of the group. The receiver operating characteristic curve (ROC) was plotted and the diagnostic efficacy of each parameter on lesions of the breast mass was analyzed. Results Malignant group ADC, D lower than the benign group (P <0.001), malignant group D * higher than the benign group (P = 0.04). There was no significant difference between malignant group and benign group (P> 0.05). According to the gold standard, the area under the curve (AUC) of ADC, D, D * values for the diagnosis of malignant breast lesions were 0.88,0.92,0.62, respectively. The difference between D and ADC was statistically significant (P = 0.03). ADC, D and D * were respectively calculated as 1.19 × 10 ~ (-3) mm ~ 2 / s, 1.05 × 10 ~ (-3) mm ~ 2 / s and 7.55 × 10 ~ (-3) mm ~ 2 / s The diagnostic thresholds and sensitivities were 89.2%, 89.7% and 89.7% respectively, and the specificity were 89.7%, 93.1% and 37.9% respectively, with the accuracy of 87.4%, 89.7% and 55.2% respectively. Conclusion The IVIM parameter D is superior to ADC in diagnosis of lesions of breast masses. It has high sensitivity and specificity. The diagnosis efficiency of D * is general, and the diagnostic value of f is limited.