论文部分内容阅读
目的：评价磁共振动态增强成像量化分析在乳腺病变诊断中的价值。方法收集女性乳腺疾病患者62例，所有病例经手术或穿刺病理证实，并选取10名健康女性志愿者作为对照组。对所有患者及正常志愿者均行MRI常规成像及DCE-MRI。观察分析病变在MRI动态增强后的时间-信号强度曲线（TIC）类型。测量并计算早期强化率（EER），最大线性斜率（Slope）及最大线性斜率比值（SlopeR）等动态增强定量参数。结果1.动态增强后，TIC类型中，Ⅰ型和Ⅳ型曲线多见于乳腺良性病变，Ⅲ型曲线多见于乳腺恶性病变，Ⅱ型曲线良恶性病变均可见。若以Ⅱ型和Ⅲ型曲线作为乳腺恶性病变的诊断标准，其准确性77.0%，敏感性90.9%，特异性71.2%。2.采用ROC曲线确定EER、Slope及 SlopeR对良恶性病变的诊断阈值。EER阈值为83.35%，其诊断准确性为77.0%，敏感性为90.9%，特异性为71.2%；Slope阈值为1.39%/s，其诊断准确性为67.6%，敏感性为100%，特异性为53.8%；SlopeR阈值为12.14，其诊断准确性为77.0%，敏感性为36.4%，特异性为94.2%。结论1.DCE-MRI后乳腺病变的TIC类型有助于良恶性病变的鉴别诊断，具有较高的敏感性。2.DCE-MRI定量参数EER、Slope、SlopeR对乳腺良、恶性病变的鉴别诊断有一定的价值，Slope的敏感性最高，SlopeR的特异性最高，EER的敏感性较高，稍低于Slope。3.对DCE-MRI进行量化分析，可提高MRI对乳腺病变诊断的准确性、敏感性、特异性。“,”Objective To evaluate the value of quantitative analysis of dynamic contrast-enhanced MRI (DCE-MRI) in the diagnosis of breast lesions. Methods 62 female cases with breast lesions were collected. All the breast lesions were proved by operation or puncture pathology. At the same time, 10 healthy women volunteers were selected as control group. All the patients and normal volunteers underwent conventional MRI imaging and DCE-MRI. The time-signal intensity curve (TIC) type of the lesions after DCE-MRI were observed and analyzed. Quantitative parameters of DCE-MRI including the rate of early enhancement (EER), the maximum linear slope (Slope) and the maximum linear slope ratio (SlopeR) were calculated. Results 1.After DCE-MRI, Breast benign lesions often show Ⅰ-type and Ⅳ-type curve, breast malignant lesions often show Ⅲ-type curve. Both of breast benign and malignant lesions may showⅡ-type curve. IfⅡ-type andⅢ-type curve were considered as the diagnosis criteria of malignant lesions, the diagnostic accuracy, sensitivity, specificity were as follows, respectively, 77.0%, 90.9%and 71.2%. 2.If the diagnostic threshold of EER, Slope and SlopeR were determined/drawn by ROC curve, the EER threshold was 83.35%, the diagnostic accuracy, sensitivity, specificity of the threshold were as follows, respectively, 77.0%, 90.9%and 71.2%;the Slope threshold was 1.39%/s, the diagnostic accuracy, sensitivity, specificity of the threshold were as follows, respectively, 67.6%, 100%and 53.8%;the SlopeR threshold was 12.14, the diagnostic accuracy, sensitivity, specificity of the threshold were as follows, respectively, 77.0%, 36.4%and 94.2%. Conclusion 1.The TIC type of the lesions after DCE-MRI are helpful for diagnosis of malignant lesions with high sensitivity. 2.The quantitative parameters of DCE-MRI including EER, Slope and SlopeR, are helpful for differential diagnosis of breast malignant lesions and benign lesions. With the highest sum of the sensitivity and specificity, the EER can more accurately predict breast malignant lesions. The Slope has the highest sensitivity;the SlopeR has the highest specificity. 3.The accuracy, sensitivity and specificity of diagnosis of breast lesions were improved with the combination of DCE-MRI and DWI.