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目的探讨MR动态增强扫描(DCE)与扩散加权成像(DWI)不同联合方法鉴别乳腺良恶性病变的价值。方法 65例乳腺病变患者行3.0 T MR动态增强扫描与DWI检查,所有病例经穿刺活检或手术病理证实。动态增强扫描以Fischer评分表及影像报告数据系统判定良恶性;DWI b值设定为50～850 s/mm2,以恶性病变表观扩散系数平均值95%可信区间上限为鉴别良恶性病变的阈值。以病理结果为金标准,分别计算DCE、DWI的独立诊断效能与不同联合方法的诊断效能。联合方法包括平行试验、系列试验、积分累计法、DCE为主DWI为辅法。结果病理结果示良性病变30例,恶性病变35例。DCE病灶检出率98.5%,1例导管内原位癌漏诊;DWI病灶检出率95.4%,3例导管原位癌漏诊;DCE诊断敏感性、特异性、准确率分别为85.7%、80%、83.1%,DWI分别为80%、83.3%、81.5%。DCE与DWI联合诊断效能:平行实验94.3%,66.7%,81.5%,系列实验77.1%,96.7%,86.2%,积分累计法80%、86.7%、83.1%,DCE为主DWI为辅法88.6%,90%,89.2%。结论 DCE与DWI不同联合方法鉴别乳腺良恶性病变的诊断价值不同。DCE为主、DWI为辅法可作为一种联合诊断方法。
Objective To investigate the value of different combination of MR dynamic contrast-enhanced scanning (DCE) and diffusion-weighted imaging (DWI) in differentiating benign and malignant breast lesions. Methods 65 patients with breast lesions underwent 3.0 T MR dynamic contrast-enhanced scanning and DWI examination, all cases were confirmed by biopsy or surgical pathology. Dynamic enhanced scan with Fischer score table and video report data system to determine the benign and malignant; DWI b value is set to 50 ~ 850 s / mm2, malignant lesions apparent diffusion coefficient 95% confidence interval upper limit for the identification of benign and malignant lesions Threshold. Pathological results as the gold standard, were calculated DCE, DWI independent diagnostic efficacy and diagnostic efficiency of different combinations of methods. The combined methods include parallel testing, series of tests, integral cumulative method, DCE based DWI supplemented. Results of pathological results showed that benign lesions in 30 cases, 35 cases of malignant lesions. The detection rate of DCE was 98.5%, and one case was misdiagnosed as ductal carcinoma in situ. The detection rate of DWI was 95.4% and 3 cases were missed by ductal carcinoma in situ. The diagnostic sensitivity, specificity and accuracy of DCE were 85.7% and 80% , 83.1%, DWI were 80%, 83.3%, 81.5% respectively. The diagnostic efficiency of DCE combined with DWI was 94.3%, 66.7% and 81.5% in parallel experiments, 77.1%, 96.7% and 86.2% in series of experiments, 80%, 86.7% and 83.1% , 90%, 89.2%. Conclusion DCE and DWI different methods of joint diagnosis of benign and malignant breast lesions of different diagnostic value. DCE-based, DWI as a secondary method can be used as a joint diagnostic method.