标题：DWI结合动态增强MRI对乳腺肿瘤的诊断价值

      作者：赵建春，雷忠东，张慎忠，季国军    (南通市通州区人民医院放射科，江苏 南通 226300)

      卷次： 2017年28卷5期

      【摘要】 目的 探讨DWI、ADC值、动态增强MRI（DCE-MRI）、时间-信号强度曲线类型等在乳腺良恶性肿瘤中的诊断与鉴别诊断价值。方法 对2011年1月至2013年6月期间在上海交通大学医学院附属第一人民医院收治的100例乳腺肿瘤患者（112个病灶）进行MRI常规检查与DWI扫描(b=800 s/mm2)及动态增强扫描，对乳腺内病灶的形态、强化特征及弥散特性进行对比研究。结果 (1)乳腺恶性肿瘤形态学上多呈分叶状、不规则状，边缘不规则或毛刺征，良性肿瘤多呈圆形或类圆形，边缘光滑，以肿瘤形态学特征评价良、恶性肿瘤组之间比较差异具有统计学意义(P<0.05)。(2) 75个恶性病灶中，9个呈Ⅰ型曲线，48个呈Ⅱ型曲线，18个呈Ⅲ型曲线；37个良性病灶中 19个呈Ⅰ型曲线，17个呈Ⅱ型曲线，1个呈Ⅲ型曲线；以Ⅰ、Ⅱ型曲线诊断良性病变，Ⅱ、Ⅲ型曲线诊断恶性病变，以肿瘤边缘特征评价良、恶性组之间比较差异具有统计学意义(P<0.05)。(3)以ADC值=1.195×10-3 mm2/s作为界值，75个恶性病灶中，61个病灶的ADC值<1.195×10-3 mm2/s；37个良性病灶中25个病灶的ADC值>1.195×10-3 mm2/s，良、恶性组之间比较差异具有统计学意义(P<0.05)。结论 乳腺DWI、DCE-MRI联合应用对评价乳腺病变性质具有重要价值。
      【关键词】 乳腺；扩散加权成像；表观扩散系数；动态增强磁共振成像；时间-信号强度曲线
      【中图分类号】 R737.9 【文献标识码】 A 【文章编号】 1003—6350（2017）05—0780—04

Diagnostic value of diffusion weighted imaging combined with dynamic contrast-enhanced MRI in breasttumors.
ZHAO Jian-chun, LEI Zhong-dong, ZHANG Shen-zhong, JI Guo-jun. Department of Radiology, NantongTongzhou District People's Hospital, Nantong 226300, Jiangsu, CHINA
【Abstract】 Objective To investigate the value of diffusion weighted imaging (DWI), apparent diffusion coef-ficient (ADC), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and time-signal intensity curve inthe diagnosis and differential diagnosis of benign and malignant breast tumors. Methods From January 2011 to June2013, 100 breast cancer patients admitted to the First Affiliated Hospital of Shanghai Jiaotong University School ofMedicine (112 lesions) undergoing conventional MRI examination, DWI (b=800 s/mm2) and DCE-MRI were recruited.The morphology, enhancement characteristics and dispersion characteristics of breast lesions were comparatively stud-ied. Results (1) Malignant breast tumors were mostly multi-lobulated and irregularly shaped, with irregular margin orspeculation, while benign tumors were round or oval, with smooth edge, showing statistically significant differences (P<0.05). (2) Among the 75 malignant tumors, there were 9 cases of typeⅠcurve, 48 cases of typeⅡ curve, and 18 cases oftype Ⅲ curve; among the 37 benign lesions, there were 19 cases of type Ⅰcurve, 17 cases of type Ⅱ curve, and 1 caseof typeⅢ curve; diagnosis of benign lesions with typeⅠ,Ⅱ curve and malignant lesions with typeⅡ,Ⅲ curve had sig-nificant differences between the benign and malignant group (P<0.05). (3) With the ADC value of 1.195×10-3 mm2/s ascutoff value, 61 of the 75 malignant lesions had ADC<1.195×10-3 mm2/s, and 25 of the 37 benign lesions had ADC>1.195×10-3 mm2/s, showing significant differences between the benign and malignant group (P<0.05). Conclusion It ishelpful to differentiate breast malignant and benign lesions by DWI and DCE-MRI.
      【Key words】 Breast; Diffusion weighted imaging (DWI); Apparent diffusion coefficient (ADC); Dynamic con-trast-enhanced magnetic resonance imaging (DCE-MRI); Time-signal intensity curve·论 著·doi:10.3969/j.issn.1003-6350.2017.05.032