国际肿瘤学杂志

国际肿瘤学杂志 ›› 2021, Vol. 48 ›› Issue (9): 527-531.doi: 10.3760/cma.j.cn371439-20200921-00102

• 论著 • 上一篇    下一篇

MRI对乳腺成簇环样强化良恶性病变的诊断价值

张贝1, 赵博峰2, 王英2, 于军3, 陈平3, 陈宝莹3()   

  1. 1陕西省肿瘤医院CT室,西安 710061
    2空军军医大学唐都医院放射科,西安 710038
    3西安国际医学中心医院放射科,西安 710100
  • 收稿日期:2020-09-21 修回日期:2020-10-26 出版日期:2021-09-08 发布日期:2021-09-22
  • 通讯作者: 陈宝莹 E-mail:chenby128@163.com
  • 基金资助:
    陕西省科技厅社会发展一般项目(2020SF-043);陕西省科技厅社会发展一般项目(2020SF-049);西安市科技计划项目(20YXYJ0010(5))

Value of MRI in diagnosis of benign and malignant breast lesions with cluster ring enhancement

Zhang Bei1, Zhao Bofeng2, Wang Ying2, Yu Jun3, Chen Ping3, Chen Baoying3()   

  1. 1Department of Computerized Tomography, Shaanxi Provincial Tumor Hospital, Xi'an 710061, China
    2Department of Radiology, Tangdu Hospital of Air Force Military Medical University, Xi'an 710038, China
    3Department of Radiology, Xi'an International Medical Center Hospital, Xi'an 710100, China
  • Received:2020-09-21 Revised:2020-10-26 Online:2021-09-08 Published:2021-09-22
  • Contact: Chen Baoying E-mail:chenby128@163.com
  • Supported by:
    General Project of Social Development of Shaanxi Science and Technology Department(2020SF-043);General Project of Social Development of Shaanxi Science and Technology Department(2020SF-049);Xi'an Science and Technology Plan(20YXYJ0010(5))

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摘要：

目的 探讨MRI对乳腺成簇环样强化良恶性病变的诊断价值。方法 回顾性分析2017年10月至2019年7月在空军军医大学唐都医院因临床触诊、超声或X线检查可疑恶性病变而行MRI检查表现为成簇环样强化的68例乳腺疾病患者的影像征象。采用χ2检验或Mann-Whitney U检验比较良性病变和恶性病变间分布方式、T2抑脂信号强度、时间-信号强度曲线(TIC)、有无导管扩张、有无周围腺体水肿、有无胸大肌水肿的差异,采用二项logistic回归模型分析乳腺恶性病变MRI影像征象的相关危险因素。结果 68例患者共68处成簇环样强化病变,均为单发病变,其中良性18例(26.5%),以浆细胞性乳腺炎最多见(9例);恶性50例(73.5%),以浸润性乳腺癌最多见(40例)。浆细胞性乳腺炎影像学特征多表现为成簇环样强化,分布方式呈区域样分布,T2抑脂稍高信号,TIC为Ⅲ型,有导管扩张,有周围腺体及胸大肌水肿;浸润性乳腺癌影像学特征多表现为成簇环样强化,分布方式呈区域样分布,T2抑脂等信号,TIC为Ⅲ型,无导管扩张,有周围腺体及胸大肌水肿。在MRI征象T2抑脂信号强度及导管扩张,良性病变和恶性病变间差异均具有统计学意义(Z=3.003,P=0.003;χ2=7.174,P=0.007);而在分布方式(χ2=5.510,P=0.313)、TIC类型(χ2=3.538,P=0.133)、周围腺体水肿(χ2=0.164,P=0.686)及胸大肌水肿(χ2<0.001,P>0.999),差异均无统计学意义。二项logistic回归模型分析显示,T2抑脂信号强度呈等信号(OR=0.182,95%CI为0.036~0.914,P=0.039)、病变无导管扩张(OR=0.198,95%CI为0.047~0.846,P=0.029)是乳腺恶性病变的相关危险因素。结论 乳腺癌MRI检查表现为成簇环样强化的影像征象,T2抑脂信号强度呈等信号、病变无导管扩张是乳腺恶性病变的相关危险因素,MRI有助于乳腺病变的早期发现、早期诊断。

关键词: 乳腺肿瘤, 磁共振成像, 成簇环样强化, 动态增强, T2抑脂

Abstract:

Objective To investigate the diagnostic value of MRI in benign and malignant breast lesions with cluster ring enhancement. Methods The imaging signs of 68 patients with clustered ring enhancement who underwent MRI examination due to clinical palpation, ultrasound or X-ray examination for suspected malignant lesions in Tangdu Hospital of Air Force Military Medical University from October 2017 to July 2019 were retrospectively analyzed. The differences between benign and malignant lesions in the distribution pattern, T2 lipid suppression signal intensity, time-signal intensity curve (TIC), ductal dilatation, peripheral gland edema, pectoralis major edema were compared using χ 2 test or Mann-Whitney U test, and the risk factors of MRI imaging signs of malignant breast lesions were analyzed using binomial logistic regression model. Results There were 68 cluster ring enhancement lesions in 68 patients, all of which were single lesions, among which 18 cases (26.5%) were benign, and the common lesions were plasma cell mastitis (9 cases). Fifty cases (73.5%) were malignant, and the most common type was invasive breast cancer (40 cases). Imaging features of plasma cell mastitis showed cluster ring enhancement, regional distribution, slightly high signal on fat suppression T2 image, type Ⅲ TIC, with ductal dilatation, edema of peripheral glands and pectoralis major. Imaging features of invasive breast cancer showed cluster ring enhancement, regional distribution, iso-signal on fat suppression T2 image, type Ⅲ TIC, no ductal dilatation, and edema of peripheral gland and pectoralis major. There were statistically significant differences in the intensity of fat-suppression T2 signal (Z=3.003, P=0.003) and duct dilatation (χ 2=7.174, P=0.007) between benign and malignant lesions. There were no significant differences in distribution (χ 2=5.510, P=0.313), TIC type (χ 2=3.538, P=0.133), peripheral gland edema (χ 2=0.164, P=0.686) and pectoralis major edema (χ 2<0.001, P>0.999). The analysis of binomial logistic regression model showed that fat-suppression T2 iso-signal (OR=0.182, 95%CI: 0.036-0.914, P=0.039) and no ductal dilatation (OR=0.198, 95%CI: 0.047-0.846, P=0.029) were the risk factors for breast malignant lesions. Conclusion Breast cancer MRI findings of cluster ring enhancement, fat-suppression T2 iso-signal and no ductal dilatation are related risk factors for malignant breast lesions. MRI is helpful for early detection and diagnosis of breast lesions.

Key words: Breast neoplasms, Magnetic resonance imaging, Cluster ring enhancement, Dynamic enhancement, T2 lipid suppression