Moy Linda, Elias Kristin, Patel Vashali, Lee Jiyon, Babb James S, Toth Hildegard K, Mercado Cecilia L
Department of Radiology, Breast Imaging Center, Cancer Institute, New York University School of Medicine, New York, NY 10016, USA.
AJR Am J Roentgenol. 2009 Oct;193(4):986-93. doi: 10.2214/AJR.08.1229.
The purpose of this study was to evaluate the usefulness of MRI of the breast in cases in which mammographic or sonographic findings are inconclusive.
We retrospectively reviewed images from 115 MRI examinations of the breast performed from 1999 to 2005 for the indication of problem-solving for inconclusive findings on a mammogram. Forty-eight of the 115 women (41.8%) were at high risk. We discerned whether sonography or MRI was used as an adjunctive tool and correlated the findings with those in the pathology database.
The equivocal findings most frequently leading to MRI were asymmetry and architectural distortion. No suspicious MRI correlate was found in 100 of 115 cases (87%). These cases were found stable at follow-up mammography or MRI after a mean of 34 months. Fifteen enhancing masses (13%) that corresponded to the mammographic abnormality were seen on MR images. All masses identified at MRI were accurately localized for biopsy, and six malignant lesions were identified. Four of six malignant tumors were seen in one mammographic view only; two were seen on second-look ultrasound images. MRI had a sensitivity of 100% and compared with mammography had significantly higher specificity (91.7% vs 80.7%, p = 0.029), positive predictive value (40% vs 8.7%, p = 0.032), and overall accuracy (92.2% vs 78.3%, p = 0.0052). Eighteen incidental lesions (15.7%) were detected at MRI, and all were subsequently found benign.
We found breast MRI to be a useful adjunctive tool when findings at conventional imaging were equivocal. Strict patient selection criteria should be used because of the high frequency of incidental lesions seen on MR images.
本研究的目的是评估在乳腺钼靶或超声检查结果不明确的情况下，乳腺MRI的实用性。
我们回顾性分析了1999年至2005年期间进行的115例乳腺MRI检查的图像，这些检查是为了解决乳腺钼靶检查结果不明确的问题。115名女性中有48名（41.8%）为高危人群。我们确定了超声或MRI是否用作辅助工具，并将检查结果与病理数据库中的结果进行了关联。
最常导致MRI检查的可疑结果是不对称和结构扭曲。115例中有100例（87%）未发现可疑的MRI相关表现。这些病例在平均34个月的随访乳腺钼靶或MRI检查中显示稳定。在MR图像上发现了15个强化肿块（13%），与乳腺钼靶异常相对应。MRI上发现的所有肿块均准确定位以进行活检，共发现6例恶性病变。6例恶性肿瘤中有4例仅在一个乳腺钼靶视图中可见；2例在二次超声检查图像中可见。MRI的敏感性为100%，与乳腺钼靶相比，特异性显著更高（91.7%对80.7%，p = 0.029），阳性预测值（40%对8.7%，p = 0.032），总体准确性（92.2%对78.3%，p = 0.0052）。MRI检测到18例偶然病变（15.7%），随后均被发现为良性。
我们发现，当传统成像结果不明确时，乳腺MRI是一种有用的辅助工具。由于MR图像上偶然病变的发生率较高，应使用严格的患者选择标准。
