Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Jena, Germany.
Breast J. 2010 May-Jun;16(3):233-9. doi: 10.1111/j.1524-4741.2010.00915.x.
The objective of this investigation was to determine the diagnostic value of unilateral edema in differentiating benign from malignant breast disease on T2w-TSE images in MR-Mammography (MRM). All patients from a 10-year period undergoing surgery in the same institution after having received MRM in our department were included in this prospective analysis of previous acquired examinations. To eliminate bias caused by prior procedures, all patients having had biopsy, operation, radiation therapy, or chemotherapy before MRM were excluded. T2w-TSE images were acquired after a dynamic contrast-enhanced series of T1-weighted images in a standardized examination protocol (1.5 T). Edema was defined as a high-signal intensity on T2w-TSE images and it was categorized as absent, perifocal, or diffuse. Examinations were rated by two experienced observers blinded to all procedures and results following MRM. In cases of disconcordance, the opinion of a third radiologist decided. Statistical testing included Pearson's Chi-squared test and Fisher's exact testing. A total of 1,010 patients with a mean age of 55 years (SD: 11.6 years, range: 16-87 years) with 1,129 histologically verified lesions were included in this investigation. After removing all patients with prior procedures from the patient collective, 974 lesions were left for statistical analysis. Perifocal edema was highly significantly (p < 0.001) associated with malignant disease, leading to a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 33.5%, 93.9%, 89.6, and 57.1%, respectively. Unilateral edema in general showed the following diagnostic parameters: sensitivity 53.0%, specificity 80.5%, PPV 80.9%, and NPV 52.3%. Edema seems to be associated with malignancy in the majority of cases. Especially, specificity and PPV were found to be high. These findings may be helpful in diagnostic decisions on otherwise equivocal cases.
本研究旨在探讨磁共振乳腺成像（MRM）T2w-TSE 序列中单侧水肿在鉴别良恶性乳腺疾病中的诊断价值。本前瞻性分析纳入了 10 年间在我院行 MRM 检查后于同一机构接受手术的所有患者。为了消除 MRM 前操作引起的偏倚，所有在 MRM 前接受过活检、手术、放疗或化疗的患者均被排除在外。T2w-TSE 图像是在标准化检查方案（1.5 T）中获得动态对比增强 T1 加权图像系列后采集的。水肿定义为 T2w-TSE 图像上的高信号强度，并分为无、周围或弥漫性。在对所有患者进行 MRM 后，两位有经验的观察者在不知道所有程序和结果的情况下对检查结果进行了盲法评估。如果存在分歧，则由第三位放射科医生决定。统计检验包括 Pearson χ2 检验和 Fisher 确切检验。本研究共纳入 1010 例平均年龄为 55 岁（标准差：11.6 岁，范围：16-87 岁）的患者，共 1129 个经组织学证实的病变。从患者群体中去除所有有前期操作的患者后，共有 974 个病变用于统计分析。周围性水肿与恶性疾病高度相关（p < 0.001），其敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 33.5%、93.9%、89.6%和 57.1%。单侧水肿的总体诊断参数为：敏感性 53.0%、特异性 80.5%、PPV 80.9%和 NPV 52.3%。水肿在大多数情况下与恶性肿瘤有关。特别是，特异性和 PPV 较高。这些发现可能有助于对其他不确定病例做出诊断决策。
