Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa 16059, Turkey.
Eur J Radiol. 2012 Feb;81(2):203-8. doi: 10.1016/j.ejrad.2010.12.022. Epub 2011 Jan 13.
Spiculation of breast masses is usually the result of significant desmoplastic reaction. Diminished neovascularization is expected due to sparsely dispersed tumor cells within the lesion. This feature can cause differences in enhancement patterns which can cause pitfalls while evaluating MR images as well. Aim of this study is to explore the enhancement characteristics of malignant spiculated masses and to correlate these findings with histopathological features.
Eighteen spiculated and seventeen non-spiculated masses depicted with mammography were included in the study. MR imaging was performed with 1.5 T magnet with breast coil. In MR imaging, T2-weighted turbo spin echo (TSE) with fat suppression sequence followed by pre- and post-contrast T1-weighted 3D-fast low angle shot (FLASH) sequences were used. Lesions were evaluated according to enhancement characteristics: early phase enhancement (first 2 min; less than 50%, 50-100% and more than 100%), late phase enhancement (2-6 min; persistent, plateau and washout) and inner enhancement pattern (homogenous, heterogenous and rim). Desmoplasia and lymphocyte infiltration was classified as mild, moderate and severe. MR images and histopathological findings (desmoplasia, lymphocyte infiltration and grade) of both groups were compared.
Mean ages of patients in spiculated and non-spiculated-mass groups were 55.07 (41-71) and 47.35 (31-62), respectively. Mean diameter of lesions was 17.3mm (10-31 mm) for spiculated masses while non spiculated masses were 15.8mm (6-40 mm). There were statistically significant differences between late phase enhancement, persistent enhancement, plateau and washout (p<0.05). Intergroup comparison of desmoplasia revealed significant difference between severe versus and mild, moderate (p<0.05).
Spiculated malignant lesions are supposed to contain intense desmoplastic reaction. On DCE-MR images they can show persistent enhancement pattern more often than non-spiculated lesions.
乳腺肿块的分叶状表现通常是显著的纤维组织反应的结果。由于病变内肿瘤细胞稀疏分布，新生血管生成减少。这种特征会导致强化模式的差异，在评估磁共振成像时可能会产生陷阱。本研究旨在探讨恶性分叶状肿块的强化特征，并将这些发现与组织病理学特征相关联。
本研究纳入了 18 个分叶状和 17 个非分叶状肿块，这些肿块在乳腺 X 线摄影中显示出来。使用 1.5T 磁共振成像仪和乳腺线圈进行磁共振成像。在磁共振成像中，使用 T2 加权涡轮自旋回波（TSE）脂肪抑制序列，随后是对比前和对比后的 T1 加权三维快速小角度激发（FLASH）序列。根据强化特征评估病变：早期强化（前 2 分钟；小于 50%、50-100%和大于 100%）、晚期强化（2-6 分钟；持续、平台和洗脱）和内部强化模式（均匀、不均匀和边缘）。纤维组织增生和淋巴细胞浸润分为轻度、中度和重度。比较两组的磁共振图像和组织病理学发现（纤维组织增生、淋巴细胞浸润和分级）。
分叶状和非分叶状肿块组患者的平均年龄分别为 55.07（41-71）和 47.35（31-62）。分叶状肿块的病变平均直径为 17.3mm（10-31mm），而非分叶状肿块的病变平均直径为 15.8mm（6-40mm）。晚期强化、持续强化、平台和洗脱之间存在统计学显著差异（p<0.05）。纤维组织增生的组间比较显示，重度与轻度、中度之间存在显著差异（p<0.05）。
分叶状恶性病变被认为含有强烈的纤维组织反应。在 DCE-MR 图像上，它们比非分叶状病变更常表现为持续强化模式。
