Durur-Subasi Irmak, Durur-Karakaya Afak, Karaman Adem, Seker Mehmet, Demirci Elif, Alper Fatih
1 Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
2 Department of Radiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.
Br J Radiol. 2017 May;90(1073):20160803. doi: 10.1259/bjr.20160803. Epub 2017 Mar 24.
To determine whether the necrosis/wall apparent diffusion coefficient (ADC) ratio is useful for the malignant-benign differentiation of necrotic breast lesions.
Breast MRI was performed using a 3-T system. In this retrospective study, calculation of the necrosis/wall ADC ratio was based on ADC values measured from the necrosis and from the wall of malignant and benign breast lesions by diffusion-weighted imaging (DWI). By synchronizing post-contrast T weighted images, the separate parts of wall and necrosis were maintained. All the diagnoses were pathologically confirmed. Statistical analyses were conducted using an independent sample t-test and receiver operating characteristic analysis. The intraclass and interclass correlations were evaluated.
A total of 66 female patients were enrolled, 38 of whom had necrotic breast carcinomas and 28 of whom had breast abscesses. The ADC values were obtained from both the wall and necrosis. The mean necrosis/wall ADC ratio (± standard deviation) was 1.61 ± 0.51 in carcinomas, and it was 0.65 ± 0.33 in abscesses. The area under the curve values for necrosis ADC, wall ADC and the necrosis/wall ADC ratio were 0.680, 0.068 and 0.942, respectively. A wall/necrosis ADC ratio cut-off value of 1.18 demonstrated a sensitivity of 97%, specificity of 93%, a positive-predictive value of 95%, a negative-predictive value of 96% and an accuracy of 95% in determining the malignant nature of necrotic breast lesions. There was a good intra- and interclass reliability for the ADC values of both necrosis and wall.
The necrosis/wall ADC ratio appears to be a reliable and promising tool for discriminating breast carcinomas from abscesses using DWI. Advances in knowledge: ADC values of the necrosis obtained by DWI are valuable for malignant-benign differentiation in necrotic breast lesions. The necrosis/wall ADC ratio appears to be a reliable and promising tool in the breast imaging field.
确定坏死/壁表观扩散系数（ADC）比值是否有助于坏死性乳腺病变的良恶性鉴别。
使用3-T系统进行乳腺磁共振成像（MRI）。在这项回顾性研究中，坏死/壁ADC比值的计算基于通过扩散加权成像（DWI）测量的恶性和良性乳腺病变坏死区及病变壁的ADC值。通过同步对比增强T加权图像，保持病变壁和坏死区的分离部分。所有诊断均经病理证实。采用独立样本t检验和受试者工作特征分析进行统计分析。评估组内和组间相关性。
共纳入66例女性患者，其中38例为坏死性乳腺癌，28例为乳腺脓肿。获取了病变壁和坏死区的ADC值。癌组织中坏死/壁ADC比值的平均值（±标准差）为1.61±0.51，脓肿中为0.65±0.33。坏死区ADC、病变壁ADC及坏死/壁ADC比值的曲线下面积值分别为0.680、0.068和0.942。坏死/壁ADC比值截断值为1.18时，在判断坏死性乳腺病变的恶性性质方面，灵敏度为97%，特异度为93%，阳性预测值为95%，阴性预测值为96%，准确度为95%。坏死区和病变壁的ADC值在组内和组间均具有良好的可靠性。
坏死/壁ADC比值似乎是一种可靠且有前景的工具，可利用DWI鉴别乳腺癌和脓肿。知识进展：通过DWI获得的坏死区ADC值对坏死性乳腺病变的良恶性鉴别有重要价值。坏死/壁ADC比值似乎是乳腺成像领域一种可靠且有前景的工具。
