Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Alexandria University, Champollion Street, El Azareeta, Alexandria, Egypt.
Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Alexandria University, Champollion Street, El Azareeta, Alexandria, Egypt.
Acad Radiol. 2018 Aug;25(8):985-992. doi: 10.1016/j.acra.2017.12.019. Epub 2018 Feb 13.
This study aims to describe the magnetic resonance imaging (MRI) features of fat necrosis on magnetic resonance mammography, which may downstage a suspicious lesion to a merely benign finding.
This prospective study included 82 female patients (mean age 50 years) who were diagnosed to have suspicious lesions by mammography, ultrasonography or both. All patients underwent MRI including diffusion-weighted imaging and spectroscopy. Image postprocessing and analysis included signal intensity, enhancement characteristics, diffusion restriction, and spectroscopic analysis. All patients underwent histopathological analysis for confirmation. Sensitivity, specificity, positive predictive value (PPV), and negative (NPV) predictive value were calculated.
To label a lesion as fat necrosis on MRI analysis, presence of fat signal in a lesion revealed sensitivity of 98.04%, specificity of 100%, PPV of 100%, and NPP of 96.88%, whereas nonenhancement of the lesion itself revealed sensitivity of 96.08%, specificity of 100%, PPV of 100%, and NPP of 93.94%. However, adding both the nonrestriction on diffusion analysis and the lack of tCholine at 3.22 ppm increased the sensitivity and specificity to 100%, as well as PPV of 100% for fat necrosis and hence a NPV for malignancy of 100%.
MRI proved to be of value in differentiating fat necrosis from malignancy based on the molecular composition of fat necrosis, clearly depicted by MRI without the need for invasive confirmation by biopsy.
本研究旨在描述磁共振乳腺摄影中脂肪坏死的磁共振成像（MRI）特征，这可能将可疑病变降级为单纯良性发现。
本前瞻性研究纳入了 82 名女性患者（平均年龄 50 岁），这些患者经乳腺摄影、超声或两者均被诊断为可疑病变。所有患者均接受了包括扩散加权成像和光谱分析在内的 MRI 检查。图像后处理和分析包括信号强度、增强特征、扩散受限和光谱分析。所有患者均接受了组织病理学分析以确认。计算了敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在 MRI 分析中将病变标记为脂肪坏死时，病变中存在脂肪信号的灵敏度为 98.04%，特异性为 100%，PPV 为 100%，NPV 为 96.88%，而病变本身的非增强显示灵敏度为 96.08%，特异性为 100%，PPV 为 100%，NPV 为 93.94%。然而，同时增加扩散分析无受限和 3.22ppm 处缺乏 tCholine 可将灵敏度和特异性提高至 100%，脂肪坏死的 PPV 也提高至 100%，因此恶性肿瘤的 NPV 提高至 100%。
MRI 基于脂肪坏死的分子成分显示出其在区分脂肪坏死与恶性肿瘤方面的价值，而无需通过活检进行有创确认。
