磁共振扩散加权成像联合灌注成像技术在诊断乳腺潜在恶性病变中的价值
Value of magnetic resonance diffusion combined with perfusion imaging techniques for diagnosing potentially malignant breast lesions.
作者信息
Zhang Hui, Zhang Xin-Yi, Wang Yong
机构信息
Department of Radiology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China.
Department of Radiology, the First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China.
出版信息
World J Clin Cases. 2022 Jun 26;10(18):6021-6031. doi: 10.12998/wjcc.v10.i18.6021.
BACKGROUND
Lesions of breast imaging reporting and data system (BI-RADS) 4 at mammography vary from benign to malignant, leading to difficulties for clinicians to distinguish between them. The specificity of magnetic resonance imaging (MRI) in detecting breast is relatively low, leading to many false-positive results and high rates of re-examination or biopsy. Diffusion-weighted imaging (DWI), combined with perfusion-weighted imaging (PWI), might help to distinguish between benign and malignant BI-RADS 4 breast lesions at mammography.
AIM
To evaluate the value of DWI and PWI in diagnosing BI-RADS 4 breast lesions.
METHODS
This is a retrospective study which included patients who underwent breast MRI between May 2017 and May 2019 in the hospital. The lesions were divided into benign and malignant groups according to the classification of histopathological results. The diagnostic efficacy of DWI and PWI were analyzed respectively and combinedly. The 95 lesions were divided according to histopathological diagnosis, with 46 benign and 49 malignant. The main statistical methods used included the Student t-test, the Mann-Whitney U-test, the chi-square test or Fisher's exact test.
RESULTS
The mean apparent diffusion coefficient (ADC) values in the parenchyma and lesion area of the normal mammary gland were 1.82 ± 0.22 × 10 mm/s and 1.24 ± 0.16 × 10 mm/s, respectively ( = 0.021). The mean ADC value of the malignant group was 1.09 ± 0.23 × 10 mm/s, which was lower than that of the benign group (1.42 ± 0.68 × 10 mm/s) ( = 0.016). The volume transfer constant (Ktrans) and rate constant (Kep) values were higher in malignant lesions than in benign ones (all < 0.001), but there were no significant statistical differences regarding volume fraction (V) ( = 0.866). The sensitivity and specificity of PWI combined with DWI (91.7% and 89.3%, respectively) were higher than that of PWI or DWI alone. The accuracy of PWI combined with DWI in predicting pathological results was significantly higher than that predicted by PWI or DWI alone.
CONCLUSION
DWI, combined with PWI, might possibly distinguish between benign and malignant BI-RADS 4 breast lesions at mammography.
背景
乳腺钼靶成像报告和数据系统（BI-RADS）4类病变良恶性各异，给临床医生鉴别带来困难。磁共振成像（MRI）检测乳腺的特异性相对较低，导致许多假阳性结果以及较高的复查或活检率。弥散加权成像（DWI）联合灌注加权成像（PWI）可能有助于鉴别乳腺钼靶成像中的BI-RADS 4类乳腺良恶性病变。
目的
评估DWI和PWI在诊断BI-RADS 4类乳腺病变中的价值。
方法
这是一项回顾性研究，纳入了2017年5月至2019年5月期间在该医院接受乳腺MRI检查的患者。根据组织病理学结果分类，将病变分为良性和恶性组。分别及联合分析DWI和PWI的诊断效能。95个病变根据组织病理学诊断进行分组，其中46个为良性，49个为恶性。主要使用的统计方法包括Student t检验、Mann-Whitney U检验、卡方检验或Fisher精确检验。
结果
正常乳腺实质和病变区域的平均表观扩散系数（ADC）值分别为（1.82±0.22）×10⁻³mm²/s和（1.24±0.16）×10⁻³mm²/s（P = 0.021）。恶性组的平均ADC值为（1.09±0.23）×10⁻³mm²/s，低于良性组（1.42±0.68）×10⁻³mm²/s（P = 0.016）。恶性病变的容积转运常数（Ktrans）和速率常数（Kep）值高于良性病变（均P < 0.001），但在容积分数（V）方面无显著统计学差异（P = 0.866）。PWI联合DWI的敏感度和特异度分别为91.7%和89.3%，高于单独的PWI或DWI。PWI联合DWI预测病理结果的准确性显著高于单独的PWI或DWI。
结论
DWI联合PWI可能有助于鉴别乳腺钼靶成像中的BI-RADS 4类乳腺良恶性病变。
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