Mun Han Song, Kang Bong Joo, Kim Sung Hun, Park Ga Eun
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Tomography. 2025 Jan 20;11(1):10. doi: 10.3390/tomography11010010.
To evaluate the effectiveness of breast MRI, including diffusion-weighted imaging (DWI), in detecting residual lesions in patients with malignancy after excisional biopsy.
From January 2018 to December 2023, 3T breast MRI was performed to assess lesion morphology, residual size, and enhancement kinetics. The apparent diffusion coefficient (ADC) values were measured, and the diagnostic outcomes of CE-MRI, CE-MRI with DWI, mammography (MG), and ultrasound (US) were compared with clinical and histopathological data.
A total of 152 lesions were analyzed, with 36.2% showing residual malignancy. Both CE-MRI and CE-MRI with DWI effectively identified residual lesions, with significant differences in morphology, size, kinetic patterns, and ADC values (all < 0.001). CE-MRI with DWI showed a sensitivity of 90.9% and an NPV of 93.6%, compared with 89.1% sensitivity and 92.2% NPV for CE-MRI alone. Sensitivities for MG and US were 57.1% and 38.7%, with NPVs of 64.7% and 59.6%, respectively. Diagnostic accuracy was highest for CE-MRI with DWI (80.9%), followed by CE-MRI (79.0%), MG (60.3%), and US (59.7%). The AUC for CE-MRI with DWI (0.831) was slightly higher than CE-MRI alone (0.811), though not significant ( = 0.095). AUCs for MG and US were lower at 0.623 and 0.563, with no significant difference between MG and US ( = 0.234).
CE-MRI with DWI and CE-MRI alone were comparable and demonstrated excellent performance in discriminating between women with and without residual disease. Integrating CE-MRI with DWI could become a standard protocol for patients with suspected residual malignancy after excisional biopsy.
评估乳腺磁共振成像（MRI），包括扩散加权成像（DWI），在切除活检后恶性肿瘤患者中检测残留病变的有效性。
2018年1月至2023年12月，采用3T乳腺MRI评估病变形态、残留大小及强化动力学。测量表观扩散系数（ADC）值，并将对比增强MRI（CE-MRI）、联合DWI的CE-MRI、乳腺钼靶摄影（MG）和超声（US）的诊断结果与临床及组织病理学数据进行比较。
共分析152个病变，其中36.2%显示残留恶性肿瘤。CE-MRI和联合DWI的CE-MRI均能有效识别残留病变，在形态、大小、动力学模式和ADC值方面存在显著差异（均<0.001）。联合DWI的CE-MRI敏感性为90.9%，阴性预测值为93.6%，而单纯CE-MRI的敏感性为89.1%，阴性预测值为92.2%。MG和US的敏感性分别为57.1%和38.7%，阴性预测值分别为64.7%和59.6%。联合DWI的CE-MRI诊断准确性最高（80.9%），其次是CE-MRI（79.0%）、MG（60.3%）和US（59.7%）。联合DWI的CE-MRI的曲线下面积（AUC）为0.831，略高于单纯CE-MRI的0.811，但差异无统计学意义（P=0.095）。MG和US的AUC较低，分别为0.623和0.563，MG和US之间无显著差异（P=0.234）。
联合DWI的CE-MRI和单纯CE-MRI相当，在鉴别有无残留疾病的女性方面表现出色。将CE-MRI与DWI相结合可能成为切除活检后疑似残留恶性肿瘤患者的标准检查方案。
