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目的探讨利用 MR 扩散成像(DWI)和表观扩散系数(ADC)测定确定乳腺癌范围的可行性。方法测定57例59个乳腺癌在扩散敏感因子(b)值分别取500(b=500 s·mm~(-2)组)和1000(b=1000 s·mm~(-2)组)时的 ADC 值,根据设定的 ADC 值测量不同 b 值时的肿瘤范围;比较动态增强和 DWI 测量病灶大小的异同。以2条径线作为比较参照:病灶最大径、过最大径线中点并与之垂直的径线。所有测量结果与病理对照。结果 (1)59个病灶包括浸润性导管癌48个,导管原位癌伴微浸润6个,黏液腺癌3个,髓样癌2个。(2)小于设定 ADC 值的异常区域作为扩散所测病灶大小,则 b 值为500和1000 s·mm~(-2)时2组结果与病理检查肿瘤范围比较。范围一致组 b=500 s·mm~(-2)组略高于 b=1000 s·mm~(-2)组,但差异无统计学意义(χ~2=0.160,P=0.689);过度诊断2组一致(2个);假阴性 b=500 s·mm~(-2) 组略低于 b=1000 s·mm~(-2)组(χ~2=0.172,P=0.679)。2组均诊断错误14个,分别是过度诊断2个,假阴性12个。8个病灶2组表现不一致,5个在 b 值为500 s·mm~(-2)时诊断正确的病灶中,3个是导管原位癌伴微浸润。(3)以4 min 时测定的大小作为动态增强显示病灶的测定点,与同一层面 DWI 上显示的异常区域大小进行比较。两者符合47个(80%);增强径线测定较小而 DWI 测定符合8个,其中3个为黏液腺癌,5个为浸润性导管癌3级。结论 MR DWI和 ADC 测定可以对乳腺癌范围进行评价。对某些特定病理类型乳腺癌范围的测量,DWI 有其优势。
Objective To explore the feasibility of using MR diffusion imaging (DWI) and apparent diffusion coefficient (ADC) to determine the range of breast cancer. Methods Fifty-five cases (59 cases) of breast cancer with diffusion-sensitive factor (b) values of 500 (b = 500 s · mm -2) and 1000 (b = 1000 s · mm -2) Of the ADC value, according to set the ADC value measured at different b value of the tumor range; compare dynamic enhancement and DWI measurement of lesion size similarities and differences. Take two radial lines as a reference for comparison: the maximum diameter of the lesion and the diameter of the line perpendicular to and perpendicular to the maximum diameter. All measurements were compared to the pathology. Results (1) Fifty-nine lesions included 48 invasive ductal carcinomas, 6 ductal carcinoma in situ with microinvasion, 3 mucinous adenocarcinoma and 2 medullary carcinoma. (2) The area of lesion smaller than the set ADC value was used as the size of lesion to be diffused, then the two groups of results were compared with the tumor range of pathological examination when the b value was 500 and 1000 s · mm ~ (-2). The group with consistent range b = 500 s · mm ~ (-2) was slightly higher than the group with b = 1000 s · mm ~ (-2), but the difference was not statistically significant (χ ~ 2 = 0.160, P = 0.689) The two groups were identical in the diagnosis (2). The false negative b = 500 s · mm ~ (-2) group was slightly lower than the b = 1000 s · mm ~ (-2) group (χ ~ 2 = 0.172, P = 0.679). There were 14 diagnostic errors in both groups, 2 were over-diagnosed, and 12 were false-negative. Of the 8 lesions, the two groups showed inconsistent results. Of the 5 lesions diagnosed correctly with a b value of 500 s · mm -2, three were ductal carcinoma in situ with microinvasion. (3) The size measured at 4 min was used as the measurement point of the dynamic enhancement of the lesion, and compared with the size of the abnormal area displayed on the same level of DWI. Both of them conformed to 47 (80%). The enhanced diameter measurement was smaller and the DWI was consistent with 8, of which 3 were mucinous adenocarcinoma and 5 were invasive ductal carcinoma. Conclusion MR DWI and ADC measurements can be used to assess the extent of breast cancer. DWI has its advantages for the measurement of the extent of breast cancer in certain types of pathology.