目的与 X 线片、超声检查比较,评价 MRI 对乳腺导管原位癌及其微浸润诊断的正确率和界定病灶范围的准确性。方法经手术病理证实、术前行乳腺 MR 检查的乳腺导管原位癌及导管原位癌伴微浸润连续病例17例,其中13例同时行 X 线检查、16例行超声检查。以病理资料作为金标准,作对照分析。结果 (1)MR 检查14例病灶有强化,11例表现为非块状强化,其中6例呈段样强化,2例呈区域性强化,导管样强化、多灶性局灶性强化、双乳大致对称的弥漫性强化各1例。这11例中有2例伴病变侧增强前的乳头后大导管扩张,其中1例增强后大导管强化,这2例均以乳头滴血为临床症状。2例块样强化表现为信号均匀、形态不规则的肿块。混合有肿块和非块样强化的1例,为信号均匀、边缘光整的卵圆形肿块伴肿块周围线样强化。(2)13例行 X 线检查,2例阴性;单纯钙化表现6例;钙化伴其他征象2例;非钙化病灶3例。8例含钙化的病灶中,恶性钙化5例,交界性钙化3例;钙化簇状分布5例,区域性分布2例,弥漫分布1例。(3)16例行超声检查,4例阴性,1例诊为良性病变,其余11例作出了正确的术前诊断,表现为不规则的低回声区内伴有点状的强回声改变。(4)以病理检查测量的大小作为金标准,对病灶范围界定方面 MRI 符合13例(13/17),高估2例;X 线诊断符合7例(7/13),高估3例,低估1例;超声符合7例(7/16),高估2例,低估3例。差异无统计学意义(P=0.161)。结论乳腺导管原位癌及原位癌伴微浸润 MRI 表现具有特征性,联合X线和 MR 检查能提高其正确诊断。 OBJECTIVE: To evaluate the accuracy of MRI in diagnosing ductal carcinoma in situ and its microinvasion in MRI and the accuracy of defining the range of lesions by X-ray and ultrasonography. [Methods] 17 cases of ductal carcinoma in situ and carcinoma of ductal carcinoma in situ with microinvasive invasion confirmed by surgery and pathology were examined preoperatively. Thirteen cases were examined by X-ray and 16 cases by ultrasound. The pathological data as the gold standard for control analysis. Results (1) Forty lesions were enhanced by MR and 11 were non-massive. Among them, 6 were segmental enhancement, 2 were regional enhancement, catheter-like enhancement, multifocal focal enhancement, The general symmetry of diffuse enhancement in 1 case. Two of the eleven cases had dilated large dilatation of the dorsal duct before the lesion enhancement, and one of them had enhanced dilatation of the large duct, both of which were treated by the nipple bleedings as the clinical symptom. 2 cases of block-like enhancement showed uniform signal, irregular shape of the mass. One case was mixed with lumps and non-lump-like enhancement. The oval lumps with uniform signal and smooth edge had line-like enhancement around the lumps. (2) 13 cases underwent X-ray examination, 2 cases were negative; simple calcification in 6 cases; calcification with other signs in 2 cases; non-calcified lesions in 3 cases. Of the 8 calcified lesions, 5 were malignant calcification and 3 borderline calcifications; 5 were clustered with clusters of calcification, 2 were regional and 1 were diffusely distributed. (3) 16 cases underwent ultrasonography, 4 cases were negative, 1 case was diagnosed as benign lesion, and the other 11 cases had correct preoperative diagnosis. The irregular hypoechoic area was accompanied by punctate hyperechoic changes. (4) According to the pathological examination of the size of the gold standard, the scope of the lesion defined MRI consistent with 13 cases (13/17), overestimated in 2 cases; X-ray diagnosis in line with 7 cases (7/13), overestimated in 3 cases, 1 case was underestimated; 7 cases (7/16) were evaluated by ultrasound, 2 cases were overestimated and 3 cases underestimated. The difference was not statistically significant (P = 0.161). Conclusion The breast ductal carcinoma in situ and in situ carcinoma with microinvasive MRI have the characteristic features. Combined with X-ray and MR examination can improve the correct diagnosis.