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目的:研究小乳腺癌在各种MR灌注参数图像上的影像表现及其灌注特征,评价磁共振灌注成像参数图的临床应用价值。方法:29例女性小乳腺癌[共46个经病理证实的病灶(最大径≤2cm)]被纳入研究范畴。采用快速小角度激发(FLASH)序列行双侧乳腺动态高分辨对比增强MR成像(DCEMRI),共连续6个回合成像,绘制时间-信号强度曲线(TIC),并选取3个时间点,通过软件获得Washin、Washout、MIPt及PEI等4种乳腺灌注伪彩参数图像,分别测定整个病灶、病灶周边及中心以及对侧正常乳腺组织的各灌注参数值,分析小乳腺癌的灌注特点。结果:Washin、Washout、MIPt及PEI等4种灌注参数图像分别可以显示41个、19个、44个及45个小乳腺癌灶,检出率分别为89.1%、41.3%、95.7%及97.8%。Washin图不能检出的5个病灶中4个(80.0%)TIC为Ⅰ型曲线,Washout图检出的19个病灶中,15个(78.9%)为Ⅲ型曲线。46个小乳腺癌中,35个(76.1%)呈现明显不均匀异常灌注增强,其中26个周边灌注更明显。对各参数值的测定及分析结果显示小乳腺癌灶与正常乳腺组织之间、乳癌周边部分与中心部分间的各灌注参数值差异有统计学意义(P<0.05)。结论:乳腺动态高分辨对比增强MR灌注成像参数图对乳腺癌病灶的检出率较高,大部分小乳腺癌呈明显不均匀灌注增强,且增强早期即出现异常灌注,周边部分灌注更显著。乳腺MR灌注参数图像可为小乳腺癌的诊断和鉴别提供重要的补充信息。
Objective: To study the imaging features and perfusion characteristics of small breast cancer in various MR perfusion parameters and to evaluate the clinical value of MR perfusion imaging. METHODS: Twenty-nine women with small breast cancer [46 pathologically confirmed lesions (maximum diameter ≤ 2 cm)] were included in the study. A total of 6 consecutive rounds of imaging were performed using the FLASH sequence with bilateral breast dynamic contrast-enhanced MR imaging (DCEMRI). The time-signal intensity curve (TIC) was drawn and three time points were selected. Washin, Washout, MIPt and PEI were used to obtain pseudo-color parameters of breast perfusion, and the perfusion parameters of the whole lesion, peri-lesion and center of the lesion and normal breast tissue were measured respectively. The perfusion characteristics of small breast cancer were analyzed. Results: The four perfusion parameters, Washin, Washout, MIPt and PEI, showed 41, 19, 44 and 45 small breast lesions respectively. The detection rates were 89.1%, 41.3%, 95.7% and 97.8% . Four of the five lesions (80.0%) that were not detected by the Washin map were type I and 15 of 19 (78.9%) Washout maps were type III. Of the 46 small breast cancers, 35 (76.1%) showed significantly increased heterogeneity of perfusion, with 26 peri-perfusion more pronounced. The results of the measurement and analysis of the parameters showed that there were significant differences in perfusion parameters between the small breast lesions and the normal breast tissues and between the peripheral part and the central part of the breast cancer (P <0.05). Conclusion: The dynamic high-resolution contrast-enhanced MR perfusion imaging of mammary gland has a high detection rate of breast cancer lesions. Most small breast cancers showed markedly increased non-uniform perfusion, and enhanced abnormal early perfusion and more peripheral perfusion. Breast MR perfusion parameter images can provide important additional information for the diagnosis and differential diagnosis of small breast cancer.