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目的:探讨磁共振动态增强曲线(DCE-MRI)、波谱成像(1H-MRS)及其联合应用对乳腺病变的定性诊断价值。方法:32例乳腺疾病患者,全部行动态增强扫描及1H-MRS成像,分别判断时间-信号强度(TIC)曲线类型、波谱曲线有无异常增高胆碱峰(Cho);以病理结果为标准,比较DCE-MRI及1H-MRS诊断乳腺疾病的敏感性、特异性和诊断符合率。结果:病理结果证实乳腺癌20例,良性肿瘤12例。20例乳腺癌患者中,1例呈缓慢上升型(Ⅰ型),5例呈上升平台型(Ⅱ型),14例呈上升下降型(Ⅲ型);16例MRS检出胆碱峰。12例良性肿瘤中,7例呈Ⅰ型,4例呈Ⅱ型,1例呈Ⅲ型,MRS检查2例出现胆碱峰且TIC曲线均为Ⅰ型。TIC曲线诊断乳腺癌的敏感性95.00%,特异性58.30%,诊断符合率81.25%;胆碱峰诊断的敏感性80.00%、特异性83.30%、诊断符合率71.87%;两者联合诊断的敏感性95.00%、特异性100.00%、诊断符合率96.90%。结论:DCE-MRI对乳腺恶性病变的检出有较高的敏感性,1H-MRS可以弥补DCE-MRI特异性低的不足,因此,二者联合应用可以提高乳腺良恶性病变诊断的敏感性、特异性及诊断符合率。
Objective: To investigate the value of dynamic contrast-enhanced magnetic resonance (DCE-MRI), spectral imaging (1H-MRS) and their combination in the diagnosis of breast lesions. Methods: Thirty-two patients with breast disease underwent dynamic contrast-enhanced scanning and 1H-MRS imaging, respectively, to determine the type of TIC curve and whether there was an abnormal increase of Cho in the spectral curve. According to the pathological results, The sensitivity, specificity and diagnostic coincidence rate of DCE-MRI and 1H-MRS in the diagnosis of breast diseases were compared. Results: Twenty cases of breast cancer and 12 benign tumors were confirmed by pathology. Among the 20 patients with breast cancer, one showed a slowly increasing type (type Ⅰ), five showed elevated type (type Ⅱ), and 14 showed ascending type (type Ⅲ). Cholestatic peak was detected in 16 patients with MRS. Of the 12 benign tumors, 7 were type Ⅰ, 4 were type Ⅱ, and 1 was type Ⅲ. Choline peak was found in 2 of MRS and TIC curve was type Ⅰ. TIC curve diagnosis of breast cancer sensitivity 95.00%, specificity 58.30%, diagnostic coincidence rate 81.25%; choline peak diagnostic sensitivity 80.00%, specificity 83.30%, the diagnostic coincidence rate 71.87%; the combined diagnostic sensitivity 95.00%, specificity 100.00%, diagnostic coincidence rate 96.90%. Conclusion: The detection of malignant breast lesions by DCE-MRI is highly sensitive and the 1H-MRS can make up for the low specificity of DCE-MRI. Therefore, the combination of the two can improve the sensitivity of diagnosis of benign and malignant breast lesions, Specificity and diagnostic coincidence rate.