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目的探讨磁共振(MRI)成像对全数字化乳腺摄影(Full-field digital mammography,FFDM)表现为非肿块样病变的良恶性的诊断价值。方法以穿刺或手术病理诊断作为金标准,回顾性分析FFDM表现为非肿块样病变共77例,所有病变均行磁共振平扫、增强、弥散加权扫描。结果 77个非肿块样病变中,脂肪型腺体7例,少量脂肪型腺体15例,中量腺体型28例,致密腺体型27例。BI-RADS 3类56例,BI-RADS 4-5类21例。病理诊断良性51例,占66.23%,包括硬化性腺病13例,纤维腺瘤或纤维囊性增生8例,不典型增生8例,浆细胞性乳腺炎17例,肉芽肿性乳腺炎3例,导管内乳头状瘤3例;恶性26例,占33.76%,包括导管原位癌7例,浸润性小叶癌4例,浸润性导管癌15例。FFDM表现非肿块样良性病变中,17例乳腺炎性变及4例纤维囊性增生在STIR上可见不同程度的高信号,而恶性病变中19例表现为等低信号,病变与周围正常腺体组织分界不清。增强扫描时,在良性病变中,肿块样强化、非肿块样强化分别为19例和32例;恶性病变中肿块样强化、非肿块样强化分别9例和17例。良性病变强化分布方式以局限区域性、弥漫性为主,恶性病变强化分布以段样、分支导管样分布为主;而内部强化特征,良性病灶以均匀强化为主,恶性病灶以卵石状、簇集状及导管样强化为主。FFDM非肿块样病变中,恶性病变多在3 min内出现强化,早期强化率达70%左右,后期以流出型为主;良性病灶后期增强以渐升型为主。MRI误诊的11例,其中假阳性、假阴性分别为7、4例。钼靶预测恶性病变的主要依据为钙化和星芒状结构扭曲;MRI判断良恶性的依据为增强扫描时病灶内部强化特征和弥散加权时病灶的信号强度变化。结论磁共振弥散加权与动态增强联合,对FFDM表现为非肿块病变有较高的诊断及鉴别诊断价值。
Objective To investigate the value of magnetic resonance imaging (MRI) in the diagnosis of benign and malignant lesions in full-field digital mammography (FFDM). Methods The puncture or pathological diagnosis was used as the gold standard. Retrospective analysis of 77 cases of FFDM showed non-mass-like lesions. All the lesions were scanned by MRI, enhanced and diffusion-weighted scan. Results Among the 77 non-massy lesions, there were 7 fatty glands, 15 small fat glands, 28 medium glandular glands and 27 dense glandular glands. BI-RADS Class 3 56 cases, BI-RADS 4-5 Class 21 cases. Pathological diagnosis of benign 51 cases, accounting for 66.23%, including sclerosing adenosis in 13 cases, fibroadenoma or fibrocystic hyperplasia in 8 cases, atypical hyperplasia in 8 cases, plasma cell mastitis in 17 cases, 3 cases of granulomatous mastitis, 3 cases of intraductal papilloma; 26 cases of malignant, accounting for 33.76%, including ductal carcinoma in situ in 7 cases, invasive lobular carcinoma in 4 cases, invasive ductal carcinoma in 15 cases. FFDM showed non-lump-like benign lesions, 17 cases of mammary inflammatory lesions and 4 cases of fibrocystic hyperplasia in the STIR showed varying degrees of high signal, and malignant lesions in 19 cases showed low signal lesions and the surrounding normal glands Organizational boundaries are unclear. In contrast, in benign lesions, mass-like and non-mass-like enhancement were 19 and 32 respectively. In malignant lesions, mass-like and non-mass-like enhancement were found in 9 and 17 cases, respectively. The distribution of benign lesions was mainly regional and diffuse. The distribution of malignant lesions was mainly in section-like and branching duct-like distribution. The internal enhancement was characterized by uniform enhancement of benign and malignant lesions with pebbles and clusters Aggregate and catheter-like enhancement. FFDM non-mass-like lesions, malignant lesions more than 3 min to strengthen, the early enhancement rate of about 70%, the latter part of the outflow-based; benign lesion enhancement to the latter-based. MRI misdiagnosed in 11 cases, of which false positive, false negative were 7,4 cases. The main basis for the prognosis of malignant lesions of molybdenum targets is calcification and stellate structure distortion; MRI to determine the basis of benign and malignant lesions to enhance the scan of the enhanced features of lesions and diffuse weighted lesions signal intensity changes. Conclusion The combination of diffusion weighted MRI and dynamic enhancement has a good diagnostic and differential diagnostic value for non-mass lesion of FFDM.