磁共振成像在慢性乳腺炎与乳腺癌鉴别诊断中应用研究
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摘要
目的探讨磁共振成像(Magnetic resonance imaging,MRI)在鉴别诊断慢性乳腺炎与乳腺癌中的应用价值。方法选择2017年6月—2018年9月本院收治的经穿刺活检、超声检查或手术病理证实的38例慢性乳腺炎患者及同期经病理证实的40例乳腺癌患者的影像学资料进行回顾性分析。所有患者均进行了MRI检查,分析并比较两者形态学征象及动态增强表现。结果 38例慢性乳腺炎患者中,21例位于右侧乳房、17例位于左侧乳房;其中26例位于单个象限,12例位于2个及2个以上象限; 40例乳腺癌患者中,左、右侧乳房各20例;其中38例位于单个象限,2例位于2个象限。慢性乳腺炎与乳腺癌环形强化、病灶形状及病灶周围水肿征象相比,差异有统计学意义(P<0.05);毛刺征、腋窝淋巴结肿大、累及乳头、皮肤增厚征象相比,差异无统计学意义(P>0.05)。慢性乳腺炎Ⅰ型、Ⅱ型、Ⅲ型病例分别为20例、12例、6例,乳腺癌Ⅰ型、Ⅱ型、Ⅲ型病例分别为5例、16例、19例,两者TIC相比,差异有统计学意义(P<0.05)。慢性乳腺炎与乳腺癌早期强化率相比,差异无统计学意义(P> 0.05)。结论慢性乳腺炎及乳腺癌MRI表现均具有一定特征性,临床诊断中可通过病灶形状、环形强化、病灶周围水肿、TIC等征象对两者进行有效鉴别。
Objective To explore the application value of magnetic resonance imaging( MRI) in the differential diagnosis of chronic mastitis and breast cancer. Methods The imaging data of 38 cases of chronic mastitis confirmed by needle biopsy or ultrasonic examination or surgical pathology from June 2017 to September2018 in our hospital were retrospectively analyzed,and 40 patients with breast cancer confirmed by pathology at the same time were selected. All patients received MRI detection,and the morphological signs and dynamic enhancement findings were analyzed and compared between the two groups. Results Among 38 patients with chronic mastitis,21 cases were in the right breast and 17 cases were in the left breast.26 cases were in a single quadrant and 12 cases were in 2 and above 2 quadrants. Among the 40 patients with breast cancer,there were 20 cases in left and right breast. 38 cases were in a single quadrant and 2 cases were in 2 quadrants. There were statistically significant differences between chronic mastitis and breast cancer in the aspect of ring enhancement,lesion shapes and signs of edema around the lesion( P< 0.05). There were no differences in spicule sign,axillary lymph node enlargement,nipple involvement and skin thickening sign( P> 0.05). There were 20 cases,12 cases,and 6 cases of chronic mastitis in type Ⅰ,type Ⅱ and type Ⅲ,and there were 5 cases,16 cases,and 19 cases of breast cancer respectively,and the difference of TIC was statistically significant( P<0.05).There was no significant difference in the early enhancement rate between chronic mastitis and breast cancer( P>0.05).Conclusions The MRI features of chronic mastitis and breast cancer have certain characteristics.In clinical diagnosis,the two could be effectively identified by the lesion shape,ring enhancement,edema around the lesion,TCI and other signs.
Objective To explore the application value of magnetic resonance imaging( MRI) in the differential diagnosis of chronic mastitis and breast cancer. Methods The imaging data of 38 cases of chronic mastitis confirmed by needle biopsy or ultrasonic examination or surgical pathology from June 2017 to September2018 in our hospital were retrospectively analyzed,and 40 patients with breast cancer confirmed by pathology at the same time were selected. All patients received MRI detection,and the morphological signs and dynamic enhancement findings were analyzed and compared between the two groups. Results Among 38 patients with chronic mastitis,21 cases were in the right breast and 17 cases were in the left breast.26 cases were in a single quadrant and 12 cases were in 2 and above 2 quadrants. Among the 40 patients with breast cancer,there were 20 cases in left and right breast. 38 cases were in a single quadrant and 2 cases were in 2 quadrants. There were statistically significant differences between chronic mastitis and breast cancer in the aspect of ring enhancement,lesion shapes and signs of edema around the lesion( P< 0.05). There were no differences in spicule sign,axillary lymph node enlargement,nipple involvement and skin thickening sign( P> 0.05). There were 20 cases,12 cases,and 6 cases of chronic mastitis in type Ⅰ,type Ⅱ and type Ⅲ,and there were 5 cases,16 cases,and 19 cases of breast cancer respectively,and the difference of TIC was statistically significant( P<0.05).There was no significant difference in the early enhancement rate between chronic mastitis and breast cancer( P>0.05).Conclusions The MRI features of chronic mastitis and breast cancer have certain characteristics.In clinical diagnosis,the two could be effectively identified by the lesion shape,ring enhancement,edema around the lesion,TCI and other signs.
引文
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[15]杨滢,兰军.动态增强MRI在乳腺良恶性病变鉴别与诊断中的应用价值[J].中国肿瘤临床与康复,2017,24(10):1208-1210.
[2] Allarakha,Atiya,高燕,等.乳腺癌MRI诊断进展[J].中国医学影像技术,2018,34(2):306-309.
[3]严莉,袁新平,朱莉莉,等.磁共振波谱分析技术在乳腺良恶性病变鉴别诊断中的应用价值[J].贵州医药,2017,41(9):984-985.
[4]蒋国元,罗义云,柏拉拉,等.非特异性乳腺炎的MRI表现及与乳腺癌的鉴别诊断[J].中国临床医学影像杂志,2017,28(11):781-784.
[5]陈俐君,杨晓萍.乳腺癌的MRI临床诊断研究[J].医疗卫生装备,2015,36(9):104-106.
[6]计玉芳,陈淑君.超声及核磁共振检查对乳腺良性和恶性病变的诊断价值[J].检验医学与临床,2015,(24):3639-3642.
[7]陈胜军,吴丽君,罗颖楠.MRI、CT与乳腺X线摄影诊断乳腺疾病临床价值分析[J].医学影像学杂志,2017,27(6):1188-1190.
[8]荆彦平,高峥嵘,骆宾,等.MRI动态增强扫描在乳腺肿块性病变的诊断价值及病生基础[J].中华全科医学,2015,13(11):1830-1831.
[9]佟琪,张冰,李茗,等.MRI多序列成像对乳腺疾病诊断的优选研究[J].中国CT和MRI杂志,2017,15(4):80-83.
[10] Wu S,Berg WA,Zuley ML,et al.Breast MRI contrast enhancement kinetics of normal parenchyma correlate with presence of breast cancer[J].Breast Cancer Res Bcr,2016,18(1):76.
[11]陈蕾,王秀荣,申云霞,等.动态增强MRI与乳腺X线摄影在乳腺病变诊断中的应用对比[J].医学影像学杂志,2016,26(1):138-141.
[12]尹华,黄瑞岁,胡宗永,等.磁共振诊断乳腺疾病的临床价值研究[J].中国CT和MRI杂志,2015,13(11):44-46.
[13] Liao L,Li L,Germaine P,et al. Contrast-enhanced spectral mammography(CESM)compared with breast MRI for breast cancer detection[J].J Natl Cancer I,2015,43(43):1289-1296.
[14] Wallace TE,Patterson AJ,Abeyakoon O,et al. Detecting gas‐induced vasomotor changes via blood oxygenation level‐dependent contrast in healthy breast parenchyma and breast carcinoma[J].J Magn Reson Imaging,2016,44(2):335-345.
[15]杨滢,兰军.动态增强MRI在乳腺良恶性病变鉴别与诊断中的应用价值[J].中国肿瘤临床与康复,2017,24(10):1208-1210.