非哺乳期乳腺炎性病变的MRI诊断价值
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摘要
目的探讨磁共振成像在非哺乳期乳腺炎性病变中的诊断价值。材料与方法回顾性分析经手术及穿刺病理证实且有完整MRI资料的非哺乳期乳腺炎性病变共83例,分别对病灶形态学、信号强度、表观扩散系数(apparent diffusion coefficient,ADC)值、强化特点及时间信号强度曲线(timeintensitycurve,TIC)类型进行评价及测量。结果 54例表现为肿块,包括单灶(29/54,53.7%)和多灶(25/54,46.3%),形态以不规则形为主(27/54,50.0%),边缘多不规则(27/54,50.0%)或清楚(21/54,38.9%),增强扫描呈不均匀强化(27/54,50.0%)或环形强化(27/54,50.0%)。29例表现为非肿块强化,分布方式以节段样强化为主(16/29,55.2%),增强扫描多呈不均匀强化(20/29,69.0%)。T2WI/IDEAL WATER (T2 weighted image/iteration decomposition of water with echo asymmetry and least-squares estimation)序列多表现为等信号(31/83,37.3%)或稍高信号(31/83,37.3%),扩散加权成像(diffusion weighted imaging,DWI)序列以稍高信号(33/83,39.8%)或高信号(46/83,55.4%)为主,平均ADC值为(1.15±0.30)×10-3 mm2/s。TIC类型以平台型为主(52/83,62.7%)。病灶内常伴有囊变及坏死区(54/83,65.1%)、灶周水肿(35/83,42.2%)、部分病灶伴出血(9/83,10.8%)。伴随征象包括邻近皮肤异常改变(30/83,36.1%)、胸壁异常改变(11/83,13.3%)、同侧腋窝淋巴结肿大(23/83,27.7%)。结论非哺乳期乳腺炎性病变在MR影像上具有一定特征性,与乳腺癌的鉴别诊断价值较大。
Objective: To investigate the value of magnetic resonance imaging(MRI) in the diagnosis of non-lactation mastitis lesions. Materials and Methods: To retrospective analysis of 83 cases of non-lactation mastitis lesions confirmed by surgery and biopsy pathology with complete MRI data, the lesion morphology, signal intensity, apparent diffusion coefficient(ADC) value, enhancement characteristics and time intensity curve(TIC) types were evaluated and measured respectively. Results: Fifty-four cases showed masses, including single focus(29/54, 53.7%) and multiple foci(25/54, 46.3%). The shape was mainly irregular(27/54, 50.0%). The margin was mainly irregular(27/54, 50.0%) or clear(21/54, 38.9%). The enhancement scan showed heterogeneous(27/54, 50.0%) or rim enhancement(27/54, 50.0%) respectively. Twentynine cases showed non-mass enhancement(NME). Segmental distribution was the main type(16/29, 55.2%). The internal enhancement pattern was mainly heterogeneous(20/29, 69.0%). T2 weighted image/iteration decomposition of water with echo asymmetry and least-squares estimation(T2WI/IDEAL WATER) sequence showed middle(31/83, 37.3%) or slightly high signal intensity(31/83, 37.3%). Diffusion weighted imaging(DWI) sequence was mainly slightly high(33/83, 39.8%) and high signal intensity(46/83, 55.4%). The average value of ADC was(1.15±0.30)×10-3 mm2/s. TIC was mainly plateau type(52/83, 62.7%). The lesions were complicated by cystic degeneration and necrosis(54/83, 65.1%), peripheral edema(35/83, 42.2%) and hemorrhage(9/83, 10.8%). Accompanying signs included adjacent abnormal skin changes(30/83, 36.1%), abnormal chest wall change(11/83, 13.3%) and axillary lymph node enlargement at the same side(23/83, 27.7%). Conclusions: Non-lactation mastitis lesions have some characteristics on magnetic resonance imaging, which is of great value in differential diagnosis with breast cancer.
Objective: To investigate the value of magnetic resonance imaging(MRI) in the diagnosis of non-lactation mastitis lesions. Materials and Methods: To retrospective analysis of 83 cases of non-lactation mastitis lesions confirmed by surgery and biopsy pathology with complete MRI data, the lesion morphology, signal intensity, apparent diffusion coefficient(ADC) value, enhancement characteristics and time intensity curve(TIC) types were evaluated and measured respectively. Results: Fifty-four cases showed masses, including single focus(29/54, 53.7%) and multiple foci(25/54, 46.3%). The shape was mainly irregular(27/54, 50.0%). The margin was mainly irregular(27/54, 50.0%) or clear(21/54, 38.9%). The enhancement scan showed heterogeneous(27/54, 50.0%) or rim enhancement(27/54, 50.0%) respectively. Twentynine cases showed non-mass enhancement(NME). Segmental distribution was the main type(16/29, 55.2%). The internal enhancement pattern was mainly heterogeneous(20/29, 69.0%). T2 weighted image/iteration decomposition of water with echo asymmetry and least-squares estimation(T2WI/IDEAL WATER) sequence showed middle(31/83, 37.3%) or slightly high signal intensity(31/83, 37.3%). Diffusion weighted imaging(DWI) sequence was mainly slightly high(33/83, 39.8%) and high signal intensity(46/83, 55.4%). The average value of ADC was(1.15±0.30)×10-3 mm2/s. TIC was mainly plateau type(52/83, 62.7%). The lesions were complicated by cystic degeneration and necrosis(54/83, 65.1%), peripheral edema(35/83, 42.2%) and hemorrhage(9/83, 10.8%). Accompanying signs included adjacent abnormal skin changes(30/83, 36.1%), abnormal chest wall change(11/83, 13.3%) and axillary lymph node enlargement at the same side(23/83, 27.7%). Conclusions: Non-lactation mastitis lesions have some characteristics on magnetic resonance imaging, which is of great value in differential diagnosis with breast cancer.
引文
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[10]Gautier N,Lalonde L,Tran-Thanh D,et a1.Chronic granulomatous mastitis:imaging,pathology and management.Eur J Radiol,2013,82(4):e165-175.
[2]Trop I,Dugas A,David J,et a1.Breast abscesses:evidence-based algorithms for diagnosis,management,and follow-up.Radiographics,2011,31(6):1683-1699.
[3]American College of Radiology.ACR BI-RADS:Magnetic resonance imaging.In ACR breast imaging reporting and data system,breast imaging atlas.Reston:American College of Radiology,2013:23-173.
[4]Li YL,Tang JW,Wen JM,et al.Pathology.6th ed.Beijing:People's Medical Publishing House,2007:70-71.李玉林,唐建武,文剑明,等.病理学.6版.北京:人民卫生出版社,2007:70-71.
[5]Tan H,Li R,Peng W,et a1.Radiological and clinical features of adult non-puerperal mastitis.Br J Radiol,2013,86(1024):20120657.
[6]Wang LJ,Wang DB,Fei XC,et al.MRI findings of inflammatory breast diseases with pathologic correlation in non-lactating woman.Chin JRadiol,2014,48(10):836-840.王丽君,汪登斌,费晓春,等.非哺乳期乳腺炎性病变的MRI表现及其与病理的对照研究.中华放射学杂志,2014,48(10):836-840.
[7]Dursun M,Yilmaz S,Yahyayev A,et al.Multimodality imagingfeatures of idiopathic granulomatous mastitis:outcome of 12 years of experience.Radiol Med,2012,117(4):529-538.
[8]Chen M,Dong WY,Gu L,et al.The MR features of granulomatous mastitis.Chin J Pract Radiol,2014,30(5):774-777.陈敏,董渭盈,古凌,等.肉芽肿性乳腺炎的MR表现分析.实用放射学杂志,2014,30(5):774-777.
[9]Tan HN,Peng WJ,Li RM,et al.Radiological features of mastitis.Chin J Radiol,2013,47(8):690-694.谭红娜,彭卫军,李瑞敏,等.乳腺炎的影像特征.中华放射学杂志,2013,47(8):690-694.
[10]Gautier N,Lalonde L,Tran-Thanh D,et a1.Chronic granulomatous mastitis:imaging,pathology and management.Eur J Radiol,2013,82(4):e165-175.