CAJ | 학술논문

目的评估乳腺导管原位癌(DCIS)的MRI形态及动态增强表现,提高对DCIS的认识,为早期发现及制定治疗计划提供影像支持.方法回顾性分析经手术病理证实,术前行乳腺MR检查的纯DCIS 44例,DCIS伴微浸润27例,共71例,将其分成N1(乳腺纯DCIS)和N2(DCIS伴微浸润)2组.参照乳腺影像报告和数据系统(BI-RADS)标准,所有可疑病灶定义为斑点状(直径＜5 mm)、肿块和非肿块3类.描述病灶形态特征(M1=斑点状,M2=线样、线样导管样,M3=导管分支样,M4=段样,M5=局灶性,M6=区域性,M7=弥漫性,M8=肿块)和时间-信号强度曲线(TIC,Ⅰ型=持续上升型,Ⅱ型=平台型,Ⅲ型=廓清型,Ⅳ=与腺体同步强化).应用x2检验对病灶的形态学特征进行统计学分析.结果 71例共检出73个DCIS病灶.4个(5.5%)为斑点状病灶,64个(87.7%)为非肿块样病灶,5个(6.8%)为肿块样病灶.在64个非块样强化的病灶中,M3、M4、M5、M6分别有15、34、9和6个,其中以M3、M4最常见;在N1组(45个)中M3、M4、M5、M6分别有7、21、7和3个;N2组(28个)分别有8、13、2和3个;2组形态学表现差异无统计学意义(P＞0.05).64个非块样强化的病灶中31个内部不均匀强化,M3、M4均占35.5%(11/31);26个簇状小环状强化,M4占88.5%(23/26);网状强化4个;丛状强化2个;均匀强化1个.5个肿块样病灶中,N1组3个,N2组2个;4个形态呈分叶状;4个边缘毛刺,1个边缘光整;5个肿块均为不均匀强化.可绘制TIC的25个病灶中Ⅰ型8个,Ⅱ型11个,Ⅲ型3个,Ⅳ型3个.结论 DCIS的典型形态表现为M3、M4,其中以段样分布的成簇小环状强化最具特点.DCIS的TIC常表现为Ⅰ型和Ⅱ型.
목적 평고유선도관원위암(DCIS)적MRI형태급동태증강표현,제고대DCIS적인식,위조기발현급제정치료계화제공영상지지.방법 회고성분석경수술병리증실,술전행유선MR검사적순DCIS 44례,DCIS반미침윤27례,공71례,장기분성N1(유선순DCIS)화N2(DCIS반미침윤)2조.삼조유선영상보고화수거계통(BI-RADS)표준,소유가의병조정의위반점상(직경＜5 mm)、종괴화비종괴3류.묘술병조형태특정(M1=반점상,M2=선양、선양도관양,M3=도관분지양,M4=단양,M5=국조성,M6=구역성,M7=미만성,M8=종괴)화시간-신호강도곡선(TIC,Ⅰ형=지속상승형,Ⅱ형=평태형,Ⅲ형=곽청형,Ⅳ=여선체동보강화).응용x2검험대병조적형태학특정진행통계학분석.결과 71례공검출73개DCIS병조.4개(5.5%)위반점상병조,64개(87.7%)위비종괴양병조,5개(6.8%)위종괴양병조.재64개비괴양강화적병조중,M3、M4、M5、M6분별유15、34、9화6개,기중이M3、M4최상견;재N1조(45개)중M3、M4、M5、M6분별유7、21、7화3개;N2조(28개)분별유8、13、2화3개;2조형태학표현차이무통계학의의(P＞0.05).64개비괴양강화적병조중31개내부불균균강화,M3、M4균점35.5%(11/31);26개족상소배상강화,M4점88.5%(23/26);망상강화4개;총상강화2개;균균강화1개.5개종괴양병조중,N1조3개,N2조2개;4개형태정분협상;4개변연모자,1개변연광정;5개종괴균위불균균강화.가회제TIC적25개병조중Ⅰ형8개,Ⅱ형11개,Ⅲ형3개,Ⅳ형3개.결론 DCIS적전형형태표현위M3、M4,기중이단양분포적성족소배상강화최구특점.DCIS적TIC상표현위Ⅰ형화Ⅱ형.
Objective To evaluate and recognize the dynamic and morphological MRI charactristics of ductal carcinoma in situ (DCIS) of the breast and provide imaging information for the early detection and treatment planning Methods All MRI data in 71 patients with histollogically proved DCIS were analyzed retrospectively. The 71 patients were divided into two groups, NI ( pure DCIS, 44 patients) and N2 ( DCIS with microinvasion, 27 patients). According to the BI-RADS descriptors, all lesions were defined as a focus (smaller than 5 mm in diameter), mass and no-mass-like three enhancement types. The morphological features (M1 = focus, M2 = linear or linear-branched, M3 = branching-ductal, M4 = segmental, M5 = focal,M6 = regional, M7 = diffuse, M8 = mass) and the time-intensity curve (TIC) pattern [type l ( persistent enhancement curves), type Ⅱ( plateau), type Ⅲ(washout) and type Ⅳ (the same enhancement as glandular tissue)] were described. Chi-square test was used for the morphological characteristics of lesions.Results The 73 DCIS lesions were found in 71 patients, and 5.5% (n =4) were stippled lesions, 87.7%( n =64) were no-mass-like lesions, 6.8%(n=5) were mass-like lesions. In no-mass-like lesions (n=64), M3 was found in 15 cases, M4 in 34 cases, M5 in 9 cases and M6 in 6 cases, respectively, M3 and M4 were the most common distribution patterns. In N1 group(n =45) and N2 group (n =28), M3, M4,M5, M6 were found in 7 and 8, 21 and 13, 7 and 2, 3 and 3 cases, respectively. There were no statistic differences between two groups (P＞0.05). In 31 showed heterogeneous enhancement, both M3 and M4 were observed in 35.5% (11/31). In 26 clustered ring enhancement lesions, M4 was observed in 88.5% (23/26). Four lesions showed reticular enhancement,2 lesions showed a clumped enhancement and 1 lesion showed homogeneous enhancement. In 5 mass-like lesions, N1 group had 3 cases, N2 group had 2 cases.Four lesions showed lobulated margin, 4 lesions showed speculated margin, 1 mass showed smooth margin.Five mass showed heterogeneous enhancement. Type Ⅰ , type Ⅱ , type Ⅲ and type Ⅳ TIC ( n = 25) were demonstrated in 8, 11, 3 and 3 lesions, respectively. Conclusions M3, M4, especially segmental clustered ring enhancement, are the most common morphological characteristics of DCIS. Type Ⅰ and type Ⅱ TIC are the most common types.