中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2011年
12期
1117-1121
,共5页
朱萍%王亚非%黄昊%刘琴芳%谌业荣%单秀红%谭继善
硃萍%王亞非%黃昊%劉琴芳%諶業榮%單秀紅%譚繼善
주평%왕아비%황호%류금방%심업영%단수홍%담계선
乳腺疾病%磁共振成像,弥散
乳腺疾病%磁共振成像,瀰散
유선질병%자공진성상,미산
Breast diseases%Diffusion magnetic resonance imaging
目的 评价ADC值及相对ADC值(rADC)在乳腺结节病灶检查中的应用价值.方法 对52例66个乳腺结节病灶行MR DWI扫描,b值分别为0、800、1000 s/mm2,测量乳腺结节及同侧、对侧乳头层面未受累乳腺实质组织ADC值,计算rADC1(病灶ADC值/同侧未受累乳腺实质ADC值)及rADC2(病灶ADC值/对侧未受累乳腺实质ADC值),对所获资料采用两独立样本t检验、x2检验进行统计学分析.所有病灶均经穿刺活检或手术病理证实.结果 52例患者中,浸润性导管癌18例,纤维腺瘤34例,DWI显示50例,共64个病灶.b=800s/mm2时,良、恶性结节平均ADC值、同侧rADC800-1及对侧rADC800-2分别为(1.54±0.28)×10-3、(1.01±0.09)×10-3 mm2/s和0.77±0.15、0.52±0.07,0.76±0.14、0.51±0.06；其差异均有统计学意义(t值分别为8.217、9.339、10.394,P值均＜0.01)；以乳腺浸润性导管癌平均值95％参考值范围上限界值作为恶性病变上限阈值点,ADC值、rADC8o0-1及rADC800-2分别为1.05×10-3 mm2/s、0.55、0.53,诊断的敏感度分别为75.0％、65.0％、60.0％,特异度分别为100.0％、95.7％、97.8％,阳性预测值分别为100.0％、86.7％、92.3％,阴性预测值分别为90.2％、86.3％、84.9％,诊断符合率分别为92.4％、86.4％、86.4％.b=1000 s/mm2时,良、恶性结节平均ADC值、rADC1000-1及rADC1000-2分别为(1.45±0.28)×10-3、(0.93±0.08)×10-3mm2/s和0.75±0.16、0.53±0.09,0.74±0.15、0.52±0.07;其差异有统计学意义(t值分为11.844、5.820、8.082；P值均＜0.01)；ADC值、rADC1ooo-1及rADC1000-2阈值点分别为0.97×10-3 mm2/s、0.58、0.55,诊断的敏感度均为70.0％,特异度分别为100.0％、95.7％、93.5％,阳性预测值分别为100.0％、87.5％、82.4％,阴性预测值分别为88.5％、88.0％、87.8％,诊断符合率分别为90.9％、87.9％、86.5％.以上6种诊断方法的敏感度及诊断符合率差异无统计学意义(x2值分别为1.232、2.263,P值分别为0.942、0.812).结论 ADC值与rADC值均为鉴别良恶性乳腺病变的重要参数,尤其是b= 800 s/mm2时的ADC值临床应用价值最高.
目的 評價ADC值及相對ADC值(rADC)在乳腺結節病竈檢查中的應用價值.方法 對52例66箇乳腺結節病竈行MR DWI掃描,b值分彆為0、800、1000 s/mm2,測量乳腺結節及同側、對側乳頭層麵未受纍乳腺實質組織ADC值,計算rADC1(病竈ADC值/同側未受纍乳腺實質ADC值)及rADC2(病竈ADC值/對側未受纍乳腺實質ADC值),對所穫資料採用兩獨立樣本t檢驗、x2檢驗進行統計學分析.所有病竈均經穿刺活檢或手術病理證實.結果 52例患者中,浸潤性導管癌18例,纖維腺瘤34例,DWI顯示50例,共64箇病竈.b=800s/mm2時,良、噁性結節平均ADC值、同側rADC800-1及對側rADC800-2分彆為(1.54±0.28)×10-3、(1.01±0.09)×10-3 mm2/s和0.77±0.15、0.52±0.07,0.76±0.14、0.51±0.06；其差異均有統計學意義(t值分彆為8.217、9.339、10.394,P值均＜0.01)；以乳腺浸潤性導管癌平均值95％參攷值範圍上限界值作為噁性病變上限閾值點,ADC值、rADC8o0-1及rADC800-2分彆為1.05×10-3 mm2/s、0.55、0.53,診斷的敏感度分彆為75.0％、65.0％、60.0％,特異度分彆為100.0％、95.7％、97.8％,暘性預測值分彆為100.0％、86.7％、92.3％,陰性預測值分彆為90.2％、86.3％、84.9％,診斷符閤率分彆為92.4％、86.4％、86.4％.b=1000 s/mm2時,良、噁性結節平均ADC值、rADC1000-1及rADC1000-2分彆為(1.45±0.28)×10-3、(0.93±0.08)×10-3mm2/s和0.75±0.16、0.53±0.09,0.74±0.15、0.52±0.07;其差異有統計學意義(t值分為11.844、5.820、8.082；P值均＜0.01)；ADC值、rADC1ooo-1及rADC1000-2閾值點分彆為0.97×10-3 mm2/s、0.58、0.55,診斷的敏感度均為70.0％,特異度分彆為100.0％、95.7％、93.5％,暘性預測值分彆為100.0％、87.5％、82.4％,陰性預測值分彆為88.5％、88.0％、87.8％,診斷符閤率分彆為90.9％、87.9％、86.5％.以上6種診斷方法的敏感度及診斷符閤率差異無統計學意義(x2值分彆為1.232、2.263,P值分彆為0.942、0.812).結論 ADC值與rADC值均為鑒彆良噁性乳腺病變的重要參數,尤其是b= 800 s/mm2時的ADC值臨床應用價值最高.
목적 평개ADC치급상대ADC치(rADC)재유선결절병조검사중적응용개치.방법 대52례66개유선결절병조행MR DWI소묘,b치분별위0、800、1000 s/mm2,측량유선결절급동측、대측유두층면미수루유선실질조직ADC치,계산rADC1(병조ADC치/동측미수루유선실질ADC치)급rADC2(병조ADC치/대측미수루유선실질ADC치),대소획자료채용량독립양본t검험、x2검험진행통계학분석.소유병조균경천자활검혹수술병리증실.결과 52례환자중,침윤성도관암18례,섬유선류34례,DWI현시50례,공64개병조.b=800s/mm2시,량、악성결절평균ADC치、동측rADC800-1급대측rADC800-2분별위(1.54±0.28)×10-3、(1.01±0.09)×10-3 mm2/s화0.77±0.15、0.52±0.07,0.76±0.14、0.51±0.06；기차이균유통계학의의(t치분별위8.217、9.339、10.394,P치균＜0.01)；이유선침윤성도관암평균치95％삼고치범위상한계치작위악성병변상한역치점,ADC치、rADC8o0-1급rADC800-2분별위1.05×10-3 mm2/s、0.55、0.53,진단적민감도분별위75.0％、65.0％、60.0％,특이도분별위100.0％、95.7％、97.8％,양성예측치분별위100.0％、86.7％、92.3％,음성예측치분별위90.2％、86.3％、84.9％,진단부합솔분별위92.4％、86.4％、86.4％.b=1000 s/mm2시,량、악성결절평균ADC치、rADC1000-1급rADC1000-2분별위(1.45±0.28)×10-3、(0.93±0.08)×10-3mm2/s화0.75±0.16、0.53±0.09,0.74±0.15、0.52±0.07;기차이유통계학의의(t치분위11.844、5.820、8.082；P치균＜0.01)；ADC치、rADC1ooo-1급rADC1000-2역치점분별위0.97×10-3 mm2/s、0.58、0.55,진단적민감도균위70.0％,특이도분별위100.0％、95.7％、93.5％,양성예측치분별위100.0％、87.5％、82.4％,음성예측치분별위88.5％、88.0％、87.8％,진단부합솔분별위90.9％、87.9％、86.5％.이상6충진단방법적민감도급진단부합솔차이무통계학의의(x2치분별위1.232、2.263,P치분별위0.942、0.812).결론 ADC치여rADC치균위감별량악성유선병변적중요삼수,우기시b= 800 s/mm2시적ADC치림상응용개치최고.
Objective To estimate the applications of ADC value and rADC value in the diagnosis of nodular lesions of breasts.Methods Fifty-two cases with 66 nodular lesions of breasts confirmed by histopathology underwent diffusion-weighted magnetic resonance imaging.Three b values (0,800 and 1000 s/mm2) were applied.The mean ADC values of the breast nodules,the ADC values of ipsilateral breast( rADC1 ) and ADC values of contralateral breast (rADC2 )were respectively measured.The independent-samples t-test and chi-square test were used for statistical analyses.Results Of the 52 patients,there were 18 patients with infiltrating ductal carcinoma and 34 patients with fibroadenoma.50 patients with 64 lesions were examined by DWI.( 1 ) at b = 800 s/mm2,the mean ADC values of malignant nodules [ ( 1.01 ±0.09) × 10-3 mm2/s],rADC800-1 (0.52 ±0.07)and rADC800-2 (0.51 ±0.06) were lower than that of the benign nodules [ ADC value = ( 1.54 ± 0.28 ) × 10 -3 mm2/s,t = 8.217,P ＜ 0.01 ; rADC800-1 =0.77 ±0.15,t =9.339,P＜0.01 ; rADC800-2 =0.76 ±0.14,t = 10.394,P ＜0.01 ].The one-side upper limits of 95％ medical reference value of mean values of infiltrating ductal carcinoma were adopted as the threshold point to distinguish the malignant from the benign.The threshold value of breast malignant nodule ADC,the rADC800-1 and rADC800-2 were respectively 1.05 × 10-3 mm2/s,0.55 and 0.53.The sensitivities of the three methods were 75.0％,65.0％ and 60.0％ ; the specificities were 100.0％,95.7％ and 97.8％ ;the positive predictive values were respectively 100.0％,86.7％ and 92.3％ ; the negative predictive values were 90.2％,86.3％ and 84.9％; the diagnosis accordance rates were respectively 92.4％,86.4％ and 86.4％.( 2 ) at b = 1000 s/mm2,the mean ADC values of malignant nodules [ ( 0.93 ± 0.08 ) ×10-3 mm2/s],rADC1000-1 (0.53 ±0.09) and rADC1000-2 (0.52 ±0.07) were also lower than that of the benign nodules[ ADC value= (1.45 ±0.28) ×10-3 mm2/s,t=11.844,P＜0.01; rADC1000-1 =0.75 ±0.16,t=5.820,P ＜ 0.01 ; rADC1000-2 = 0.74 ± 0.15,t = 8.082,P ＜ 0.01 ].The threshold value points breast malignant nodule ADC,the rADC1000-1 and rADC1000-2 were respectively 0.97 × 10-3 mm2/s,0.58,0.55.The sensitivities were all 70.0％ ; the specificities were respectively 100.0％,95.7％ and 93.5％ ;the positive predictive values were 100.0％,87.5％ and 82.4％ ; the negative predictive values were 88.5％,88.0％ and 87.8％ ; the diagnosis accordance rates were 90.9％,87.9％ and 86.5％ respectively.There were no significant differences in specificities and the diagnosis accordance rates ( x2 = 1.232,2.263 ; P =0.942,0.812 ).Conclusions ADC value and rADC value are both important parameters of MRI in differentiating benign and malignant breast diseases.The study indicated that ADC value ( at b =800 s/mm2) was the most valuable parameter.
