中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2010年
5期
459-464
,共6页
叶芳%曾蒙苏%严福华%张博恒%周梅玲%单艳%李韧晨
葉芳%曾矇囌%嚴福華%張博恆%週梅玲%單豔%李韌晨
협방%증몽소%엄복화%장박항%주매령%단염%리인신
乳腺肿瘤%磁共振成像,弥散
乳腺腫瘤%磁共振成像,瀰散
유선종류%자공진성상,미산
Breast neoplasms%Diffusion magnetic resonance imaging
目的 评价ADC值在不同强化形态及不同肿块大小的乳腺病灶中的诊断价值.方法 136个经手术病理证实的乳腺病灶,根据其不同的强化形态及大小分为3组,分别为非肿块样强化组(G1)、最大径≤2.0 cm的肿块样强化组(G2a)、最大径＞2.0 cm的肿块样强化组(G2b).采用单激发EPI序列,3个扩散敏感梯度,b值分别为0、800、1000 s/mm2.两样本比较t检验分析各组内恶性与非恶性病灶平均ADC值的差异有无统计学意义,并绘制ROC曲线检验诊断效能.计算不同阈值下,ADC值诊断的敏感度、特异度、阴性预测值、阳性预测值、诊断符合率,并与形态学评价相结合,确定合适的b值和阈值.结果 G1组恶性与非恶性病灶的平均ADC值的差异无统计学意义[恶性病灶与非恶性病灶b=800 mm2/s时,平均ADC值分别为(1.13±0.23)×10-3和(1.28±0.27)×10-3mm2/s,t=1.636,P=0.112;b=1000 mm2/s时,平均ADC值分别为(1. 05±0.20)×10-3和(1.20±0.23)×10-3mm2/s,t=1.720,P=0.109];G2a组恶性与非恶性病灶平均ADC值的差异有统计学意义[恶性病灶与非恶性病灶b=800 mm2/s时,平均ADC值分别为(1.07±0.15)×10-3和(1.37±0.37)×10-3mm2/s,t=4.803,P=0.000;b=1000 mm2/s时,平均ADC值分别为(0.99±0.14)×10-3和(1.30±0.34)×10-3mm2/s,t=5.235,P=0.000];G2b组恶性与非恶性病灶平均ADC值的差异有统计学意义[恶性病灶与非恶性病灶b=800 mm2/s时,平均ADC值分别为(0.97±0.14)×10-3和(1.40±0.39)×10-3mm2/s,t=4.227,P=0.000;b=1000 mm2/s时,恶性病灶与非恶性病灶的平均ADC值分别为(0.93±0.14)×10-3和(1.35±0.36)×10-3mm2/s,t=4.329,P=0.000].b选取800或1000 s/mm2时,ADC值在肿块样强化组中的诊断效能相同(x2=0.36,P=0.5460).当b值取1000 s/mm2,阈值取1.25×10-3s/mm2时,ADC值诊断乳腺恶性病灶的敏感度和阴性预测值最高,分别为97.7%和97.1%.结论 ADC值对于肿块样强化的乳腺病灶具有诊断价值,但不适用于非肿块样强化灶的诊断.
目的 評價ADC值在不同彊化形態及不同腫塊大小的乳腺病竈中的診斷價值.方法 136箇經手術病理證實的乳腺病竈,根據其不同的彊化形態及大小分為3組,分彆為非腫塊樣彊化組(G1)、最大徑≤2.0 cm的腫塊樣彊化組(G2a)、最大徑＞2.0 cm的腫塊樣彊化組(G2b).採用單激髮EPI序列,3箇擴散敏感梯度,b值分彆為0、800、1000 s/mm2.兩樣本比較t檢驗分析各組內噁性與非噁性病竈平均ADC值的差異有無統計學意義,併繪製ROC麯線檢驗診斷效能.計算不同閾值下,ADC值診斷的敏感度、特異度、陰性預測值、暘性預測值、診斷符閤率,併與形態學評價相結閤,確定閤適的b值和閾值.結果 G1組噁性與非噁性病竈的平均ADC值的差異無統計學意義[噁性病竈與非噁性病竈b=800 mm2/s時,平均ADC值分彆為(1.13±0.23)×10-3和(1.28±0.27)×10-3mm2/s,t=1.636,P=0.112;b=1000 mm2/s時,平均ADC值分彆為(1. 05±0.20)×10-3和(1.20±0.23)×10-3mm2/s,t=1.720,P=0.109];G2a組噁性與非噁性病竈平均ADC值的差異有統計學意義[噁性病竈與非噁性病竈b=800 mm2/s時,平均ADC值分彆為(1.07±0.15)×10-3和(1.37±0.37)×10-3mm2/s,t=4.803,P=0.000;b=1000 mm2/s時,平均ADC值分彆為(0.99±0.14)×10-3和(1.30±0.34)×10-3mm2/s,t=5.235,P=0.000];G2b組噁性與非噁性病竈平均ADC值的差異有統計學意義[噁性病竈與非噁性病竈b=800 mm2/s時,平均ADC值分彆為(0.97±0.14)×10-3和(1.40±0.39)×10-3mm2/s,t=4.227,P=0.000;b=1000 mm2/s時,噁性病竈與非噁性病竈的平均ADC值分彆為(0.93±0.14)×10-3和(1.35±0.36)×10-3mm2/s,t=4.329,P=0.000].b選取800或1000 s/mm2時,ADC值在腫塊樣彊化組中的診斷效能相同(x2=0.36,P=0.5460).噹b值取1000 s/mm2,閾值取1.25×10-3s/mm2時,ADC值診斷乳腺噁性病竈的敏感度和陰性預測值最高,分彆為97.7%和97.1%.結論 ADC值對于腫塊樣彊化的乳腺病竈具有診斷價值,但不適用于非腫塊樣彊化竈的診斷.
목적 평개ADC치재불동강화형태급불동종괴대소적유선병조중적진단개치.방법 136개경수술병리증실적유선병조,근거기불동적강화형태급대소분위3조,분별위비종괴양강화조(G1)、최대경≤2.0 cm적종괴양강화조(G2a)、최대경＞2.0 cm적종괴양강화조(G2b).채용단격발EPI서렬,3개확산민감제도,b치분별위0、800、1000 s/mm2.량양본비교t검험분석각조내악성여비악성병조평균ADC치적차이유무통계학의의,병회제ROC곡선검험진단효능.계산불동역치하,ADC치진단적민감도、특이도、음성예측치、양성예측치、진단부합솔,병여형태학평개상결합,학정합괄적b치화역치.결과 G1조악성여비악성병조적평균ADC치적차이무통계학의의[악성병조여비악성병조b=800 mm2/s시,평균ADC치분별위(1.13±0.23)×10-3화(1.28±0.27)×10-3mm2/s,t=1.636,P=0.112;b=1000 mm2/s시,평균ADC치분별위(1. 05±0.20)×10-3화(1.20±0.23)×10-3mm2/s,t=1.720,P=0.109];G2a조악성여비악성병조평균ADC치적차이유통계학의의[악성병조여비악성병조b=800 mm2/s시,평균ADC치분별위(1.07±0.15)×10-3화(1.37±0.37)×10-3mm2/s,t=4.803,P=0.000;b=1000 mm2/s시,평균ADC치분별위(0.99±0.14)×10-3화(1.30±0.34)×10-3mm2/s,t=5.235,P=0.000];G2b조악성여비악성병조평균ADC치적차이유통계학의의[악성병조여비악성병조b=800 mm2/s시,평균ADC치분별위(0.97±0.14)×10-3화(1.40±0.39)×10-3mm2/s,t=4.227,P=0.000;b=1000 mm2/s시,악성병조여비악성병조적평균ADC치분별위(0.93±0.14)×10-3화(1.35±0.36)×10-3mm2/s,t=4.329,P=0.000].b선취800혹1000 s/mm2시,ADC치재종괴양강화조중적진단효능상동(x2=0.36,P=0.5460).당b치취1000 s/mm2,역치취1.25×10-3s/mm2시,ADC치진단유선악성병조적민감도화음성예측치최고,분별위97.7%화97.1%.결론 ADC치대우종괴양강화적유선병조구유진단개치,단불괄용우비종괴양강화조적진단.
Objective To investigate the diagnostic value of ADC for breast lesions with different enhancement shape or mass size. Methods One hundred and thirty-six breast lesions confirmed by histopathology were included in this study. According to enhancement shape and size of the lesion, all lesions were divided into 3 groups: non-masslike enhancement ( G1 ), masslike enhancement with the largest diameter ＜ 2. 0 cm (G2a) and masslike enhancement with the largest diameter ＞ 2. 0 cm (G2b). Echo planar imaging DWI was performed and three b-values (0,500 and 1000 s/mm2) were applied. The t-test was used for testing the difference of ADC between malignant and non-malignant breast lesions in each group. ROC curve was deduced to test the diagnostic efficiency of ADC. The sensitivity, specificity, negative predictive value( NPV), positive predictive value(PPV) and accuracy of ADC for the diagnosis of breast lesions were calculated under the different threshold. Appropriate b value and threshold were determined with the combination of morphologic evaluation. Results There were no significant differences for the mean ADC values between malignant [b =800 mm2/s: ADC value = ( 1.13 ±0. 23) × 10-3 mm2/s,b=1000 mm2/s: ADC value = (1.05 ±0.20) × 10-3 mm2/s] and non-malignant breast lesions [b =800 mm2/s: ADC value = ( 1.28 ±0. 27) × 10-3 mm2/s, t = 1. 636, P =0. 112,b = 1000 mm2/s: ADC value=(1.20 ±0.23) × 10-3 mm2/s, t = 1.720, P =0. 109] in Group 1. The mean ADC values of malignant breast lesion [b =800 mm2/s: ADC value = (1.07 ±0. 15) × 10-3 mm2/s,b = 1000 mm2/s:ADC value = (0. 99 ±0. 14) × 10-3 mm2/s] were significantly lower than that of non-malignant lesion [b =800 mm2/s: ADC value = ( 1.37 ± 0. 37 ) × 10-3 mm2/s, t = 4. 803, P = 0. 000; b = 1000 mm2/s: ADC value= (1.30 ±0.34) × 10-3 mm2/s, t =4.227, P =0.000] in Group 2a. The mean ADC values of malignant breast lesion [b =800 mm2/s: ADC value = (0. 97 ±0. 14) × 10-3 mm2/s; b = 1000 mm2/s:ADC value = (0. 93 ±0. 14) × 10-3 mm2/s] were significantly lower than that of non-malignant lesion [b =800 mm2/s: ADC value = ( 1.40 ± 0. 39) × 10 -3 mm2/s, t = 4. 227, P = 0. 000; b = 1000 mm2/s: ADC value = ( 1.35 ±0. 36) × 10-3 mm2/s, t =4. 329, P =0. 000] in Group 2b. The diagnostic efficiency was equal( x2 =0. 36,P =0. 5460) whenever b value of 800 or 1000 s/mm2 was selected. The highest sensitivity (97.7%) and NPV (97. 1%) were obtained with b value of 1000 s/mm2 and threshold of 1.25 ×10 -3 s/mm2. Conclusion MR DWI is useful for the differential diagnosis of breast lesions with masslike enhancement rather than nonmasslike enhancement.
