中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
8期
3324-3328
,共5页
钟井松%陈君坤%陈小宇%张维珍
鐘井鬆%陳君坤%陳小宇%張維珍
종정송%진군곤%진소우%장유진
乳腺肿瘤%磁共振成像,弥散%诊断
乳腺腫瘤%磁共振成像,瀰散%診斷
유선종류%자공진성상,미산%진단
Breast neoplasms%Diffusion magnetic resonance imaging%Diagnosis
目的评价磁共振弥散加权成像（ diffusion-weighted imaging ，DWI）及其表观扩散系数（ appar-ent diffusion coefficient ，ADC）在乳腺良、恶性结节鉴别诊断中的价值。方法回顾性分析56例患有乳腺结节性疾病患者及13例健康女性志愿者（对照组）乳腺MRI资料，所有病例全部行MRI常规成像、DWI检查，扩散敏感系数（ b值）取0、500、1000 s/mm2。观察分析病变在MRI常规平扫、DWI图像的信号特征，测量不同b值感兴趣区（ ROI）的ADC值。根据手术病理，按照恶性结节、良性结节、正常腺体分为三组，比较各组之间的ADC值，采用单因素方差分析统计分析，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、准确度，并与形态学评价相结合，确定合适的b值和阈值。结果当b＝500、1000 s/mm2时，恶性结节、良性结节及正常腺体的平均ADC值两两之间均有统计学差异（ P＜0.05）。同一b值下，乳腺恶性结节较良性结节和正常腺体明显低，而良性结节平均ADC值较正常腺体低。通过受试者工作特征曲线（ ROC curve），确定不同b值下诊断乳腺良、恶性结节的ADC阈值，当b＝500 s/mm2阈值为1.202×10-3 mm2/s；b＝1000 s/mm2阈值为1.117×10-3 mm2/s。结论 ADC值分析结合DWI图像对乳腺良、恶性结节的鉴别诊断有重要价值。
目的評價磁共振瀰散加權成像（ diffusion-weighted imaging ，DWI）及其錶觀擴散繫數（ appar-ent diffusion coefficient ，ADC）在乳腺良、噁性結節鑒彆診斷中的價值。方法迴顧性分析56例患有乳腺結節性疾病患者及13例健康女性誌願者（對照組）乳腺MRI資料，所有病例全部行MRI常規成像、DWI檢查，擴散敏感繫數（ b值）取0、500、1000 s/mm2。觀察分析病變在MRI常規平掃、DWI圖像的信號特徵，測量不同b值感興趣區（ ROI）的ADC值。根據手術病理，按照噁性結節、良性結節、正常腺體分為三組，比較各組之間的ADC值，採用單因素方差分析統計分析，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、準確度，併與形態學評價相結閤，確定閤適的b值和閾值。結果噹b＝500、1000 s/mm2時，噁性結節、良性結節及正常腺體的平均ADC值兩兩之間均有統計學差異（ P＜0.05）。同一b值下，乳腺噁性結節較良性結節和正常腺體明顯低，而良性結節平均ADC值較正常腺體低。通過受試者工作特徵麯線（ ROC curve），確定不同b值下診斷乳腺良、噁性結節的ADC閾值，噹b＝500 s/mm2閾值為1.202×10-3 mm2/s；b＝1000 s/mm2閾值為1.117×10-3 mm2/s。結論 ADC值分析結閤DWI圖像對乳腺良、噁性結節的鑒彆診斷有重要價值。
목적평개자공진미산가권성상（ diffusion-weighted imaging ，DWI）급기표관확산계수（ appar-ent diffusion coefficient ，ADC）재유선량、악성결절감별진단중적개치。방법회고성분석56례환유유선결절성질병환자급13례건강녀성지원자（대조조）유선MRI자료，소유병례전부행MRI상규성상、DWI검사，확산민감계수（ b치）취0、500、1000 s/mm2。관찰분석병변재MRI상규평소、DWI도상적신호특정，측량불동b치감흥취구（ ROI）적ADC치。근거수술병리，안조악성결절、량성결절、정상선체분위삼조，비교각조지간적ADC치，채용단인소방차분석통계분석，병회제ROC곡선검험진단효능，계산불동역치하，ADC치진단적민감도、특이도、준학도，병여형태학평개상결합，학정합괄적b치화역치。결과당b＝500、1000 s/mm2시，악성결절、량성결절급정상선체적평균ADC치량량지간균유통계학차이（ P＜0.05）。동일b치하，유선악성결절교량성결절화정상선체명현저，이량성결절평균ADC치교정상선체저。통과수시자공작특정곡선（ ROC curve），학정불동b치하진단유선량、악성결절적ADC역치，당b＝500 s/mm2역치위1.202×10-3 mm2/s；b＝1000 s/mm2역치위1.117×10-3 mm2/s。결론 ADC치분석결합DWI도상대유선량、악성결절적감별진단유중요개치。
Objective To evaluate the value of MRI diffusion-weighted imaging ( DWI ) and apparent diffusion coefficient ( ADC) values analysis in differential diagnosis between benign and malignant breast nodules . Methods Breast MRI findings were analysized of 56 patients suffering from breast nodular disease and 13 healthy female volunteers (control group) retrospectively.All subjects were tested with conventional imaging of MRI ,and DWI,with diffusion-sensitive coefficients (b-value) being set at 0,500,1000 s/mm2.The signal characteristics of the lesions observed in a conventional MRI scan ,DWI image were analyzed.The ADC values of regions of interest ,ROI were measured at different b-values .According to the surgical pathology , Malignant nodules , benign nodules and normal glands were divided into 3 categories .The ADC values among the 3 categories were compared using one-way ANOVA.Receiver Operating Characteristic curves ( ROC) were drawn to evaluate the diagnostic performance .The diagnostic sensitivity , specificity, and accuracy of ADC values were evaluated under different thresholds , which combined with morphological evaluations , in order to determine appropriate b-value and threshold .Results Using b=500 and 1000 s/mm2 ,there were significant statistical difference in mean ADC values between any two groups of the 3 categories(P<0.05).The mean ADC values in malignant and benign nodules were lower than that in normal gland tissue with the same b-value.The ADC threshold was determined to diagnose benign and malignant breast nodules under different b-values with ROC curves .When using b=500 s/mm2 ,threshold=1.202 ×10 -3 mm2/s or when using b=1000 s/mm2 ,threshold=1.117 ×10 -3 mm2/s.Conclusion ADC values combined the imagings of DWI were of important significance for differentiating benign from malignant breast nodules .
