CAJ | 학술논문

背景与目的：乳腺导管原位癌(ductal carcinoma in situ，DCIS)属于乳腺浸润性癌的前驱病变，是一类非全身性的导管内局部病变，与其他导管内病变在影像上存在相似之处。本研究旨在探讨乳腺MRI鉴别诊断DCIS与其他乳腺导管内病变的价值。方法：回顾性分析2011年7月-2012年2月于复旦大学附属肿瘤医院行乳腺MRI检查并经手术病理证实的DCIS患者24例、DCIS伴微浸润(breast ductal carcinoma in situ with microinvasion，DCIS-MI)9例、乳腺导管内乳头状瘤(breast intraductal papilloma，BIDP)20例临床资料。以DCIS为研究主体，分析3种病变MRI及动态增强表现。结果：DCIS与DCIS-MI的病灶强化形态、强化方式、时间-信号强度曲线(TIC)、病灶伪彩图像间差异均无统计学意义(P＞0.05)，而DCIS与BIDP的病灶强化形态、强化方式、TIC、病灶伪彩图像间差异均有统计学意义(P＜0.05)。DCIS以导管样(8/24)及段样强化(6/24)为主、病灶伪彩图像为红色(22/24)、TIC以Ⅲ型(12/24)为主要特征性表现；BIDP以乳头后局灶性强化为主(13/20)、病灶伪彩图像为非红色(14/20)、TIC以Ⅱ型(11/20)为主要特征性表现。结论：MRI较难鉴别DCIS与DCIS-MI，但具有鉴别诊断DCIS与BIDP的价值。
배경여목적：유선도관원위암(ductal carcinoma in situ，DCIS)속우유선침윤성암적전구병변，시일류비전신성적도관내국부병변，여기타도관내병변재영상상존재상사지처。본연구지재탐토유선MRI감별진단DCIS여기타유선도관내병변적개치。방법：회고성분석2011년7월-2012년2월우복단대학부속종류의원행유선MRI검사병경수술병리증실적DCIS환자24례、DCIS반미침윤(breast ductal carcinoma in situ with microinvasion，DCIS-MI)9례、유선도관내유두상류(breast intraductal papilloma，BIDP)20례림상자료。이DCIS위연구주체，분석3충병변MRI급동태증강표현。결과：DCIS여DCIS-MI적병조강화형태、강화방식、시간-신호강도곡선(TIC)、병조위채도상간차이균무통계학의의(P＞0.05)，이DCIS여BIDP적병조강화형태、강화방식、TIC、병조위채도상간차이균유통계학의의(P＜0.05)。DCIS이도관양(8/24)급단양강화(6/24)위주、병조위채도상위홍색(22/24)、TIC이Ⅲ형(12/24)위주요특정성표현；BIDP이유두후국조성강화위주(13/20)、병조위채도상위비홍색(14/20)、TIC이Ⅱ형(11/20)위주요특정성표현。결론：MRI교난감별DCIS여DCIS-MI，단구유감별진단DCIS여BIDP적개치。
Background and purpose: Ductal carcinoma in situ (DCIS), is precursor lesions of invasive breast cancer, belongs to non-systemic ductal lesions, which is similar to other ductal lesions on imaging. This study aimed to investigate the differential diagnostic value of MRI in DCIS between DCIS with microinvasion (DCIS-MI) and breast intraductal papilloma (BIDP). Methods:All the cases were surgico-pathologically conifrmed. Twenty-four patients were DCIS, 9 patients were DCIS-MI, and 20 patients were BIDP. The MRI charateristics of DCIS, DCIS-MI and BIDP were analyzed and compared. Results:DCIS and DCIS-MI’s performance in the form of MRI is dififcult to differentiate (P<0.05). Compared with BIDP, the ductal and segmental enhancement, typeⅢtime-signal intensity curve (TIC), and the red pseudo-color image were associated with the DCIS. The local area enhancement, typeⅡTIC, and no-red pseudo-color image were associated with BIDP. Conclusion:MRI is a useful for differentiate between DCIS and BIDP, but is dififcult for DCIS and DCIS-MI.