CAJ | 학술논문

目的：探讨MRI对叶状肿瘤与纤维腺瘤鉴别诊断中的应用价值。材料与方法回顾性分析经手术或穿刺病理证实的23例乳腺叶状肿瘤(24个病灶)和59例乳腺纤维腺瘤(62个病灶)患者的MRI表现，采用χ2检验(Fisher精确概率法)和t检验进行统计学分析。结果叶状肿瘤的平均最大径大于纤维腺瘤，两者有统计学差异(P=0.004)。叶状肿瘤和纤维腺瘤的形状和边缘表现有统计学差异(P<0.05)；叶状肿瘤以分叶状形态多见(12/24，50.00%)，也可出现不规则形态(2/24，8.33%)；纤维腺瘤以类圆形(29/62，46.77％)和分叶状(27/62，43.55％)多见，无不规则形态出现。纤维腺瘤边缘多表现为光滑(58/62，93.55％)，边缘不规则少见；叶状肿瘤边缘不规则更多见：7个(29.17％)边缘不规则，1个出现毛刺。11例(11/24，45.83%)叶状肿瘤T1WI出现斑片状高信号(提示有出血)，纤维腺瘤无T1WI斑片状高信号表现。叶状肿瘤T2WI脂肪抑制上以高信号为主(21/24，87.5%)，无等或低信号出现；纤维腺瘤T2WI抑脂上等、低、高、混杂信号都有，以高信号为主(43/62，69.35％)；两者表现有统计学差异(P=0.025)。8例(8/24，33.33%)叶状肿瘤可见囊变区，纤维腺瘤无一例囊变表现。在强化方式和未强化的低信号分隔方面两者无明显统计学差异。在曲线类型上，叶状肿瘤以Ⅱ型多见，纤维腺瘤以Ⅰ型多见；Ⅲ型曲线更多见于叶状肿瘤，两者表现有统计学差异(P=0.008)。在平均ADC值方面，叶状肿瘤与纤维腺瘤无明显统计学差异(P=0.068)。结论叶状肿瘤与纤维腺瘤在MRI表现上存在差异，应用动态增强MR检查能够提高叶状肿瘤与纤维腺瘤的鉴别诊断。
목적：탐토MRI대협상종류여섬유선류감별진단중적응용개치。재료여방법회고성분석경수술혹천자병리증실적23례유선협상종류(24개병조)화59례유선섬유선류(62개병조)환자적MRI표현，채용χ2검험(Fisher정학개솔법)화t검험진행통계학분석。결과협상종류적평균최대경대우섬유선류，량자유통계학차이(P=0.004)。협상종류화섬유선류적형상화변연표현유통계학차이(P<0.05)；협상종류이분협상형태다견(12/24，50.00%)，야가출현불규칙형태(2/24，8.33%)；섬유선류이류원형(29/62，46.77％)화분협상(27/62，43.55％)다견，무불규칙형태출현。섬유선류변연다표현위광활(58/62，93.55％)，변연불규칙소견；협상종류변연불규칙경다견：7개(29.17％)변연불규칙，1개출현모자。11례(11/24，45.83%)협상종류T1WI출현반편상고신호(제시유출혈)，섬유선류무T1WI반편상고신호표현。협상종류T2WI지방억제상이고신호위주(21/24，87.5%)，무등혹저신호출현；섬유선류T2WI억지상등、저、고、혼잡신호도유，이고신호위주(43/62，69.35％)；량자표현유통계학차이(P=0.025)。8례(8/24，33.33%)협상종류가견낭변구，섬유선류무일례낭변표현。재강화방식화미강화적저신호분격방면량자무명현통계학차이。재곡선류형상，협상종류이Ⅱ형다견，섬유선류이Ⅰ형다견；Ⅲ형곡선경다견우협상종류，량자표현유통계학차이(P=0.008)。재평균ADC치방면，협상종류여섬유선류무명현통계학차이(P=0.068)。결론협상종류여섬유선류재MRI표현상존재차이，응용동태증강MR검사능구제고협상종류여섬유선류적감별진단。
Objective:To evaluate the MRI appearance of phyllodes breast tumors and to differentiate them from ifbroadenomas. Materials and Methods:MR images were obtained on GE medical system 3.0-T imager. MR images of 23 patients with 24 phyllodes breast tumors proved by surgery or biopsy pathology were retrospectively analyzed. The results were compared with the MRI appearance of 62 ifbroadenomas of 59 patients by using Chi-square test Fisher’s Exact test and t test. Results:There is statistical difference (P=0.004) in average maximum diameter between phyllodes breast tumor and ifbroadenomas. Still, there is another statistical difference (P<0.05) in tumor shape and edge between the both. Phyllodes tumors show as lobulated shape commonly (12/24, 50.00%) or irregular shape sometimes (2/24, 8.33%), while ifbroadenomas show as quasi-circular shape (29/62, 46.77%) or lobulated shape (27/62, 43.55%) commonly and no irregular shape seen. In the aspects of tumor edge, most ifbroadenomas show smoothly (58/62, 93.55%) and less irregular edge. On the contrary, phyllodes tumors have more irregular edges (7 tumors with irregular edges (29.17%) and 1 tumor with spiculation). Meanwhile, 11 (11/24, 45.83%) phyllodes tumors show patchy hyperintense (bleeding tip) on T1WI compared with ifbroadenomas, which has no this kind of signal. On T2WI fat saturation, it shows statistical difference (P=0.025) that phyllodes tumors have hyperintense mostly (21/24, 87.5%) with no isointense or hypointense and fibroadenomas have isointense, hypointense and mixed signal as well as hyperintense (43/62, 69.35%). Furthermore, cystic change area is to be seen in 8 (8/24, 33.33%) phyllodes tumors and no this kind of area in ifbroadenomas. In terms of enhanced low signal lace and no-enhanced one, both tumors have not evidently statistical difference. Regarding of curve characteristic, the statistical difference (P=0.008) has showed that II type and III type is mostly seen in phyllodes tumors I type is seen at most in ifbroadenomas. Finally, there is no evidently statistical difference (P=0.068) of average ADC between both tumors. Conclusions:There are differences between the phyllodes breast tumors and ifbroadenomas on MRI performance. Several DCE-MR ifndings can be used to help differentiation of phyllodes breast tumors from ifbroadenomas.