CAJ | 학술논문

目的：分析乳腺病变术前 MRI 漏诊、高估、低估病例的临床、影像及病理特点，探讨 MRI 误诊原因。方法：回顾性分析行乳腺 MRI 检查并经手术病理证实的175名患者，共计222枚病灶的临床、影像及病理资料，分析其 MRI 表现特点并按 BI-RADS 分类进行评估；比较 MRI 对不同强化类型病灶诊断效能。以患者临床信息及 BI-RADS-MRI 词典为依据采用二元 logistic 回归分析建立模型预测病灶良恶性，并与评估结果对比，比较不同影像学表现对诊断结果的影响。结果：222枚病灶中良性161个、恶性61个。MRI 漏诊6个病理均为良性；低估4个病灶中3个含导管原位癌成分；高估14个病灶包括12个肿块型和2个非肿块强化病灶。ADC 值对肿块型病灶诊断效能高、AUC 达0．932，对非肿块强化病灶诊断效能较差；DCE-MRI 联合 DWI 诊断乳腺癌的敏感度93．4％，特异度91．3％，诊断准确度91．9％；MRI 对肿块型和非肿块强化病灶总体诊断效能无显著差异。结论：乳腺 DCE-MRI 联合 DWI 诊断乳腺恶性肿瘤的敏感度、特异度均较高，对肿块样强化与非肿块强化病灶的总体诊断效能相仿。低估的病灶病理以导管原位癌为主。医师进行 BI-RADS-MRI 分类评估时带有一定主观性，诊断结果有高估的趋势、同时减少大部分低估，对总体诊断准确性影响不大。
목적：분석유선병변술전 MRI 루진、고고、저고병례적림상、영상급병리특점，탐토 MRI 오진원인。방법：회고성분석행유선 MRI 검사병경수술병리증실적175명환자，공계222매병조적림상、영상급병리자료，분석기 MRI 표현특점병안 BI-RADS 분류진행평고；비교 MRI 대불동강화류형병조진단효능。이환자림상신식급 BI-RADS-MRI 사전위의거채용이원 logistic 회귀분석건립모형예측병조량악성，병여평고결과대비，비교불동영상학표현대진단결과적영향。결과：222매병조중량성161개、악성61개。MRI 루진6개병리균위량성；저고4개병조중3개함도관원위암성분；고고14개병조포괄12개종괴형화2개비종괴강화병조。ADC 치대종괴형병조진단효능고、AUC 체0．932，대비종괴강화병조진단효능교차；DCE-MRI 연합 DWI 진단유선암적민감도93．4％，특이도91．3％，진단준학도91．9％；MRI 대종괴형화비종괴강화병조총체진단효능무현저차이。결론：유선 DCE-MRI 연합 DWI 진단유선악성종류적민감도、특이도균교고，대종괴양강화여비종괴강화병조적총체진단효능상방。저고적병조병리이도관원위암위주。의사진행 BI-RADS-MRI 분류평고시대유일정주관성，진단결과유고고적추세、동시감소대부분저고，대총체진단준학성영향불대。
Objective:Joint analysis of clinical,MRI,and pathological features of missed,false-negative,and false-posi-tive lesions was performed to explore the causes of preoperative misdiagnosis.Methods:A consecutive cohort of 175 patients who underwent preoperative breast MRI with 222 pathologically confirmed lesions were retrospectively reviewed.Two breast imaging radiologists performed the MRI interpretation according to BI-RADS atlas.Comparison of MRI diagnostic performance between different lesion types was carried out.Logistic regression models were also established to differentiate benign and malignant lesions.Results:Of all 222 breast lesions (161 benign and 61 malignant),6 benign lesions were missed on MRI.Three in 4 false-negative lesions had ductal carcinoma in situ (DCIS)component.The other 14 lesions were overes-timated.ADC value worked great for masses with AUC of 0.932,but poor for non-mass enhanced NME lesions.The sensi-tivity,specificity,and accuracy of DCE-MRI combined with DWI were 93.4%,91.3%,and 91.9%,respectively.The overall accuracy of mass and NME lesions was similar.Conclusion:Accuracy of DCE-MRI combined with DWI was high in differen-tiating benign and malignant lesions,and similar in masses and NME lesions.Underestimated lesions were mainly DCIS.Ra-diologists tended to overestimate lesions and avoided underestimation at the same time,in that the overall accuracy was al-most unaffected.