CAJ | 학술논문

目的：探讨 MR-DWI 及其表观弥散系数（ADC）值对乳腺炎性病变与非肿块样强化乳腺恶性肿瘤鉴别诊断价值。方法：回顾性分析2013年1月-2014年2月经手术或穿刺活检病理确诊的乳腺炎性病变患者共32例与同时期非肿块样强化的乳腺恶性病变45例的乳腺 MR-DWI 表现及 ADC 值。32例炎性病变中12例为超声引导下穿刺活检病理证实，20例行手术病理证实，恶性病变均行手术治疗，获得组织病理结果证实。分析所有患者的术前 MRI 表现，包括 DWI图像中病变形态、信号表现，并测定 ADC 值，以探讨 MR-DWI 对乳腺炎性病变与非肿块强化恶性病变的鉴别诊断价值。结果：32例乳腺炎性病变 DWI 上全部检出，其中23例含脓肿或微脓肿病例，DWI 均可见不均匀高信号，部分可见显著高信号灶，边界清晰。与乳腺恶性肿瘤相比乳腺炎病例较多表现为 DWI 及 STIR 均呈高信号（P ＜0．01）；乳腺恶性肿瘤病例较乳腺炎病例多表现为 DWI 高信号、STIR 稍低信号（P ＜0．01）。32例乳腺炎病例的周围炎性渗出或增生肉芽组织ADC 值为（1．48±0．21）×10-3 mm2/s，其中23例含脓腔或微脓腔的乳腺炎性病变，其显著高信号脓腔的 ADC 值为（0．91±0．19）×10-3 mm2/s。45例乳腺恶性肿瘤实性成分的 ADC 值为（1．15±0．23）×10-3 mm2/s。结论：MR-DWI 联合 STIR 及 ADC 值对于非哺乳期乳腺炎性病变与非肿块样强化的乳腺恶性病变的鉴别诊断具有较大价值。
목적：탐토 MR-DWI 급기표관미산계수（ADC）치대유선염성병변여비종괴양강화유선악성종류감별진단개치。방법：회고성분석2013년1월-2014년2월경수술혹천자활검병리학진적유선염성병변환자공32례여동시기비종괴양강화적유선악성병변45례적유선 MR-DWI 표현급 ADC 치。32례염성병변중12례위초성인도하천자활검병리증실，20례행수술병리증실，악성병변균행수술치료，획득조직병리결과증실。분석소유환자적술전 MRI 표현，포괄 DWI도상중병변형태、신호표현，병측정 ADC 치，이탐토 MR-DWI 대유선염성병변여비종괴강화악성병변적감별진단개치。결과：32례유선염성병변 DWI 상전부검출，기중23례함농종혹미농종병례，DWI 균가견불균균고신호，부분가견현저고신호조，변계청석。여유선악성종류상비유선염병례교다표현위 DWI 급 STIR 균정고신호（P ＜0．01）；유선악성종류병례교유선염병례다표현위 DWI 고신호、STIR 초저신호（P ＜0．01）。32례유선염병례적주위염성삼출혹증생육아조직ADC 치위（1．48±0．21）×10-3 mm2/s，기중23례함농강혹미농강적유선염성병변，기현저고신호농강적 ADC 치위（0．91±0．19）×10-3 mm2/s。45례유선악성종류실성성분적 ADC 치위（1．15±0．23）×10-3 mm2/s。결론：MR-DWI 연합 STIR 급 ADC 치대우비포유기유선염성병변여비종괴양강화적유선악성병변적감별진단구유교대개치。
Objective:To investigate the values of diffusion weighted imaging (DWI)and apparent diffusion coeffi-cient (ADC)in differential diagnosis of inflammatory breast diseases and non-mass enhanced breast cancer.Methods:Thirty-two patients with inflammatory breast diseases and 45 patients with non-mass enhanced breast cancer were retrospectively reviewed,which were pathologically confirmed by core needle biopsy (n=12)or surgical excision (n=65).All the patients underwent MRI including DWI sequence before surgery or biopsy.Analysis of the morphology,signal intensity,and ADC value of the lesions were performed.Results:All the inflammatory diseases were detected on DWI,including 23 patients with abscesses or micro-abscesses.They showed heterogeneous high signal intensity,partially remarkable hyperintensity,and all the lesions had clear margins.High signal intensity on both DWI and STIR was more likely to be seen in inflammatory breast diseases than breast cancer (P <0.01 ).Breast cancer mostly showed a high signal intensity on DWI and a slightly low signal intensity on STIR (P <0.01).The average ADC value of inflammatory component or granulomatous tissues (n=32)was (1.48±0.21)×10 -3 mm2/s,the average ADC value of abscesses or micro-abscesses (n=23)was (0.91±0.19)× 10 -3 mm2/s.The average ADC value of breast cancer (n=45 )was (1.15 ±0.23 )× 10 -3 mm2/s.Conclusion:ADC value from DWI combining with STIR has a high value in differential diagnosis between non-lactating inflammatory breast disease and non-mass enhanced breast cancer.