MRI动态增强联合DWI在BI-RADS 4类乳腺病变鉴别诊断中的应用

doi:10.3760/cma.j.cn441417-20250331-18015

摘要/Abstract

摘要：

目的　探讨动态对比增强磁共振成像（DCE-MRI）联合弥散加权成像（DWI）在乳腺成像报告和数据系统（BI-RADS）4类乳腺病变鉴别诊断中的应用。方法　采用回顾性分析，收集2024年1月至12月延安市人民医院收治的90例乳腺超声提示为BI-RADS 4类病变患者临床资料，均为女性，年龄（46.52±5.77）岁；左胸49例，右胸41例；结节最大长径（2.95±0.82）cm。分析DCE-MRI联合DWI与病理学检查BI-RADS 4类乳腺病变的一致性；比较恶性组与良性组DCE-MRI参数［体积转移常数（K^trans）、反向回流速率常数（K_ep）、最大增强斜率（MSI）］及DWI参数［表观弥散系数（ADC）］的差异；统计学方法采用Student's t检验，受试者操作特征曲线（ROC）分析DCE-MRI与DWI参数在区分良性和恶性病变方面的性能。结果　病理学结果显示，90例患者中，恶性病变52例，良性病变38例。DCE-MRI、DWI及联合检查对BI-RADS 4类乳腺病变良恶性诊断的Kappa值分别为0.683、0.703、0.840；恶性组患者K^trans、K_ep、MSI均高于良性组，ADC值低于良性组，差异均有统计学意义（均P<0.05）；ROC结果显示，K^trans、K_ep、MSI、ADC值及联合参数在鉴别BI-RADS 4类乳腺病变良恶性中的曲线下面积分别为0.774、0.847、0.822、0.766、0.977，灵敏度分别为0.48、0.75、0.83、0.67、0.89，特异度分别为0.95、0.87、0.82、0.79、1.00。结论　DCE-MRI联合DWI在BI-RADS 4类乳腺病变良恶性诊断中具有巨大的应用潜力。

关键词:

弥散加权成像, 动态对比增强磁共振成像, BI-RADS 4类乳腺病变, 诊断价值

Abstract:

Objective　To explore the application of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with diffusion-weighted imaging (DWI) in the differential diagnosis of Breast Imaging Reporting and Data System (BI-RADS) type 4 breast lesions. Methods　By conducting a retrospective analysis, the clinical data of 90 patients with BI-RADS type 4 breast lesions indicated by breast ultrasound who were admitted to Yan'an People's Hospital from January to December 2024 were collected. All were female, with an average age of (46.52 ± 5.77) years; 49 cases were on the left side of the chest and 41 cases on the right; the maximum long diameter of the nodules was (2.95 ± 0.82) cm.The consistency between DCE-MRI combined with DWI and pathological examination of BI-RADS type 4 breast lesions was analyzed. The differences in DCE-MRI parameters [volume transfer constant (K^trans), reverse reflux rate constant (K_ep), maximum slope of increase (MSI)] and DWI parameter [apparent diffusion coefficient (ADC)] were compared between malignant group and benign group. The statistical method employed was Student's t-test. Receiver operating characteristic (ROC) curve was used to analyze the efficiency of DCE-MRI parameters and DWI parameter in distinguishing benign and malignant lesions. Results　Pathological results showed that 52 patients were malignant lesions and 38 patients were benign lesions. The consistency Kappa values of DCE-MRI, DWI, DCE-MRI combined with DWI in the diagnosis of benign and malignant BI-RADS type 4 breast lesions were 0.683, 0.703 and 0.840 respectively. The values of K^trans, K_ep and MSI in the malignant group were higher than those in the benign group, while the ADC value was lower than that in the benign group. The differences were all statistically significant (all P< 0.05). According to ROC curve analysis, the AUCs of K^trans, K_ep, MSI, ADC value and combination for benign and malignant BI-RADS type 4 breast lesions were 0.774, 0.847, 0.822, 0.766 and 0.977, and the sensitivities were 0.48, 0.75, 0.83, 0.67 and 0.89, and the specificities were 0.95, 0.87, 0.82, 0.79 and 1.00 respectively. Conclusion　DCE-MRI combined with DWI has great potential for the diagnosis of benign and malignant nature of BI-RADS type 4 breast lesions.

Key words:

Diffusion weighted imaging, Dynamic contrast-enhanced magnetic resonance imaging, BI-RADS type 4 breast lesions, Diagnostic value

吴鹏张宏霞白峥嵘陈海海.

MRI动态增强联合DWI在BI-RADS 4类乳腺病变鉴别诊断中的应用 [J]. 国际医药卫生导报, 2025, 31(18): 3071-3076.

Wu Peng, Zhang Hongxia, Bai Zhengrong, Chen Haihai.

Application of dynamic contrast-enhanced MRI combined with DWI in the differential diagnosis of BI-RADS type 4 breast lesions [J]. International Medicine and Health Guidance News, 2025, 31(18): 3071-3076.

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