作　　者： (高欣）; (周丽娟）; (徐孝秋）; (武江芬）; (曹鹏）; (杨晓春）; (沈钧康）;

机构地区： 苏州大学附属第二医院影像科,215004

出　　处： 《中华放射学杂志》 2017年第8期583-587,共5页

摘　　要： 目的 探讨扩散峰度成像（DKI）对乳腺良、恶性病变的鉴别诊断价值.方法 回顾性分析经手术或穿刺病理证实的72例（75个病灶）乳腺病变患者资料.良性病变30例（32个病灶）,恶性病变42例（43个病灶）.患者均行乳腺横断面T1WI、T2WI、抑脂T2WI、多b值DWI及动态对比增强（DCE）-MRI检查.测量病灶单指数模型的ADC值,DKI模型的非高斯分布的表观扩散系数（D）值和峰度系数（K）值.采用乳腺影像报告和数据系统（BI-RADS）对病灶进行描述分类,将BI-RADS 4B类及以上类别定为恶性.采用独立样本t检验比较良、恶性病变间的ADC、D及K值的差异.采用ROC评价ADC、D、K值及BI-RADS分类诊断乳腺良、恶性病变的效能.应用χ2检验比较良、恶性病变间病变形态及时间-信号曲线（TIC）类型等的差异.结果 乳腺恶性病变的ADC、D值均低于良性病变,而K值高于良性病变,差异均有统计学意义（P均＜0.01）.乳腺良恶性病变的形状、边缘、强化方式、TIC和BI-RADS分类的差异均有统计学意义（P均＜0.05）.采用ADC、D、K、DCE-MRI、DCE-MRI联合K值诊断乳腺良、恶性病变的ROC下面积分别为0.857、0.884、0.949、0.806和0.958,DCE-MRI联合K值的诊断效能最大.以K=0.856为阈值,诊断敏感度和特异度分别为83.7%和93.8%.结论 DKI对乳腺良、恶性病变的诊断效能优于传统DWI,DCE-MRI联合K值能提高诊断效能. Objective To evaluate the role of the diffusion kurtosis imaging（DKI）in the differential diagnosis of breast lesions. Methods Seventy five breast lesions（32 benign and 43 malignant）in 72 patients confirmed by histopathology were studied. All patients underwent 3.0 T MR examinations, including T1WI, T2WI, T2WI-spectral adiabatic inversion recovery, 4b diffusion-weighted imaging, and dynamic contrast-enhanced MR imaging（DCE-MRI）. Data were post-processed by mono-exponential and diffusion kurtosis models for quantitation of ADC, apparent diffusion for non-Gaussian distribution（D）, and apparent kurtosis coefficient（K）. All breast lesions were described with the classification by breast imaging report and data system（BI-RADS）. Lesions with BI-RADS class 4B or above were rated as malignancy. Independent sample t test was used to compare the ADC, D, and K value differences between benign and malignant lesions . ROC analysis was performed to assess the role of ADC, D, K value, and BI-RADS in the differential diagnosis of breast lesions. The morphological characteristics, time-signal curve（TIC）type, and other differences between benign and malignant lesions were analyzed with Chi-square test. Results ADC and D values were significantly lower in malignant than in benign lesions（P〈0.01）. Conversely, K value was significantly higher in malignant lesions than in benign ones（P〈0.01）. The shape of the benign and malignant breast lesions, edge, enhancement mode, TIC, and BI-RADS classification difference had statistical significance（P〈0.05, respectively）. The areas under the ROC curve of ADC, D, K, DCE-MRI, and DCE-MRI combined with K value were 0.857, 0.884, 0.949, 0.806, and 0.958, respectively. DCE-MRI combined with K value had the highest diagnosis efficiency. At a cutoff value of K= 0.856, the sensitivity and specificity were 83.7% and 93.8%, respectively. Conclusions DKI model showed higher diagnostic efficiency than that of traditional DWI model. DCE-MRI combined with K value

关 键 词： 乳腺肿瘤 磁共振成像 对比研究