磁共振体素内不相干运动定量评估乳腺良恶性病变的价值

doi:10.3969/j.issn.2095-9400.2020.03.009

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摘要目的：讨论磁共振体素中不相干运动（IVIM）扩散加权成像（DWI）的定量参数值在乳腺良恶性病变评价中的意义。方法：收集温州医科大学附属第二医院2017年1月至12月期间行乳腺MR检查并经病理证实乳腺病变的50例患者，所有患者进行多b值DWI（b=0～2 000 s/mm2）检查，测定相应乳腺病变IVIM的定量参数，包括标准化表观扩散系数（ADC standard）、真实扩散系数（D）、假性扩散系数（D*）和灌注分数（f）。根据病理结果，将患者分为2组，其中21例为恶性（恶性组），29例为良性（良性组）；对2组病变的IVIM参数进行统计学分析，比较2组间的差异，绘制ROC曲线并分析其诊断效率。结果：良性组和恶性组的ADC standard和D值差异有统计学意义（P＜0.05），D*值与f值差异无统计学意义（P＞0.05）。在恶性组中，ADC standard、D值分别是（1.10±0.38）×10-3 mm2/s、（0.88±0.24）×10-3 mm2/s，明显低于良性组的（1.69±0.26）×10-3 mm2/s、（1.56±0.25）×10-3 mm2/s，ADC standard和D值诊断良恶性病变的ROC曲线下面积为0.879、0.966，诊断的最佳阈值为1.26×10-3 mm2/s、1.18×10-3 mm2/s，ADC standard对乳房的良恶性肿瘤敏感度和特异度分别为83.33%、95.45%，D值的敏感度和特异度分别为91.67%和90.91%。结论：IVlM模型获得的定量参数有助于对乳腺良恶性病变进行鉴别诊断，其中D值是判别良恶性乳腺病变的最佳诊断指标。

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	谢筱筱
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	严志汉
	程建敏

关键词 ：乳腺肿瘤, 弥散磁共振成像, 体素内不相干运动

Abstract：Objective: To evaluate the quantitative parameter values of incoherent motion diffusion weighted imaging (IVIM) in magnetic resonance magnetins for the diagnosis of mammary good malignant lesions. Methods: Totally 50 cases who underwent breast MR and confirmed pathologically were collected from January to December, 2017 in the Second Affiliated Hospital of Wenzhou Medical University. Multiple b-value DWI (b=0-2 000 s/mm2) was examined for all patients, and quantitative parameters of IVIM disease levels were measured, including standardized epigenetic diffusion coefficient (ADC standard), true diffusion coefficient (D), false diffusion coefficient (D*) and perfusion score (f). According to their pathological results, the patients were divided into 2 groups, with 21 malignant (malignant group) and 29 benign (benign group). Their IVIM parameters of lesions were statistically analyzed, the differences between the two groups were compared, the ROC curve drawn, and the diagnostic efficiency was analyzed. Results: There was significant difference between the benign group and the malignant group in ADC standard and D value (P<0.05), while there was no statistical difference between the D*-value and the f-value (P>0.05). In the malignant group, the ADC standard and D values were (1.10±0.38)×10-3 mm2/s, (0.88±0.24)× 10-3 mm2/s, significantly lower than the ADC standard and D values in the benign group (1.69±0.26)×10-3 mm2/s, (1.56±0.25)×10-3 mm2/s, ADC standard and D value diagnosed as good malignant lesions ROC area 0.879, 0.966, best threshold for diagnosis is 1.26×10-3 mm2/s, 1.18×10-3 mm2/s. ADC standard’s sensitivity and specificity to good malignant tumors in the breast were 83.33% and 95.45% respectively, and the sensitivity and specificity of D value were 91.67% and 90.91% respectively. Conclusion: The quantitative parameters obtained by the IVlM model are helpful to the differential diagnosis of mammary malignant lesions, of which the D value is the best diagnostic index to distinguish between good malignant mammopathy.

Key words： breast neoplasms diffusion magnetic resonance imaging intravoxel incoherent motion

基金资助:浙江省自然科学基金资助项目（GD20C060002）；温州市公益性社会发展科技项目（Y20170809）。

通讯作者: 程建敏，主任医师，硕士生导师，Email：chengjm@wzhealth.com。

作者简介: 谢筱筱（1982-），女，浙江乐清人，主治医师，在职博士生。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.03.009 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I3/212

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