潘淑淑 陈文辉★ 阮梅 汪荣

不同磁共振成像技术联合应用在BI-RADS4类乳腺病变中的诊断价值

潘淑淑 陈文辉★ 阮梅 汪荣

目的 探讨不同磁共振成像技术联合应用在BI-RADS4类乳腺病变中的的诊断价值。方法 回顾性分析经病理证实的106例BIRADS4类乳腺病变，对良恶性病变的形态、边缘、强化方式、表观扩散系数（ADC）值进行分析，并计算各种MRI征象及其联合应用的敏感度、特异度、准确度。结果 106例BI-RADS4类乳腺病变，恶性76例，良性30例，两者在边缘、强化方式、ADC值表现差异均具有统计学意义（P＜0.05），单一征象中强化方式的敏感度、准确度均最高，分别为84%、82%，ADC值的特异度最高为80%；两项影像征象联合中，强化方式+ADC值的敏感度、特异度、准确度均最高，分别为80%、90%、83%；三项MRI征象联合诊断中，病变边缘+强化方式+ADC值的敏感度、特异度、准确度均最高，分别为75%、100%、82%；四项MRI征象联合中，诊断的敏感度、特异度、准确度分别为59%、100%、71%。结论 不同MRI征象在鉴别BI-RADS4类乳腺良恶性病变有着重要意义，联合诊断的应用可明显提高病变诊断的特异度，减少误诊的发生。

乳腺肿瘤 乳腺影像报告与数据系统 磁共振成像 扩散加权成像

【Abstract】Objective To investigate the diagnosis value of magnetic resonance imaging（MRI）for the Breast Imaging and Reporting Data System（BI-RADS）category 4 breast lesions. Methods Analysis was made to the lesion shape，edge，enhancement pattern，ADC value，to distinguish between benign and malignant，and calculate the sensitivity，specificity，accuracy，based on the retrospectively analyzed 106 BI-RADS category 4 lesions which have been pathologically proven. Results There were 76 cases of malignant and 30 cases of benign in the totally 106 cases，both types had the statistical significance in the lesion edge，enhancement pattern and ADC value. Enhancement pattern showed the highest sensitivity （84%）and accuracy（82%），meanwhile，ADC value showed the highest specificity（80%），Combining two signs together，ADC value and enhancement pattern showed the highest sensitivity，specificity，and accuracy of 80%、90%and 83% respectively. Combining three signs together，lesion edge，enhancement pattern and ADC value，showed the highest sensitivity，specificity，and accuracy of 75%、100%、82%. Combining four signs together showed a sensitivity，specificity，and accuracy of 59%、100%、71%. Conclusion MRI is important for the identification between benign and malignant in BI-RADS category 4 lesions，the application of combining diagnosis could significantly increase the specificity of disease，thus greatly reduced the incidence of misdiagnosis.

【Key words】Breast neoplasms Breast Imaging and Reporting Data System Magnetic resonance imaging Diffusion weighted imaging

根据美国放射学会制定的乳腺影像报告及数据系统标准，BI-RADS4类病变是指一组可疑恶性，需临床活检的病变，这组病变的恶性率约为4%～94%，阳性预测值（PPV手术）为10.7%～24.3%［1］，多数的穿刺活检为良性肿瘤。因此，需在活检前区分良恶性病变，以避不必要的活检风险和并发症。虽然MRI征象中病变形态、边缘、强化方式及ADC值对乳腺良恶性的诊断价值已经得到一定的证实［2～4］，但目前尚无关于各种MRI征象联合应用在BI-RADS4类乳腺病变中的诊断价值报道。……