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目的探讨动态增强MRI、超声及X射线在乳腺良、恶性病变鉴别诊断中的价值。方法回顾性分析四川大学华西医院2008年6月至2009年6月期间对50个乳腺病灶进行动态增强MRI、超声及X射线检查的影像资料,基于乳腺影像报告和数据系统(BI-RADS)分别判定病变的良、恶性,以病理诊断为标准,采用Z检验比较三者的受试者操作特征(ROC)曲线下面积,对比分析三者对乳腺良、恶性肿瘤的诊断效能。结果 44例患者50个乳腺病灶,26个恶性病灶,24个良性病灶。基于BI-RADS,X射线对26个乳腺恶性病灶判定结果为5类5个,4类7个,3类6个,2类3个,1类1个,0类4个;24个良性病灶判定结果为4类1个,3类3个,2类4个,1类13个,0类3个。超声对26个乳腺恶性病灶的诊断结果为5类17个,4类4个,3类1个,2类1个,1类3个;24个良性病灶的诊断结果为5类1个,4类2个,3类4个,2类14个,1类2个,0类1个。MRI对26个乳腺恶性病灶的诊断结果为5类6个,4类18个,3类1个,1类1个;24个良性病灶的诊断结果为1类20个,2类3个,3类1个。MRI、超声、X射线对乳腺肿瘤诊断的ROC曲线下面积分别为0.977、0.835、0.764,MRI与超声、X射线比较,差异有统计学意义(分别P=0.021、P=0.025),超声与X射线比较,差异无统计学意义(P=0.230)。结论动态增强MRI是鉴别乳腺病变良、恶性的一种准确检查方法,对乳腺良、恶性病变的鉴别诊断效能优于超声和X射线。
Objective To investigate the value of dynamic contrast-enhanced MRI, ultrasonography and X-ray in the differential diagnosis of benign and malignant breast lesions. Methods We retrospectively analyzed the imaging data of 50 breast lesions dynamically enhanced from June 2008 to June 2009 in West China Hospital of Sichuan University from June 2008 to June 2009 based on the Breast Imaging Report and Data System (BI-RADS) To determine the benign and malignant lesions, pathological diagnosis as the standard Z-test to compare the three subjects under the operating characteristics (ROC) area under the curve, comparative analysis of the three breast benign and malignant tumors diagnostic efficacy. Results Forty-four patients had 50 breast lesions, 26 malignant lesions and 24 benign lesions. According to BI-RADS, the results of X-ray on 26 malignant breast lesions were 5 categories, 5 categories, 4 categories, 7 categories, 3 categories, 6 categories, 2 category 3, 1 category 1, 0 category 4; 24 benign lesions The result of the judgment was 1 in 4 categories, 3 in 3 categories, 4 in 2 categories, 13 in category 1 and 3 in category 0. The diagnostic results of 26 breast malignant lesions by ultrasound were 5 of 17 categories, 4 of 4 categories, 1 of 3 categories, 1 of 2 categories, and 1 of 3 categories. The diagnostic results of 24 benign lesions were 1 of 5 categories, 4 Class 2, Class 3 4, Class 2 14, Class 1 2, Class 0 1. The MRI diagnosis of 26 malignant breast lesions was 6 in 5 categories, 18 in 4 categories, 1 in 3 categories and 1 in category 1. The diagnostic results of 24 benign lesions were 20 in category 1, 3 in category 2, 3 in category 2 1 class The area under the ROC curve of MRI, ultrasound and X-ray for the diagnosis of breast tumors were 0.977, 0.835 and 0.764, respectively. The differences between MRI and ultrasound and X-ray were statistically significant (P = 0.021, P = 0.025, Ray comparison, the difference was not statistically significant (P = 0.230). Conclusion Dynamic contrast-enhanced MRI is an accurate method to differentiate benign and malignant breast lesions. It is superior to ultrasonography and X-ray in differential diagnosis of benign and malignant breast lesions.