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目的分析乳腺叶状肿瘤(phyllodes tumors,PTs)MRI平扫、动态增强、扩散加权成像(DWI)和磁共振波谱(MRS)表现特征,提高对本病MRI诊断水平。资料与方法搜集2005年1月至2008年12月期间于我院行乳腺MRI检查并经手术病理证实的5例乳腺PTs,按照美国放射学会提出的乳腺影像报告和数据系统磁共振成像(BI-RADS-MRI)标准,回顾性分析病变的MRI表现,包括形态学、平扫T1WI及T2WI信号、动态增强表现及强化曲线类型、DWI信号及表观扩散系数(ADC)值和MRS表现特征。结果5例乳腺PTs病理诊断良性1例,交界性2例,恶性2例。MRI上4例表现为分叶状,1例为卵圆形;5例PTsMRI平扫T1WI均呈较低信号,T2WI呈高信号,其中1例内有低信号分隔;4例行动态增强检查的PTs于动态增强早中期(增强后第一至第三时相)呈快速渐进性强化,动态增强中后期时间-信号强度曲线3例呈平台型,1例呈轻度流出型;5例PTs于DWI上均呈高信号,ADC值低于正常乳腺组织,且低于鉴别乳腺良恶性病变的ADC界值;3例行MRS检查,均可见胆碱(Cho)峰。结论MRI检查有助于乳腺PTs的诊断,但确诊仍需依靠组织病理学检查。
OBJECTIVE: To analyze MRI manifestations of dynamic changes, dynamic enhancement, diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) of phyllodes tumors (PTs) to improve the diagnostic value of MRI in this disease. Materials and Methods Collecting 5 cases of breast PTs confirmed by surgery and pathology from January 2005 to December 2008 in our hospital, according to the American Society of Radiology’s Breast Imaging Report and Data System Magnetic Resonance Imaging (BI- RADS-MRI). The MRI findings of the lesions were retrospectively analyzed. Morphology, T1WI and T2WI signals, dynamic enhancement and enhancement curve types, DWI signal and apparent diffusion coefficient (ADC) values and MRS features were analyzed retrospectively. Results Five cases of benign breast lesions were diagnosed as benign in 1 cases, borderline in 2 cases and malignant in 2 cases. MRI in 4 cases showed lobulated, 1 case was oval; 5 cases of PTsMRI plain T1WI showed a lower signal, T2WI was high signal, including 1 case of low signal separation; 4 cases of dynamic enhanced examination PTs showed rapid ascent enhancement in the early to mid-term stage of dynamic enhancement (first to third phases of enhancement), with dynamic enhancement of mid-late time-signal intensity curves in 3 cases with plateau type and in 1 case with mild effusion; PTs in 5 cases DWI were high signal, ADC value lower than normal breast tissue, and lower than the differential diagnosis of benign and malignant breast lesions ADC boundaries; 3 MRS examination showed cholinergic (Cho) peak. Conclusion MRI examination is helpful for the diagnosis of breast PTs, but the diagnosis still depends on the histopathological examination.