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    您现在的位置: 论文网 >> 医药学论文 >> 医学论文 >> 乳腺黏液腺癌与纤维腺瘤的MRI诊断研究论文

    乳腺黏液腺癌与纤维腺瘤的MRI诊断研究

    出处:论文网
    时间:2019-09-11

    乳腺黏液腺癌与纤维腺瘤的MRI诊断研究

      【中图分类号】R445. 2 【文献标识码】A 【文章编号】1005-0019(2019)15--01

      乳腺粘液腺瘤发病率较低,临床数据显示其占乳腺癌的1%-6%,具有大量细胞外粘液成分,按照细胞外粘液含量可分为单纯粘液腺瘤以及混合性粘液腺瘤。该肿瘤临床表现以及影像学图像均无典型性,容易与纤维腺瘤混合,造成误诊。MRI为一种无创诊断方式,应用乳腺线圈和各种扫描序列可进行多方位检查,根据以上情况本次重点分析MRI诊断乳腺黏液腺癌与纤维腺瘤表现的差异,为提高后续临床诊断率提供依据。

      1 资料与方法

      1.1 一般资料 2017年1月至2018年12月 期间在我院接受治疗的经手术病理证实的7例(8病灶)乳腺粘液腺癌患者以及11例(13病灶)纤维腺癌患者。乳腺粘液腺癌患者年龄22-51岁,平均(36.5±2.3)岁,纤维腺癌患者年龄22-56岁,平均(38.0±2.9)岁,比较分析两组患者一般资料差异不显著(P>0.05),患者均用以本次检查方法并签订相关协议。

      1.2 方法 GE Excite HD 1.5T MRI扫描仪。叮嘱患者取仰卧位,双侧乳房自然下垂于线圈内。扫描序列及参数:(1)矢状面脂肪抑制FSE T2W 扫描,TR3140-4640ms,TE81-85ms,5.0mm层厚,1.0mm间距;轴位:SE-EPI DWI 扫描,b值为0.8s/mm2,TR为5000-6000ms,TEwei 62-71ms,6.0mm层厚,1.5mm间距;轴位脂肪抑制GRE T1W扫描:TR为6ms,TE为3ms,T1为13ms,FA为10°,3.2mm层厚,层间距为0。轴位脂肪抑制T1W多时相动态增强扫描:TR为6ms,TE为3ms,T1为13ms,FA为10°,3.2mm层厚,层间距为0,对比剂为Gd-DTPA,剂量为15ml,时相为8。

      1.3 图像处理 按照ACR BI-RAD MRI标准写诊断报告书,并强调病灶点状、肿块型强化、非肿块型强化分类。肿块病灶需要描述形态、边缘以及内部强化情况;非肿块型需要按照分布以及内部强化描述,记录T2以及T1特征。工作站利用Functool 软件进行动态增强曲线以及表现扩展系数(apparent diffusion coefficient,ADC)测量,评分测量三次取最小值。图像由两名经验丰富影像学专家阅读,意见不合时由第三名医师加入。

      1.4 数据分析 结果中符合正太分布的计量资料使用(均数±标准差)表示,并以t检验分析,P值(双侧)<0.05时表示差异具有统计学意义。

      2 结果

      2.1 形态学特征 乳腺粘液腺癌7例患者中,中6例单发,1例多发;纤维腺瘤11例患者中,6例单发,5例多发。粘液腺癌形态:3个病灶为圆形,2个病灶为浅分叶状,3个为不规则;2病灶边缘光滑,6病灶边缘毛糙。纤维腺瘤5个病灶为圆形,3个病灶为浅分叶状,3个为不规则;4病灶边缘光滑,7病灶边缘毛糙。

      2.2 ADC值比较 粘液腺癌患者ADC值为(2.13±0.35)*10-3mm2/s;纤维腺瘤患者为(1.01±0.30)*10-3mm2/s,两组患者ADC值差异具有统计学意义(t=3.06,P=0.041)。

      2.3 动态增强扫描曲线特征

      粘液腺瘤患者3个病灶呈环形强化,并逐渐具有填充趋势,5病灶不均匀强化,4个病灶呈Ⅰ型,2个病灶呈Ⅱ,2个呈Ⅲ型。纤维腺瘤8病灶为均匀强化,3病灶为不均匀分隔强化;10个病灶呈Ⅰ型,3个病灶呈Ⅱ型。

      3 讨论

      乳腺粘液腺癌属于特殊类型的浸润性癌症,可分为单纯性和混合型,临床一般以单纯型常见,其临床特征以及影像学情况均与纤维腺瘤具有较大相似性。本次对两种疾病分析进行MRI诊断,结果显示两组形态学具有交叉重叠,比较难以根据形态学区分。增强扫描后,两种肿瘤均表现为流入型的曲线,病灶主要以逐渐强化为主,差异无统计学意义。粘液腺癌患者ADC值为(2.13±0.35)*10-3mm2/s;纤维腺瘤患者为(1.01±0.30)*10-3mm2/s,具有差异。粘液腺癌ADC值明显高于纤维腺瘤,主要为乳腺粘液腺癌含有较多粘液成分,粘液一般为大分子以及中等分子物質,含水量较低,因此不具备水分子弥散受限物理基础,使得ADC值升高。总之,经对比分析我们认为:粘液腺瘤和纤维腺瘤MRI表现具有重叠,但ADC值具有明显差异,可根据该项进行鉴别。

    乳腺黏液腺癌与纤维腺瘤的MRI诊断研究

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