动态增强3.0 T MRI在乳腺良恶性病变鉴别诊断的应用.DOCVIP

临床医学论文-动态增强3.0 T MRI在乳腺良恶性病变鉴别诊断的应用 【摘要】? 目的 探讨3.0 T MRI三维动态增强扫描鉴别诊断乳腺良恶性病变。 方法 20例乳腺病变患者24个病灶,行三维动态增强扫描,生成时间信号强度曲线,计算早期增强率。根据病灶增强形态、时间信号强度曲线类型及早期增强率预测病变良恶性。 结果 常规T2WI并脂肪抑制检出病灶24个。良性病变强化边缘多光滑,早期增强率均60%,时间信号强度曲线多为单相型(7/10,70%);恶性病灶强化边缘多毛刺,早期增强率大部分60%,时间信号强度曲线多为流出型(11/14,78.57%)。 结论 3.0 T MRI动态增强扫描对乳腺良恶性病变鉴别诊断具有较高的敏感性。 【关键词】? 乳腺肿瘤 乳腺疾病 磁共振成像 图像增强 ??? ABSTRACT:? Objective? To evaluate the diagnostic value of dynamic contrastenhanced MRI in breast lesions.? Methods? 20 cases with 24 breast lesions were examined with Flash 3D dynamic MRI series.? The timesignal intensity curve（TIC） and early phase enhancement rates of the breast lesions were calculated.? Results? 24 lesions were enrolled.? Most of the benign lesions were smooth with an earlyphase enhancement rate lower than 60%.? The TIC types of benign lesions were 70%(7/10) monophasic.? The malignant lesions were mostly spiculated and the earlyphase enhancement rate was mostly higher than 60%.? The TIC types for malignant were 79.57%(11/14).? Conclusion? Flash 3D dynamic MRI has a high sensitivity in differential diagnosis of malignant and benign breast lesions. ??? KEY WORDS:? breast neoplasms; breast disease magnetic resonance imaging; image enhancement ??? 核磁共振成像(magnetic resonance imaging,MRI)对乳腺病变的诊断主要基于病灶形态学和增强后病灶局部血液动力学特性进行评估。3.0 T超高场磁共振仪具极高的空间和时间分辨率,对显示和分析病灶的形态结构、强化特征具有无可比拟的优势,目前国内仅有1.5 T场强机应用报道[12]。笔者采用快速三维动态扫描序列分析乳腺病灶的强化形态、时间信号强度曲线(timesignal intensity curve,TIC)和早期增强率,探讨动态增强扫描技术在乳腺良恶性病变鉴别诊断的价值。 　　1? 对象与方法 　　1.1? 对象 　　收集2006年12月-2007年5月行乳腺3.0 T MRI检查的女性患者20例,年龄中位数(44.7±1.5)岁(32～67岁)。所有病例均经病理结果证实。1.2? 扫描方法? 使用3.0 T磁共振扫描仪(MAGNETOM Trio Tim,德国西门子公司),乳腺线圈,俯卧位。行常规磁共振扫描。 　　1.2.1? 常规磁共振成像扫描参数? 　　扫描参数见表1。表1? 常规磁共振成像扫描参数（略） 　　1.2.2? 轴位动态增强扫描参数 　　轴位动态增强扫描采用Flash 3D序列,重复时间（TR）/回波时间（TE）=4.1/1.7 ms,层厚0.9 mm,翻转角6°,采集1次,覆盖双侧乳腺,单次扫描时间1.03 min,采集时间（TA）6.33 s。钆喷替酸葡甲胺(GdDTPA)按0.1 mmol/kg剂量、以2.0 mL/s的速度用高压注射器静脉注射,注药前平扫1期,注入造影剂后开始增强扫描,每隔1 min扫描1期,持续5期。延时扫描T1fl3dtradelayed VIEWS序列,TR/TE=8.00/3.77 ms,层厚0.80 mm,翻转角12