乳腺影像学诊断 讲课比赛.ppt

实性肿物，边缘不规则，可见长毛刺。经证实为乳腺癌。 * 尽管超声对肿块诊断的敏感性和特异性都较高，但也有一定局限性。超声的空间分辨率较低，对病变的显示缺乏细节，不能检出微小的肿块和位于乳腺深方的病变。另外超声受操作者和仪器的影响较大。此外超声不能显示微小的钙化灶。 * 核磁诊断乳腺疾病的优势在于他可以在任意方向,任意层面上进行成像.对微小病变的敏感性极高,可以发现钼靶与超升不能发现多中心型的肿瘤,并可以准确的显示肿瘤的范围,尤其是肿瘤侵犯胸大肌.从而帮助临床制定治疗方案.此外对于假乳也有很好的显示. * 磁共振乳腺显示左乳外象限肿块影,侵犯胸大肌. * 假体植入后的乳腺右乳内侧肿物. * 次共振的局限性在于其价格较为昂贵,并且对钙化显示不敏感. * 原位癌是指肿瘤细胞未突破基底膜,没有侵犯周围组织.原位癌有85%表现为单纯微小钙化.肿块合并钙化约占10%.单纯肿块或结构紊乱的仅为5%.因此对于钙化诊断最敏感的钼靶照相被FDA认证为乳腺筛查的唯一影像方法.而超升和MRI则作为进一步确诊方法. * X片显示乳头深方钙化灶.放大后清晰显示沙砾样钙化.病理证实为原位癌. * Let’s have a summary. When a woman came to the hospital for mammary screening, she should have a physical exam and mammography. If both two examinations found the malignant lesion, she must go to operation. If the physician felt something but the mammogram showed nothing, remember you mustn’t let her go, an ultrasound was necessary, then according to the result of ultrasound, the patient could choose operation, 6 months follow up and biopsy. If the physician found nothing, but the X ray showed mass or calcifications possibly malignant, then the patient needed biopsy. If both two exams found normal, that’s OK, 1year follow up was enough. * Imaging examinations of breasts * ppt课件 Question How to choose a proper examination for screening and diagnosis What examinations we could use * ppt课件 Breast cancer Higher incident rate of breast cancer for recent years Risk factors: procreation, family history, environment, hormone …… Clinic findings：mass，skin changes The survival rate based on the stage of breast cancer Screening：ductal carcinoma in situ * ppt课件 Anatomy 15－18 lobes Lobules: Terminal Ductal Lobular Units (TDLUs) * ppt课件 Anatomy TDLU：1－2mm Drained by a terminal duct attached to the main duct system Most breast diseases arise in TDLU * ppt课件 Imaging methods Mammography Ultrasound MRI * ppt课件 Projection： CC MLO Mammography * ppt课件 Mammographic characters Calcification Mass * ppt课件 Calcification PO43- Calcium phosphat Ca++ * ppt课件 Calcification The main val