Abstract
目的 探讨利用MR扩散成像(DWI)和表观扩散系数(ADC)测定确定乳腺癌范围的可行性.方法 测定57例59个乳腺癌在扩散敏感因子(b)值分别取500(b=500 s·mm-2组)和1000(b=1000 s·mm-2组)时的ADC值,根据设定的ADC值测量不同b值时的肿瘤范围;比较动态增强和DWI测量病灶大小的异同.以2条径线作为比较参照:病灶最大径、过最大径线中点并与之垂直的径线.所有测量结果与病理对照.结果 (1)59个病灶包括浸润性导管癌48个,导管原位癌伴微浸润6个,黏液腺癌3个,髓样癌2个.(2)小于设定ADC值的异常区域作为扩散所测病灶大小,则b值为500和1000 s·mm-2时2组结果与病理检查肿瘤范围比较.范围一致组b=500 s·mm-2组略高于b=1000 s·mm-2组,但差异无统计学意义(X2=0.160,P=0.689);过度诊断2组一致(2个);假阴性b=500 s·mm-2组略低于b=1000 s·mm-2组(X2=0.172,P=0.679).2组均诊断错误14个,分别是过度诊断2个,假阴性12个.8个病灶2组表现不一致,5个在b值为500 s·mm-2时诊断正确的病灶中,3个是导管原位癌伴微浸润.(3)以4 min时测定的大小作为动态增强显示病灶的测定点,与同一层面DWI上显示的异常区域大小进行比较.两者符合47个(80%);增强径线测定较小而DWI测定符合8个,其中3个为黏液腺癌,5个为浸润性导管癌3级.结论 MR DWI和ADC测定可以对乳腺癌范围进行评价.对某些特定病理类型乳腺癌范围的测量,DWI有其优势。
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