【摘要】 目的比较乳腺动态增强MRI定量和半定量血流动力学参数鉴别诊断乳腺病变良恶性的效能。方法采用杂合动态增强MR序列对59例患者共66个乳腺病变进行扫描,获得半定量参数和定量参数。半定量参数为时间-信号强度曲线（TIC）、初始增强曲线下面积（IAUGC）、最大增强斜率（MaxSlope）、对比增强比率（CER）及正向增强积分（PEI）;定量参数为前向容积转移常数(K^trans)、反向容积转移常数(K_ep)和每单位体积组织的血管外细胞外间隙容积（V_e）。以非参数检验比较良恶性病变间各参数的差异,并绘制ROC曲线,分析其诊断效能。结果 66个乳腺病变中,恶性31个（恶性组）,良性35个（良性组）,2组间K^trans、K_ep、TIC、IAUGC、MaxSlope差异均有统计学意义（P均<0.05）,V_e、PEI、CER差异无统计学意义（P均>0.05）;K^trans、K_ep、TIC、IAUGC、MaxSlope的AUC均>0.7。半定量参数联合诊断乳腺病变良恶性的AUC较单个参数均有显著提高（P均<0.05）;定量参数联合后的AUC较K^trans无显著提高（P=0.134）,较K_ep和V_e有显著提高（P均<0.001）。半定量联合与定量参数联合诊断诊断乳腺病变良恶性的AUC差异无统计学意义（P=0.614）。结论 K^trans、K_ep、TIC、IAUGC及MaxSlope对鉴别诊断乳腺良恶性病变具有较高效能;多参数联合,乳腺动态增强MRI半定量和定量参数诊断效能相似。更多还原

【Abstract】 Objective To compare the diagnostic performance of quantitative and semi-quantitative hemodynamic parameters of breast dynamic contrast-enhanced MRI（DCE-MRI） in differential diagnosis of benign and malignant breast lesions. Methods Fifty-nine patients（66 lesions） with breast lesions underwent hybrid DCE MRI with high temporal and spatial resolution, and semi-quantitative and quantitative hemodynamic parameters were obtained. The semi-quantitative parameters included time-intensity curve（TIC）, initial area under the gadolinium curve（IAUGC）, maximum slope of increase（MaxSlope）, contrast enhancement rate（CER） and positive enhancement integral（PEI）, while quantitative parameters included volume transfer constant(K^trans), rate constant(K_ep) and extravascular extracellular volume fraction（V_e）. The differences of all the parameters between benign and malignant breast lesions were compared by using non-parametric tests. ROC was used to analyze the diagnostic performance. Results There were 31 malignant lesions（malignant group） and 35 benign ones（benign group）. There were significant differences of K^trans, K_ep, TIC, IAUGC and MaxSlope between the two groups（all P<0.05）, while no significant difference in V_e, PEI nor CER（all P>0.05）. AUC of ROC curve of K^trans, K_ep, TIC, IAUGC and MaxSlope were all >0.7. AUC of semi-quantitative parameter combination in diagnosis of benign and malignant breast lesions were significantly higher than those of single parameter（all P<0.05）, AUC of quantitative parameter in combination was not significantly higher than those of K^trans（P=0.134）, but significantly higher than those of K_ep and V_e（all P<0 001）. There was no significant difference in AUC between combined semi-quantitative and quantitative parameters in diagnosis of benign and malignant breast lesions（P=0.614）. Conclusion K^trans, K_ep, TIC, IAUGC and MaxSlope have good diagnostic performance in differentiating benign and malignant breast lesions. The combined semi-quantitative and quantitative hemodynamic DCE-MRI parameters have similar diagnostic performance.更多还原