摘要
目的探讨乳腺磁共振Fischer's评分结合扩散加权成像(DWI)在鉴别乳腺病变良恶性中的应用价值。方法 104例患者(共109个病灶)均行常规MRI平扫、动态增强及DWI检查,所有病例均经手术或穿刺活检证实。Fischer's评分法以Fisher评分表及乳腺影像报告和数据系统(BI-RADS-MRI)分级判定良恶性。DWI检查通过受试者工作特征(ROC)曲线分析确定最佳界值作为判断良恶性的阈值。结合Fischer's评分结果及DWI对BI-RADSMRI 4类病变进行亚分类,并根据亚分类结果判定良恶性。分别计算并比较DWI、Fischer's评分法以及Fischer's评分结合DWI对乳腺疾病的诊断效能。结果表观扩散系数(ADC)值的最佳诊断界值为1.1×10-3mm2/s,DWI诊断的敏感性、特异性、准确性分别为82.1%、77.4%、79.8%;Fischer's评分法诊断的敏感性、特异性、准确性分别为100%、67.9%、84.4%;Fischer's评分结合DWI诊断的敏感性、特异性、准确性分别为100%、81.1%、90.8%。BIRADS-MRI 4A、4B、4C的阳性预测值分别为0、20%、85.7%。结论 Fischer's评分结合DWI能够对BI-RADS-MRI4类病变进行合理的亚分类,并能明显提高诊断的特异性和准确性,且保持了很高的诊断敏感性。
Objective To investigate the value of Fischer＇s scoring system combined with diffusion weighted imaging in differential diagnosis of breast lesions. Methods 104 patients（ 109 lesions） proven by operation or biopsy received dynamic contrast enhancement and diffusion weighted imaging. Fischer＇s scoring system and BI-RADS-MRI were used to distinguish the benign lesions from the malignant in the Fischer＇s scoring system method. The optimal boundary value of the ROC curve was set as the threshold in DWI. A combination of the Fischer＇s scoring system and diffusion weighted imaging to subcategorize breast lesions categorized as BI-RADS was used. The result was the used to distinguish the benign lesions from the malignant. The diagnostic efficacy of DWI,Fischer＇s scoring system method and the adjunctive method was calculated and compared. Results The best diagnostic boundary of ADC values was 1. 1 × 10^- 3mm2/ s. The sensitivity,specificity and diagnostic accuracy of DWI,Fischer＇s scoring system method and the adjunctive method was 82. 1% 、77. 4% 、79. 8%,100% 、67. 9% 、84. 4% and 100% 、81. 1% 、90. 8% respectively. The PPV of BI-RADS-MRI 4A、4B、4C were 0、20% 、85. 7% respectively. Conclusion Fischer＇s scoring system combined with diffusion weighted imaging could subcategorize breast lesions categorized as BI-RADS 4 reasonably,which could raise the specificity and diagnostic accuracy and also guarantee the sensitivity.
出处
《临床放射学杂志》
CSCD
北大核心
2016年第10期1498-1502,共5页
Journal of Clinical Radiology
