摘要
目的探讨三维酰胺质子转移加权成像(APTWI)鉴别诊断乳腺良性与恶性病变的价值及APTWI联合扩散加权成像(DWI)的诊断效能。方法本研究为前瞻性研究。收集2020年7月至12月郑州大学第一附属医院经手术或穿刺病理证实的226例乳腺病变患者。所有患者均接受MR T_(1)加权成像、T_(2)加权成像、DWI、APTWI及动态增强扫描,并从DWI和APTWI分别获得病变的表观扩散系数(ADC)值和偏移量为3.5 ppm的非对称性磁化传递率[MTRasym(3.5 ppm)]。采用Mann-Whitney U检验比较乳腺良性与恶性病变DWI和APTWI参数的差异,采用受试者操作特征(ROC)曲线评价DWI、APTWI及两者联合诊断效能的差异。结果226例乳腺病变患者(226个病灶),恶性病变124个、良性病变102个。乳腺恶性病变患者的ADC值[1.03(0.93,1.13)×10^(-3) mm^(2)/s]和MTRasym(3.5 ppm)[1.95%(1.10%,2.88%)]均低于乳腺良性病变[分别为1.38(1.11,1.55)×10^(-3) mm^(2)/s、3.30%(2.20%,4.20%)],差异均有统计学意义(Z分别为-8.19、-6.51,P<0.05)。DWI、APTWI及两者联合鉴别诊断乳腺良性与恶性病变的AUC分别为0.817、0.752、0.868。两者联合诊断的AUC高于DWI、APTWI诊断的AUC(Z分别为4.00、2.93,P<0.05),DWI与APTWI诊断的AUC差异无统计学意义(Z=1.58,P>0.05)。以1.25×10^(-3) mm^(2)/s为ADC值最佳临界值,DWI鉴别乳腺良性与恶性病变的灵敏度、特异度和准确度分别为94.4%(117/124)、62.7%(64/102)和80.1%(181/226);以2.70%为MTRasym(3.5 ppm)最佳临界值,APTWI鉴别乳腺良性与恶性病变的灵敏度、特异度和准确度分别为73.4%(91/124)、64.7%(66/102)、69.5%(157/226),DWI联合APTWI鉴别乳腺良性与恶性病变的灵敏度、特异度和准确度分别为82.3%(102/124)、79.4%(81/102)、81.0%(183/226)。结论APTWI能够用于鉴别诊断乳腺良性与恶性病变,且APTWI联合DWI有更高的诊断效能,优于单独诊断。
Objective To investigate the diagnostic value of three-dimensional amide proton transfer-weighted imaging(APTWI)and its combination with diffusion weighted imaging(DWI)for differentiating breast benign from malignant lesions.Methods This was a prospective study.From July to December 2020,226 patients with breast lesions confirmed by surgery or puncture pathology in the First Affiliated Hospital of Zhengzhou University were collected.All patients underwent MR T_(1)-weighted imaging,T_(2)-weighted imaging,DWI,APTWI,and dynamic contrast-enhanced MRI,and the apparent diffusion coefficient(ADC)value and the magnetization transfer ratio asymmetry at an offset of 3.5 ppm[MTRasym(3.5 ppm)]were obtained from DWI and APTWI respectively.Mann-Whitney U test was used for the comparison of DWI and APTWI parameters between breast benign and malignant lesions.Receiver operating characteristic(ROC)curve was used to evaluate the differences of diagnostic efficacy between DWI,APTWI,and their combination.Results There were 226 patients with 226 breast lesions,including 124 malignant and 102 benign lesions.The ADC values of patients with malignant breast lesions[1.03(0.93,1.13)×10^(-3) mm^(2)/s]and MTRasym(3.5 ppm)[1.95%(1.10%,2.88%)]were lower than those of benign breast lesions[1.38(1.11,1.55)×10^(-3) mm^(2)/s,3.30%(2.20%,4.20%),respectively],and the differences were statistically significant(Z=-8.19,-6.51,P<0.05).The area under the ROC curves(AUC)of DWI,APTWI,and its combination in the differential diagnosis of benign and malignant breast lesions were 0.817,0.752,and 0.868,respectively.The AUC of the combination of DWI and APTWI was higher than that of DWI and APTWI(Z=4.00,2.93,P<0.05),and there was no significant difference in the AUC between DWI and APTWI diagnoses(Z=1.58,P>0.05).Taking 1.25×10^(-3) mm^(2)/s as the optimal cut-off value for ADC values,the sensitivity,specificity,and accuracy in differentiating benign from malignant breast lesions were 94.4%(117/124),62.7%(64/102),and 80.1%(181/226),respectively;Taking 2.70%as
作者
王如华
张焱
程敬亮
黄荟玉
靳雅楠
李晓茗
张勇
Wang Ruhua;Zhang Yan;Cheng Jingliang;Huang Huiyu;Jin Yanan;Li Xiaoming;Zhang Yong(Department of MRI,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2022年第3期266-272,共7页
Chinese Journal of Radiology
关键词
乳腺肿瘤
磁共振成像
酰胺质子转移加权成像
Breast neoplasms
Magnetic resonance imaging
Amide proton transfer-weighted imaging
