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目的 探讨弥散加权成像 (diffusionweightedimaging,DWI)的表面弥散系数 (apparentdiffusioncoefficients,ADC)鉴别乳腺良恶性病变的价值。方法 健康志愿者 10人 ,经手术病理证实的乳腺病变 49例 ,其中恶性肿瘤 2 6例 ,良性病变 2 3例。DWI采用单次激发回波平面成像 (echo planarimaging ,EPI)技术 ,14例取 5个b值 (b为扩散敏感度 ) ,余者取 2个b值 ,计算ADC值。以恶性肿瘤ADC值单侧上界 95 %容许区间为界限判断病灶的良恶性 ,诊断结果与动态增强比较。结果 除 1例原位癌和 1例小腺瘤外 ,DWI显示所有良恶性病变。恶性肿瘤组ADC值为 (0 96 0 8± 0 2 0 43)×10 -3 mm2 /s,明显低于良性病变组的 [(1 5 85 8± 0 32 3 4)× 10 -3 mm2 /s]及正常组的 [(1 76 17±0 40 3 1)× 10 -3 mm2 /s(P <0 0 5 ) ],良性病变组ADC值与正常组间无显著性差异。ADC诊断的敏感性为 92 3% (2 4/ 2 6 ) ,特异性为 85 0 % (17/ 2 0 ) ,准确性为 89 1% (4 1/ 46 )。其诊断能力与动态增强扫描近似 ,二者对病变良、恶性诊断结果的一致性很好 (P <0 0 1)。结论 DWI能清楚地显示乳腺良恶性肿瘤 ,ADC值是鉴别乳腺良恶性病变的一个很有价值的参数。
Objective To investigate the value of diffusion-weighted imaging (DWI) surface differential coefficient (ADC) in differentiating benign and malignant breast lesions. Methods There were 10 healthy volunteers and 49 breast lesions confirmed by pathology. Among them, 26 were malignant and 23 were benign. The single-shot echo planar imaging (EPI) technique was used for DWI. Fourteen b values (b for diffusion sensitivity) were used in 14 cases, and 2 b values were calculated for ADC values. The benign and malignant lesions were judged based on the unilateral upper bound 95% tolerance range of the ADC value of the malignant tumor. The diagnostic results were compared with the dynamic enhancement. Results Except for 1 case of carcinoma in situ and 1 case of small adenoma, DWI showed all benign and malignant lesions. The ADC value of the malignant tumor group was (0 96 0 8 ± 0 2 0 43) × 10 -3 mm 2 /s, which was significantly lower than that of the benign lesion group [(1 5 85 8 ± 0 32 3 4) × 10 -3 mm 2 / s] and normal group [(1 76 17 ± 0 40 3 1) × 10 -3 mm2 / s (P <0 05)], there is no significant difference between the ADC values of benign lesions and normal group. The sensitivity of the ADC diagnosis was 92 3% (24/26), the specificity was 850% (17/20), and the accuracy was 891% (4 1/46). The diagnostic ability was similar to the dynamic enhanced scan, and the consistency between the two was good for the diagnosis of benign and malignant lesions (P < 0 01). Conclusion DWI can clearly show benign and malignant breast tumors. ADC value is a valuable parameter to differentiate benign from malignant breast lesions.