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目的:探讨MRI的形态学特征、动态强化特征及弥散加权成像对BI-RADS 4-5类肿块性病变的诊断价值。方法:回顾分析69例经病理证实的初诊为BI-RADS 4-5类、未经治疗乳腺病变磁共振影像学特征,绘制时间-信号强度曲线,进行χ2检验或Fisher检验,测量病灶的ADC值,进行t检验并用ROC曲线分析。结果:69例病变中27例为良性,42例为恶性,BI-RADS 4-5类乳腺肿块性病变表现为边缘毛刺、环形强化、流出型曲线时恶性可能性高(P<0.05),病变形状和早期强化率均无统计学差异(P>0.05),ADC值存在统计学差异(t=4.903,P=0.000),最佳ADC诊断阈值为1.12×10-3 mm2/s,敏感性82.4%,特异性80.6%,产生假阳性的常见病变主要为纤维腺瘤、导管内乳头状瘤。结论:DWI与DCE-MRI结合对鉴别BI-RADS 4-5类病变具有重要价值,可调整部分病变的分类,对临床治疗具有指导意义。
Objective: To investigate the diagnostic value of MRI morphologic features, dynamic enhancement features and diffusion-weighted imaging in the diagnosis of BI-RADS type 4-5 tumor. Methods: A retrospective analysis of 69 cases of pathologically confirmed first diagnosis of BI-RADS 4-5 categories, untreated MRI features of breast lesions, time-signal intensity curve was drawn, χ2 test or Fisher test, the lesion ADC value , T-test and ROC curve analysis. Results: Among the 69 lesions, 27 were benign and 42 were malignant. BI-RADS type 4-5 breast lesions showed marginal burr, and were more likely to have ring-shaped enhancement and efflux-type curves (P <0.05) There was no significant difference in the shape and early enhancement rate (P> 0.05). There was a significant difference in ADC values between the two groups (t = 4.903, P = 0.000). The best ADC threshold was 1.12 × 10-3 mm2 / %, 80.6% specificity, common false-positive lesions are fibroadenoma, intraductal papilloma. Conclusion: The combination of DWI and DCE-MRI is of great value in the identification of BI-RADS type 4-5 lesions, which can adjust the classification of some lesions and has guiding significance for clinical treatment.