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目的探讨多层螺旋增强扫描及三维重建的技术对乳腺肿块的诊断及在术前评估价值。方法收集临床乳腺肿块38病例,证实乳腺癌22例,重点多层CT增强扫描及三维重建。结果38例乳腺肿块中纤维腺瘤,乳腺增生病变和恶性组平扫CT平均值分别为(22.24±6.24)HU、(17.20±5.2)HU和(24.60±8.43)HU(P>0.05),增强后△CT值分别为(22.22±8.8)HU、(12.33±5.1)HU和(36.36±15.27)HU(P<0.01);良性病灶△CT值均<35HU,乳腺癌△CT值>35HU。CT在乳腺肿块中表现为形态不规则,密度不均匀,边界不清肿块,三维重建22例乳腺癌病例,显示肿块周围水肿环,肿块邻近皮肤水肿6例,乳头内陷、导管增粗6例,8例肿块与胸壁相连,CT对转移淋巴结的总检出率为75%(9/12),其中6例同时显示胸小肌后淋巴结,1例显示锁骨上淋巴结肿大。结论多层螺旋CT增强扫描及三维重建不仅对乳腺肿块增强前后CT值变化鉴别良恶,而且对其内部结构、周围组织之间关系显示更为直接,可全方位对乳腺周围淋巴及其组织结构进行影像学观察,为临床术前评估奠定了基础,提供了新的影像学检查方法。
Objective To investigate the diagnostic value of multi-slice helical enhanced scanning and three-dimensional reconstruction in the diagnosis of breast masses and their preoperative evaluation. Methods Thirty-eight cases of clinical breast masses were collected. Twenty-two cases of breast cancer were confirmed, and multi-slice CT enhanced scanning and three-dimensional reconstruction were performed. Results The average CT values of fibroadenoma, hyperplasia of mammary gland and malignant group in 38 breast masses were (22.24 ± 6.24) HU, (17.20 ± 5.2) HU and (24.60 ± 8.43) HU (P> 0.05) The CT values were (22.22 ± 8.8) HU, (12.33 ± 5.1) HU and (36.36 ± 15.27) HU, respectively (P <0.01). The CT values of benign lesions were all less than 35HU and the CT values of breast cancer were more than 35HU. CT showed irregular shape, uneven density and unclear lumps in breast masses. Three-dimensional reconstruction of 22 breast cancer cases showed edema around the lumps, 6 cases of adjacent skin edema, 6 cases of invagination and catheter thickening , And 8 cases were connected with the chest wall. The total detection rate of CT in metastatic lymph nodes was 75% (9/12). Six cases showed posterior pectoralis minor lymph nodes and one case showed supraclavicular lymph nodes. Conclusions Multi-slice spiral CT and 3D reconstruction not only identify the changes of CT value before and after the enhancement of breast masses, but also show a more direct relationship between the internal structure and the surrounding tissues. Imaging observation, laid the foundation for clinical preoperative assessment, providing a new imaging examination method.