Multiple Parameters Analysis And Clinical Application On MRI In Breast Diseases

PartⅠClinical Study of BI-RADS MRI with Digital X-ray Mammography as well as Their Combination in the Diagnosis of Breast CancerObjective:To evaluate the value of full-field digital mammography (FFDM), MR morphology and time-signal intensity curve (TIC) in diagnosis of breast cancer according to BI-RADS..Material and method:143 breast lesions were evaluated by FFDM, MR and TIC according to BI-RADS. The positive likelihood ratios (+LR) of each symptom were studied. Moreover, the diagnosis values of single application and joint application of various methods were compared, and the diagnosis values of FFDM and MR (morphology+TIC) in groups of patients at different ages or different shapes as well. Finally, the calcificaionts without mass which were hard to diagnose on FFDM were evaluated by MR (morphology+TIC).Results:1. The diagnostic value of MRI morphology (+LR:5.02)>FFDM (+LR: 3.34)>TIC (+LR:2.67).2. The positive likelihood ratios (+LR) were arranged in the following up-down order:malignant mass with malignant calcification (FFDM,+LR: 23.26)> spiculated margin or irregular shape (MRI,+LR:7.56)>non-masslike enhancement (MRI,+LR:3.17)> malignant calcification only (FFDM,+LR: 2.846)>washout curve (+LR:2.77)> plateau curve>=architectural distortion (FFDM, +LR:2.33)>malignant mass only (FFDM,+LR:1.99)>associated findings only (FFDM, +LR:1.74).3. The sensitivity of MRI morphology in the diagnosis on breast cancer was higher than that of FFDM and TIC (p=0.014,0.007), while there was no difference in the sensitivity of FFDM and TIC (p=0.808). Regarding the specificity of the three methods, there was also no difference (P=0.405).4. For patients below 45 years'old, sensitivity of FFDM was inferior to that of MR (morphology+TIC) (P=0.005), while for patients more than 45 years' old (including 45), no difference was revealed in both sensitivity and specificity of diagnosis of breast cancer.5. For masslike breast cancer, the sensitivity of FFDM was lower than that of MR (morphology+TIC) (P=0.002), while for non-masslike breast cancer, the sensitivity of FFDM and MR (morphology+TIC) (P=0.483) was no difference.6.Concerning the calcificaionts without mass which were hard to diagnose on FFDM, MR (morphology+TIC) is of great diagnostic significance (sensitivity 100%, specificity 59%).Conclusion:The morphologic evaluation of MRI is of great value for the diagnosis of breast cancer, and TIC is its effective supplementation. For patients less than 45 years'old, for masslike breast cancer and for the calcificaionts without mass which were hard to diagnose, MR plays a better role than FFDM. PartⅡStudy on DWI and Dynamic Contrast-enhanced Parameters of Masslike Enhancement of Breast LesionsObjective:To evaluate the value of ADC and Dynamic Contrast-enhanced Parameters in diagnosis of Masslike Enhancement of Breast LesionsMaterial and method:129 masslike enhancement of breast lesions underwent DWI and dynamic enhanced examination to test the ADC value and dynamic contrast-enhanced parameters. In accordance with BI-RADS, a morphologic evaluation was conducted. Besides, the values of ADC and various dynamic contrast-enhanced parameters in diagnosis of breast cancer were evaluated. The diagnosis values when using DWI and dynamic contrast-enhanced parameters and MR morphologic assessment separately and using them jointly were compared.Results:The average ADC value of 82 benign breast masses was (1.34±0.34)×10-3s/mm2; and that of 47 malignant masses was (0.96±0.14)×10-3s/mm2; revealing a significant difference (t=8.848, p=0.000).2.26 malignant lesions reached peak values in the early stage of dynamic enhancement (within 2 minutes) and 20 benign lesions reached peak values in the early stage of dynamic enhancement. There was significant difference in their composition (x2=12.46, P=0.000).3. There were also differences in signal change at the end-stage of dynamic contrast-enhancement between the benign and malignant masses (P=0.000). For benign masses, its dynamic contrast-enhanced signal shows steady increasing trend at the end-stage, whereas that of malignant masses, there was a washout trend. 4. There was no significant difference in the diagnostic efficiencies of MRI morphologic evaluation and ADC value (x2=0.25, p=0.614), while the diagnostic efficiencies of MRI morphologic evaluation and ADC value were all higher than that of signal change at the end-stage of dynamic contrast-enhancement (which respectively are x2=6.42, p=0.011; x2=9.49, p=0.002)Conclusion:MRI morphologic evaluation, ADC and the signal change at the end-stage of dynamic contrast-enhancement are of diagnostic value for masslike enhancement of breast lesions. To jointly use these three methods will achieve higher sensitivity (100%) for the diagnosis of breast cancer. PartⅢStudy on DWI and Dynamic Contrast-enhanced Parameters of Non-masslike Enhancement of Breast LesionsObjective:To evaluate the diagnostic value of ADC and dynamic contrast-enhanced parameters in non-masslike enhancement of breast lesions.Material and method:50 non-masslike enhancements of breast lesions underwent DWI and dynamic contrast-enhanced examination to test the ADC value and dynamic contrast-enhanced parameters. Then the value of ADC and dynamic contrast-enhanced parameters in diagnosis of non-masslike enhancement of breast lesions was evaluated. The diagnosis values when using DWI and dynamic contrast-enhanced parameters separately and using them jointly were compared.Results:1. Average ADC of 17 benign non-masslike enhancement was (1.21±0.21)×10-3s/mm2, and the average ADC of 17 malignant non-masslike enhancement was (1.04±0.22)×10-3s/mm2, revealing a significantly statistic difference (t=2.606, p=0.012). When the threshold value was 1.16×10-3s/mm2, specificity and positive predictive value of ADC in the diagnosis of non-masslike enhancement of breast lesions were 94%.2.15 malignant non-masslike enhancement reached peak values in the early stage of dynamic enhancement (within 2 minutes). And 2 benign focuses reached peak values in the early stage of dynamic enhancement. There was significant difference in their composition (P= 0.026).3. There were also differences in signal values at different stages of dynamic enhancement and the overall enhancement intensities between the benign and malignant non-masslike enhancement. For malignant lesions, the overall enhanced intensities and intensities at every stage were higher than that of benign lesions. At the end of the second minute, the difference of signal intensity (S2) between benign and malignant lesions was the most reliable (with the minimum P value). The changing tendencies of signal intensity at the end-stage of benign and malignant non-masslike enhancement appeared much gently, showing no significant difference.4. The ROC area under the curve diagnosed by ADC was 0.715±0.072, while the ROC area under the curve diagnosed by S2 was 0.778±0.073. There was no significant difference in their diagnostic efficiency (x2=0.41, p=0.522).5. The sensitivity, specificity, positive predictive value and negative predicative value of ADC value and S2 jointly for diagnosis of breast cancer was 78%,88%,93%, and 65% respectively. Conclusion:ADC and enhanced intensity of S2 are of diagnostic value for non-masslike enhancement of breast lesions. To jointly use these two methods will show higher specificity and positive predictive value (both of which are 88% and 93% respectively) for the diagnosis of breast cancer.