The Clinical Study Of Benign And Malignant Breast Tumor With Multimodality MR Imaging

Purpose:To study and evaluate the diagnostic and differential diagnostic clinical value of magnetic resonance imaging(MRI) in benign and malignant breast tumor with advanced imaging technique.Develop and establish the optimal MR imaging technique criteria and an optimal MRI diagnostic criteria for breast lesions by using a combination of quantitative with qualitative criteria.Materials and Method: Sixty-five female patients with seventy-one lesions being suspected the breast tumor underwent the breat MRI with breast array coil(Siemens 1.5T Avanto).All the patients been done fat-suppressed T1-WI and T2-WI,contrast enhanced dynamic 3-D flash sequence.All the patients also underwent the diffusion weighted imaging (DWI).Counting and recording all the data such as early enhancement rate,time-signal curve patterns,lesion's morphological features before and enhanced,ADC map with different b values. All the lesions were confirmed by the histopathologic results. According the histopathologic results,all the lesions were divided into two groupsrbenign and malignant.We hope to get the diagnosis sensitivity -y ,specificity, positive predictive value and negative predictive value of all the methods.Results: 1 There are 65 patients and 71 lesions.Pathology diagnose 35 cases with 39 masses are malignant,30 cases with 32 masses are benign.2 The age of benign group was 40.81 ± 11.06 years and the age of malignant group was 52.79 ± 10.44 years, p=0.004, <0.01.3 The diagnosis sensitivity ,specificity, positive predictive value and negative predictive value of lesion's morphological features of MRI plain scan are 63.4%, 74.5%, 63.2%, 72.5%4 The diagnosis sensitivity ,specificity, positive predictive value and negative predictivevalue of lesion's morphological features of MRI enhanced scan are 93.8% -. 83.8% ^ 88.4% > 90.1%.5.The SIR of the benign group is 89.31 ±22.53(%),the SIR of the malignant group is 128.7±24.34(%),p=0.005,<0.01. The diagnosis sensitivity,specificity, positive predictive value and negative predictive value of MRI enhanced scan with judge standard of SIR at 90% (>90%ismalignent, <90% is benign) are65.4%> 54.8%> 67.2%^ 63.8%O6 The time-signal curve analysis:There are 22 (78.57% ) type I curving patterns,4(14.29%) type II curving patterns and 2(7.14%) type III curving patterns in the benign group and 4(10.25%) type I curving patterns,6(15.38%) type II curving patterns and 29(74.36%) type III curving patterns in the malignant group.There are two cysts and 1 lipoma have not enhanced. Compare the curving pattern with two groups, type I curving patterns of two group was x2=3.956, p=0.0427<0.01, type II curving patterns of two group was x2=0.9207, p=0.3373>0.05,and type III was x2=6.4145, p=0.0113<0.01.typeI and type III curving patterns were significantly different.Use type III curving pattern as the criterion to diagnosis the malignant tumors, The diagnosis sensitivity,specificity, positive predictive value and negative predictive value of MRI enhanced scan was 78.6%, 86.7%,86.5%,80.3%o7 There were significant differences among the ADC values of normal breast tissue,malignant and benign lesions,(F=559.84,P<0.01),and ADC of malignant lesions was lower than that of normal breast tissue.There are significant differences among the ADC value of b=1000-0,1000-500 ,and 500-0s/mm2.The lower the b value,the higher the ADC.The sensitivity and specificity of ADC for the diagnosis of malignant lesion were84.2% and77.3% and the positive predictive value and negative predictive value were 78.2% and 85.3% if the upper bound of 95% confidence interval was set as a differential level.The use of combine muliti-criterias can improvv MRI diagnosis for mammary disorders.8 To improve the diagnosis preciseness of the malignant tumors, we adopted the criterion that satisfied the enhanced morphologic and The type III time-signal curve at the same time and satisfied at least one guideline of the SIR and the time-signal curve type III to synthesized all the results.To our study,the sensitivity,specificity,positive predictivevalue and negative predictive value of synthesized diagnosis MRI was 96.7% > 90.3%>93.4%, 89.8%.ConcIusion.'MRI is the best imaging method to diagnosis and differential diagnosis breast tumor in the medical imaginology.Comparing with tumor's morphologic features,contrast dynamic enhancement and ADC maps,MRI play an important role for early diagnosisi and decide the operation plan of breast carcinoma.