Differential Diagnosis Value Of Dynamic Contrast MR Imaging In Breast Diseases

PartⅠDynamic contrast MR imaging:the differential diagnosis value in patients with breast diseasesObjceitve To analysis the morphologic features and enhancement kinetics of Breast lesion with three-dimensional dynamic contrast and digital subtraction MRI and to evaluate the application of MRI in diagnosing breast cancer.Methods 60 patients were enrolled in this study,including 37 malignant lesions And 26 benign lesions verified by histopathology.The imaging series included axial SE T1WI,axial fat-saturated FSE T2WI,sagital fat-saturated FSE T2WI and axial dynamically enhanced 3D-FSPGR.The image subtraction and time-signal intensity curve were achieved on work station.The diagnostic criteria for benign and malignant tumors were made for morphology,early-Phase enhancement rates,type of dynamic enhancement curve.The morphologic manifestation,early-Phase enhancement rates, Peak enhancement rates and time-signal intensity curve were evaluation in diagnosing breast diseases.Results 95%of the breast lesions were demonstrated in MRI.The benign lesions were mainly characterized by regular mass,clear boundary,internal septation, homogeneous enhancement,early-Phase enhancement rates less 90%,typeⅠtimesignal intensity curve,the malignant lesions by irregular shape,speculated margin, rim enhancement,imhomogeneous enhancement,early-Phase enhancement rates more than 90%and typeⅡ,Ⅲtime-signal intensity curve.The early-Phase enhancement rates and distribution of time-signal intensity curve proved significantly different(P＜0.05).With the morphologic feature of malignant lesions,the following diagnostic indices emerge:sensitivity 81.5%,specificity 76.3%and diagnostic accuracy 80.7%,and typeⅡ,Ⅲtime-signal intensity curve for malignant lesions,the following diagnostic indices emerge:sensitivity 83.7%,specificity 86.7%,and diagnostic accuracy 80.3%,respectively.Conclusion The begin lesions are characterized by regular mass,clear boundary internal septation,homogeneous enhancement,early-Phase enhancement rates less 90%,typeⅠcurve,the malignant lesions by irregular shape,speculated margin, rim enhancement,imhomogeneous enhancement,early-Phase enhancement rates more than 90%and typeⅡ,Ⅲcurve.The early-Phase enhancement rates and distribution of time-signal intensity curve are very useful for in diagnosing breast cancer.But there is an over lap in some patients. PartⅡDynamic contrast MR imaging:a comparative study with X-ray mammography with pathological diagnosis in patients with breast diseasesObjective To analyze the MRI and mammographic findings of breast diseases and to assess the diagnostic value of MRI and mammography for breast diseases.Methods 60 patients were enrolled in this study,including 37 malignant lesions and 28 lesions verified by histopathology.The imaging series included axial SE T1WI, axial fat-saturated FSE T2WI,sagital fat-saturated FSE T2WI and axial dynamically enhanced 3D-FSPGR.The image subtraction and time-signal intensity curve were achieved on work station,as well as mammography by conventional method.According the results of previous partⅠ,the significant diagnostic main parameters were chosen to make of an optimal MRI diagnositic criteria for breast cancer,including irregular shape,speculated margin,rim enhancement, imhomogeneous enhancemen,early- phase enhancement rates more than 90%, typeⅡ,Ⅲtime-signal intensity curve.The main diagnostic parameters of mammography were made of irregular shape,speulated margin and malignant calcification,secondary diagnostic Parameters of abnormal skin,nipple,vessel and lymph node.The main secondary diagnostic parameters consist of X- ray diagnosstic criteria for breast cancer.The results of MR and mammography were compared with histopathology.Results MR detected 26 benign and 36 malignant lesions,X-ray missed 6 malignant lesions and 5 benign lesions.X-ray had 3 false positive cases and 6 false negative cases in diagnosing breast cancer.The following diagnostic indices for MR emerge:sensitivity 95.3%,specificity 88.3%,Positive Predictive value 89.3%and Negative Predictive value 94.3%,for X-ray,82.2%,65%,71.5%,69.1%, respectively.The agreement of MR histopathology is very satisfactory,X~2=10.23, P＜0.01.Conclusion MRI is superior to mammography in demonstrating the content and degree of breast diseases.MRI plays an important role in the diagnosis and therapeutic planning for breast diseases.