A ROC Study Of Mammography, Color Doppler Ultrasound(CDU) And MRI In Distinguishing Breast Lesions

【Objective】1.To assess the characteristic mammographic,color Doppler ultrasound(CDU) and diagnositic values of breast tumor.To correlate the imaging features of tumors with pathologic types2.To investigate the availability of combination Liver Acquisition with Volume Acceleration(LAVA) dynamic contrast-enhanced MRI and diffusion-weighted MR Imaging(DWI).To explore the feasibility of breast MRI with.body surface coil and self-made breast stent in high-magnetic field(3.0T) MR scanner.3.Analyse the values of mammographic,color Doppler ultrasound(CDU) and MRI by ROC curve.Partâ… Correlativity Study of Mammographic and CDU features of breast malignant tumor and pathologic【Materials and Methods】1.Subjects:66 patients with 66 malignant lesions were enrolled during January 2007 to March 2009 in Nanfang Hospital,which were all performed with mammography and ultrasonography.All the subjects were confirmed by pathology.In addition,44 patients with 44 benign lesions were also enrolled as the control group during May 2008 to March 2009 in Nanfang hospital,all of them were performed with mammography and ultrasound.2.Equipment and Methods:X-ray mammography using Italian Giotto 2000 Molybdenum target and Siemens Mammomat Novation DR.In patients with orthostatic check,conventional head and tail,and inside and outside the skewed digital X-ray film,automatic exposure conditions.The ultrasonography imaging was performed with iU22 ultrasound system(Philips Technologies)connected to a wide frequency linear array probe. Routine procedure for breast was used to check the size,location,boundary,resonance in interior,tiny calcification of tumorl.Color Doppler flow imaging to observe the blood flow area and images were frozen and stored.3.Diagnostic tests and the grading criteria:X-ray mammography ROC curve of classification by reference to the U.S. Institute of Radiology breast imaging reporting and data system(BI-RADS) classification:â‘ certainly benign lesions,the corresponding section of the BI-RADS category 1 and category 2;â‘¡probably benign lesions,the corresponding BI-RADS category 3;â‘¢Qualitative should not correspond to the BI-RADS category 0;â‘£probably malignant,corresponding to the first BI-RADS category 4;⑤definitely malignant,corresponding to the BI-RADS category 5 and 6.Ultrasound diagnosis of ROC classification for Category 5:â‘ certainly benign lesions;â‘¡probably benign lesions;â‘¢should not qualitative;â‘£probably malignant;⑤definitely vicious.Those who have the two signs are suspicious for malignant breast cancer,classified as the firstâ‘£categories,with three and more than three signs are prompted malignant breast cancer,classified as the first category⑤.Articleâ‘ negative category for breast cancer diagnosis.4.Statistical treatment:To the pathological diagnosis as gold standard,as one of malignant,benign set to 0,to 106 cases of all cases of pathology,diagnostic imaging results enter SPSS13.0 software to draw ROC curves and area under the curve(A_mammography,A_ultrasound),and compare the size of the difference statistically significant.【Results】1.62 malignant lesions of the X-ray mammography showed malignant calcification rate was 29/62(46.8%),mass rate of the overall show that 39/62(62.9%), 62 cases of breast skin can be seen side by thick were five cases,seven cases of inverted nipple persons,13 cases of large duct symptoms,17 cases of lymph nodes increased.2.62 malignant lesions of the ultrasound edge can be observed not clear,46 cases were irregular(74.2%),59 cases(95.2%) showed inhomogeneous hypoechoic mass,mass internal scattered at point or cluster-like distribution of the strong echo of a total of 35 cases(56.4%),rear acoustic attenuation of 14 cases(22.6%),CDFI showed 62 cases of lesions 53 have blood flow within the see signal(blood flow detection rate of 85.5%),classâ…¡tumor blood flow more than 29(47.6%).3.This study shows that A_mammography=0.917＞0.9(P=0.000),A_ultrasound=0.909＞0.9(P=0.000),that X-ray mammography and ultrasound for the diagnosis of breast lesions have a significant statistical significance,diagnostic performance and higher. A_mammography＞A_ultrasound,both A value of 95%confidence interval highly overlap,the two methods was no significant differ.【Conclusion】1.X-ray mammography,B-ultrasound in the diagnosis of malignant lesions of the breast higher performance(A_Z value＞0.9),but for the diagnosis of benign lesions must exist false positive.2.X-ray mammography and ultrasound super-low-cost,short time-consuming, mammography showed only partial structural disorder(twist),focal asymmetric density or cluster shadow,early calcification,in-situ or occult breast malignancies. color Doppler flow imaging(CDFI) can observe the blood supply to the extent of lesions,and the CDFI flow classification of benign and malignant breast lesions exist qualitative overlap to some extent,the specificity was less than desirable,for the ultrasound diagnosis of a doctor experience,level has greatly dependent.Partâ…¡Contrasting study of Mammographic,CDU and MR Imaging in differential diagnosis between benign and malignant breast lesions【Materials and Methods】1.Clinical dataCollected in May 2007～November 2008 clinical or mammography,ultrasound suspected 25 cases of breast cancer patients with MRI examination,14 cases of breast cancer one of 17 lesions,age 31～61 years old,the average age of 45.6 years of age; benign breast 11 cases of lesions 14 lesions,age 38～71 years old,the average age of 47.4 years.All cases were confirmed by surgical pathology or biopsy confirmed..2.Equipment and Methods:2.1 X-ray mammography,color Doppler ultrasound and diagnostic equipment with the first part of experimental methods.2.2 MRI:All the patients were performed with GE Signa EXCITE HD 3.0T superconducting magnetic resonance scanner.Abdomen surface 8-channel phased array coil and self-made breast stent were used.Gd-DTPA was injected as paramagnetic contrast medium with high pressure injection. 2.3 DCE-MRI and DWI data were post-processed using Functool SER software package on AW 4.3 workstation.3.Examination technique:3.1 Plain scanning:Bilateral breast axial T₁WI,axial and sagittal FSE T₂WI with far suppression were performed with scan parameters as followings:axial T₁WI+FS (TR/TE=450/9.7ms) and axial T₂WI+FS(TR/TE=4000/85ms) with 6mm slice thickness,1mm gap,FOV=32cm×32cm,NEX=2.0,320×224 matrix;Sagittal FSE T2WI+FS(TR/TE=4675/85ms) with 5mm slice thickness,1mm gap,FOV=22cm×22cm,NEX=2.0,320×224 matrix.3.2 All the DWI examinations were performed before DCE-MRI examination, using EPI(echo planner imaging) sequnence(TR/TE = 2000/52.6ms,6mm slice thickness,1mm interval gap,matrix 128×128,FOV=32cm×32cm,NEX=4.0) with ASSET(array spatial sensitivity encoding) technique.Two diffusion-weighted imaging were implemented at two different b valus(600s/mm² and 1000s/mm²).All the primitive data was sent to GE AW 4.3 workstation for post-processing. ADC imaging were automatically generated with Functool software.The apparent diffusion coefficient(ADC) values were recorded and compared in different breast lesions(breast cancers,and benign lesion) with the sane b value and sane lesions with the different b value(b=600s/mm² and b=1000s/mm²).3.3 LAVA DCE-MRI:Dynamic contrast-enhanced MRI was performed with LAVA sequence(TR/TE=3.6/1.7ms,20°flip angle,4.4mm slice thickness with 50% overlapping,128×128 matrix,FOV=32cm×32cm,NEX=0.75,28s acquisition time). Mask imaging was first scanned without contrast medium,then scanning were repeated when injecting of contrast agent Gd-DTPA(flow rate of 2.0ml/s and dose of 0.2mmol/kg) by the first time,scanned again at the 0^th,0.5^th,1^th,1.5^th,2.5^th,4.5^th,7^th minute after injecting owith the same parameters and acquisition time(28s). 3.4 Data processing and data analysisAfter scanning,all the primitive sara was sent to GE AW 4.3 workstation.The time-signal intensity curve(TIC) of each ROI was automatically generated with Functool SER(signal enhance ratio)software.ROIs were chosen in slice where lesions Displayed most clearly.The morphologic features and hemodynamic characteristics of benign and malignant breast lesions were compared.ROI smaller than tumor diameter, refrain from the zone of necrosis and hemorrhage.4.Diagnostic test of MRI4.1 LAVA DCE-MRI:Reference Fischer and others,such as proposed by the people to amend Siegmann breast imaging and data system(BI-RADS) assessment of the nature of lesions,according to DEC and to enhance the kinetics of morphological scoring performance,scoring one points will be set to positive benign,probably 2～3 is divided into benign,suspicious malignant divided into 4,5～8 are divided into certain malignant.4.2 DWI:The apparent diffusion coefficient(ADC) values of 31 lesions were recorded at different b value(b=600s/mm² and b=1000s/mm²).The mean ADC values of benign breast lesions and malignant breast lesions at different b values were compared with independent-sample T Test.Using the one-side upper limits of 95% confidence interval of mean ADCs as the standard to separate malignant from benign breast lesions.The ADC value which infra-the standard or equal to the standard was diagnosed malignant lesions(1 score),The ADC value which super-the standard or equal to the standard was diagnosed benign lesions(0 score).4.3 Dynamic contrast-enhanced scan(DEC) and diffusion-weighted imaging (DWI) United diagnostic tests:dynamic contrast-enhanced scan in morphology and enhance the basic dynamics of the judge,the combination of DWI points to be divided into one definitely benign,2～3 is divided into benign the possibility of large, 4 should not be divided into qualitative,suspicious of malignant for 5 points,high grade for the 6～9pm.5.Statistical analysis:Application software mapping SPSS13.0 molybdenum target X-ray,ultrasound, MRI diagnosis of benign and malignant lesions of the performance of ROC curves, area under the curve drawn automatically(Az value),and compare the size of the difference statistically significant.【Results】1.Dynamic contrast-enhanced scan:17 malignant lesions,17 lesions with irregular shape(100%),the border has rough burr 16 lesions(94%),LAVA dynamic contrast-enhanced scan early heterogeneous enhancement,13 lesions(76.5%);14 In benign lesions who shape warping 9 foci(64.3%),smooth boundary 11 lesions (78.6%),enhanced scan after three evenly enhanced 10 foci(71.4%).Malignant lesions in typeâ…¢TIC curve often,accounting for 11 lesions(64.7%);14 benign lesions found in typeâ… curve,accounting for 7 lesions(50.0%),but typeâ…¡curves between malignant and benign lesions at the level of the larger overlap malignant lesions of typeâ…¡curve has five(29.4%),benign lesions of typeâ…¡curve has six (42.8%).2.Diffusion-weighted imaging:b=600s/mm² when the ADC values between the two groups:malignant lesions(1.1342±0.2294×10^-3mm²/s)＜benign lesions(1.6531±0.2898×10^-3mm²/s),the difference have statistical significance(P = 0.000).b = 1000s/mm² when malignant lesions(1.0494±0.2107×10^-3mm² /s)＜benign lesions (1.5465±0.2680×10^-3mm²/s),there was a significant difference statistically significant(P=0.000).B value in different malignant breast lesion ADC value of 95%confidence interval upper limit for the diagnosis of malignant lesions threshold, less than or equal to the threshold for malignant breast lesions to determine the standard,that is,b=600s/mm² when,ADC diagnosis threshold of 1.2521×10^-3mm² /s;b=1000s/mm² when,ADC threshold for diagnosis of 1.1577×10^-3mm²/s. B values in different groups all the ADC lesion data for ROC curve,b the value of taking time 600s/mm2 area under the curve(A_Z value) 600 = 0.895±0.070(P= 0.000);b value when taken under the curve 1000s/mm² area(Az) 600 = 0.887±0.075 (P=0.000),prompted b = 600s/mm2 and b = 1000s/mm² time,ADC values for the diagnosis of malignant breast lesions were significantly statistical significance.3.A_mammography=0.918,A_ultrasound=0.929,A_MRI= 0.922,A_ultrasound＞A_MRI＞A_mammography, in part of this study,three methods of diagnostic imaging performance:ultrasound＞MRI＞X-ray mammography.A value of three 95%confidence interval highly overlap, the three imaging methods was no significant difference.【Conclusion】1.Ultra-high field strength 3.0T magnetic resonance machine is equipped with 8-channel body coil examination breast tissue is feasible.2.Dynamic contrast-enhanced diffusion-weighted imaging scans United benign and malignant breast lesions on diagnostic performance of the higher(Az value＞0.9),but some exist between benign and malignant lesions overlap. 3.MRI can be observation of the entire organization and rear breast pectoralis major muscle space,such as axillary lymph nodes near the structure,on the prognosis of malignant lesions in clinical diagnosis have reference value,lesion morphology, signal performance,and enhance the characteristics of time - signal intensity curve, diffusion-weighted value of parameters such as ADC can be combined with multi-directional diagnosis of benign and malignant lesions,and the amount of information-rich picture storage,integrity,and in favor of retrospective analysis of summary.Actual diagnostic work,should be based on X-ray mammography and the combination of ultrasound malignant breast lesions improve attendance rate and,if necessary,supplemented by MRI examination.