The Application Of Dwi And ~1h-mrs In Breast

Objective:1. To observe DW1 and ADC map features of 3 kinds of normal breasts (namely dense type, lobular-pinto type and degeneration type), to analyze the statistical differences of ADC values among 3 kinds of normal breasts and the correlation between ADC values and corresponding histology. To find out the b values influences on 3 kinds of normal breasts.2. DWI and ADC map features of benign and malignant breast lesions were observed. The statistical differences of ADC values in normal breasts, benign and malignant lesions were analyzed in order to find out the differential diagnosis value of ADC values in breast lesions. The relationship between ADC values and cell density of pathology, and the influences of b values on ADC values of normal breasts, benign lesions and malignant ones were also analyzed.3. To investigate the differential diagnosis value of 1H-MRS in breast lesions.Materials and methods:The ADC values of 62 normal breasts,24 malignant breast lesions and 30 benign ones which were made final diagnosis by pathology were calculated based on the formula ADC= [In (Slow/Shigh)]/(bhigh-blow) respectively each with b values of 1000 and 0 s/mm2, '1000 and 500 s/mm2,500 and 0 s/mm2. The MRI features of 62 normal breasts were classified into 3 types according to Wolfs classification and histology, namely dense type in 10 cases, lobular-pinto type in 42 and degeneration type in 10. The statistical differences among 3 kinds of normal breasts and among normal breasts, malignant lesions, benign lesions were compared each other by using SAS (statistical analysis system) 6.12. The ADC values each with b value of 1000～0 s/mm2,500～0 s/mm2 and 1000～500 s/mm2 were also calculated and compared.35 cases whose diameter of tumors was larger than 1.5cm were chosen from 46 cases, and were scanned by 1H-MRS. MRS protocol was se_bBl designed specially for breast. EPI (TR 2900 ms, TE 84ms, thickness 5 mm) were used in order to acquire imaging.Results:1. The mean ADC value of dense type of normal breast is (1.70±0.37)×10-3mm2/s, lobular-pinto type is (1.93±0.46)×10-3mm2/s and degenerate type is (1.18±0.65)×10-3mm2/s. There are no significant differences between dense type and lobular-pinto type, but there are significant differences between dense type and degenerate type, between lobular-pinto type and degenerate type respectively. When b values decrease, the ADC values of the dense type and lobular-pinto type increase correspondingly but the degenerate type doesn't change apparently.2. There are significant statistically differences of ADC values in normal breasts, benign and malignant lesions basically because of their diverse cellular density. Among them, malignant lesions are lower than normal breasts and benign lesions; benign lesions are lower than normal breasts. There are also significant statistical differences of ADC values of each group when b values are as following:b=1000～0 s/mm,1000～500 s/mm, 500～0 s/mm2. The lower of the b values, the higher of the ADC values are. The sensitivity, specificity of diagnosis based on ADC values is 64%,96.7% respectively.3. Of all the 35 cases scanned by 1H-MRS,8 of 18 malignant tumors showed up choline resonance peak at 3.24ppm while only 2 of 17 benign ones at 3.24ppm. The positive ratio of two groups above is 44.4% and 12.8% respectively. The sensitivity and specificity is 44.4% and 88.3% respectively by using 1H-MRS to discriminate benign from malignant tumors. The main factors that influence the choline detection are low suppressed lipid, low suppressed water and low single-noise rate. Conclusions:1. There are no significant differences of ADC values between dense type and lobular-pinto type because of their similar histological composition, but there are significant differences between dense type and degenerate type, between lobular-pinto type and degenerate type because of their different histological composition.2. There are significant statistical differences of ADC values among normal breasts, benign lesions and malignant lesions because of their different cellular density. Using 1.01×10-3mm2/s of ADC value to discriminate the benign and malignant lesions of breasts, the sensitivity and the specificity is 64%,96.7% respectively.3. The ADC values of dense type and lobular-pinto type are influenced by b values whereas the degenerate type is not. ADC values of malignant and benign lesions are influenced significantly by b values and the lower b values are, the higher ADC values are.4. Choline is not specific features of malignant tumors and it can be got only if tumors grow rapidly regardless of their bionomics. Because most of malignant lesions grow faster than benign lesions, the differential diagnosis can be made based on Cho. The low detecting sensitivity of choline is due to diverse technique factors.