Diagnosis And Differential Diagnosis Of Breast Lesions By Using Magnetic Resonance Imaging

Part I The value of dynamic contrast enhancement MRI in Differential Diagnosis of benign and malignant breast lesionsObjective:The purpose of this study was to evaluate the value of dynamic contrast-enhanced MRI in diagnosising and distinguishing benign and malignant breast lesions with morphologic MR features and enhancement curve type.Materials and Methods:Volume imaging for breast assessment used as multitemporal enhanced MRI, VIBRANT was performed in 81 patients with 86 breast lesions, including 39 patients with 39 malignant breast lesions and 42 patients with 47 benign breast lesions, and all of the cases were confirmed by pathology after operation or puncture biopsy. The parameters for evaluation in DCE-MRI including the morphological features besides lesions'shape and margins, the hemodynamic besides lesions'early enhancement rate and the lesions'time-signal intensity curve pattern.Results:There are statistics difference presence in the morphological features, early enhancement rate and the time-signal intensity curve pattern between benign and malignant breast lesions. The sensitivity, specificity and accuracy of the morphological features was 82.05%,68.09%and 74.42%. The sensitivity, specificity and accuracy of the early enhancement rate was 97.43%,47.83%,70.59%.The sensitivity, specificity and accuracy of the time-signal intensity curve pattern was 82.05%,69.57%,75.29%. The sensitivity, specificity and accuracy of the three combined criteria were 82.05%,69.57%,75.29%.Conclusions:1, VIBRANT enhanced MRI was good for analysis the morphological features and hemodynamics features of the breast lesions, assessment the breast lesions in synthetical way, and can improve the sensitivity, specificity and accuracy for differential diagnosis benign and malignant lesions.2, The malignant breast lesions always showed mass with irregular shape, ill defined, and had speculated borders, the time-signal intensity curve was always showedⅢtype,the initial peak of signal intensity increase were always larger than 100%. The benign breast lesions always showed mass with regular shape,well defined, the time-signal intensity curve was always showed I type,the initial peak of signal intensity increase were always less than 100%.Part II A pilot study with the application of diffusion weighted MRI in diagnosing breast lesionsObjective:To investigate the optimal b value application in MR diffusion weighted imaging for breast lesions and its diagnostic ability differentiate benign from the malignant breast lesions. To study if the ADC is different between malignant and benign breast lesions.Materials and Methods:There were 52 patients 59 lesions were confirmed by pathology after operation or puncture biopsy, including 21 patients with 22 breast malignant lesions,31 patients with 37 breast benign lesions. There are three groups, malignant lesions,benign lesions exclude cysts and cysts, five diffusion weighted sequences for different b value were implemented with 200s/mm2,500s/mm2,800s /mm2,1000s/mm2,500s/mm2. To compare the apparent diffusion coefficient with different breast lesions in the same b value and to compare the same breast lesions' apparent diffusion coefficient in the different b value.Results:The mean ADC value of the malignant lesions,benign lesions exclude cysts and cysts were 1.511±0.310 X 10-3mm2/s,2.093±0.392 X 10-3mm2/s 2.838±0.637X 10-3mm2/s with b=200s/mm2. The mean ADC value of the malignant lesions,benign lesions exclude cysts and cysts were 1.334±0.258×10-3mm2/s,1.850±0.407×10-3mm2/s,2.607±0.504X 10-3mm2/s with b=500s/mm2. The mean ADC value of the malignant lesions,benign lesions exclude cysts and cysts were 1.195±0.219X 10-3mm2/s,1.637±0.362 X 10-3mm2/s,2.318±0.514X 10-3mm2/s with b=800s/mm2. The mean ADC value of the malignant lesions,benign lesions exclude cysts and cysts were 1.077±0.196 X 10-3mm2/s,1.501±0.328 X 10-3mm2/s,2.103±0.489×10-3mm2/s with b=1000s/mm2.The mean ADC value of the malignant lesions,benign lesions exclude cysts and cysts were 0.944±0.873X 10-3mm/s,1.306±0.271X 10-3mm2/s,1.770±0.356X 10-3mm2/s with b=1500s/mm2.Conclusions:Under the five diffusion weighted sequences for different b value, There are significant differences statistically in comparison between the ADC of the malignant lesions,the benign lesions exclude cysts and the cysts. The ADC of the malignant lesions were lower than the benign lesions exclude cysts, and the two groups were lower than cysts.