| Objective:To evaluate the diagnostic value of single and combined application of dynamic contrast enhanced magnetic resonance imaging?DCE-MRI?,diffusion weighted imaging?DWI?and hydrogen proton magnetic resonance spectroscopy?1H,magnetic resonance spectroscopy,1H-MRS?in patients with breast cancer.Methods:To collect the Affiliated Hospital of Hebei University of Technology from December 2018 to October 2019,and 65 female patients with breast lesion detected by mammography underwent MRI examinations on a 1.5 T scanner?GE HDxt?preoperatively were confirmed by puncture or surgical pathology.MRI examinations included T1 weighted imaging?T1WI?sequence,fat suppression T2weighted imaging?T2WI?sequence,8min three-dimensional DCE-MRI,DWI with b value of 1000s/mm2 by single-shot echo planar imaging sequence,and 1H-MRS by J-PRESS and Spectral Spatial PRESS.Contrast agent Gd-DTPA was injected with bolus and was followed with a 20-ml flush of isotonic saline solution.DCE-MRI time signal intensity curve?TIC?of the lesions were classified as type??steady enhancement?,type??plateau?,type??washout?.Lesions with type?were classified as benign,whereas the lesions with type?or type?were classified as malignant.The mean apparent diffusion coefficient?ADC?of the lesions were calculated on DWI with b value of 1000s/mm2,and the receiver operator characteristic?ROC?curve was drawn to identify the cutoff to differentiate the benign and malignant lesions.Lesions presenting a detectable Choline signal in their spectra at 3.2ppm were diagnosed as malignant.According to the Breast Imaging and Reporting Data System diagnostic standards designed by the American College of Radiology,the imaging diagnosis is made.Results were Compared with pathological diagnosis.The sensitivity,specificity,positive predictive value and negative predictive value of DCE-MRI,DWI and 1H-MRS regarding the diagnosis of breast cancer were determined respectively.Kappa test is used to identify the consistency between the diagnosis results of pathological and different imaging techniques.Results:According to the pathological diagnosis results as the gold standard,all the patients were divided into benign group and malignant group,21 cases were included in benign group and 44 cases in malignant group.The sensitivity,specificity and the Kappa values of DCE-MRI were 93.2%,57.1%and 0.54;ROC curve was generated in order to determine the ADC thresholds that could balance the needs of sensitivity and specificity.We selected the ADC cutoff value of 1.12×10-3mm2/s with b value of 1000s/mm2,at this cutoff value,sensitivity,specificity and the Kappa values of DWI were 77.3%,90.5%and 0.62.The sensitivity,specificity and the Kappa values of 1H-MRS were 81.8%,81.0%and 0.60.The sensitivity,specificity and the Kappa values of DCE-MRI combined with DWI were 86.4%,76.2%and 0.62;The sensitivity,specificity and the Kappa values of the combination of DCE-MRI,DWI and 1H-MRS were 93.2%,90.5%and 0.83.Conclusion:1.DCE-MRI has a high diagnostic sensitivity,but the specificity is not ideal.2.ADC diagnostic threshold is 1.12×10-3mm2/s with b value of 1000s/mm2 has high effectiveness,and DWI has higher specificity.3.ADC value has a high specificity to diagnose breast lesions.4.1H-MRS could improve the sensitivity and specificity,but limited to its individual application due to technics and the biological characteristics of the lesion.5.The combined application of DCE-MRI,DWI and 1H-MRS is more effective in diagnosing breast lesions than the combined application of DCE-MRI and DWI,thus effectively reducing unnecessary biopsy. |
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