磁共振成像在乳腺导管内原位癌与导管内乳头状瘤鉴别诊断中的价值

磁共振成像在乳腺导管内原位癌与导管内乳头状瘤鉴别诊

断中的价值

[摘要] 目的分析乳腺导管内原位癌（DCIS）和导管内乳头状瘤（BIDP）的MRI影像学特点，探讨磁共振成像对DCIS、BIDP的鉴别诊断价值。方法收集2012年1月～2014年12

月经手术病理证实的DCIS 50例、BIDP 48例，依据乳腺影像报告和数据系统（BI-RADS MRI），分析病灶的数量、分布、

信号、形态、强化方式及时间-信号曲线（TIC）类型。结果

动态增强扫描，98例患者中点状/灶状强化病灶4例（4.1%），非肿块样强化81例（82.7%），肿块样强化13例（13.3%）。DCIS组点状/灶状强化病灶2例（4.0%），非肿块样强化43

例（86.0%），肿块样强化5例（10.0%）。BIDP组点状/灶状

强化病灶2例（4.2%），非肿块样强化38例（79.2%），肿块样强化8例（16.7%）。TIC曲线：DCIS I型13例（26.0%）、

Ⅱ型28例（56.0%）、Ⅲ型9例（18.0%）；BIDP Ⅰ型9例（18.8%）、Ⅱ型27例（56.3%）、Ⅲ型12例（25.0%），差异无统计学意义（P>0.05）。结论DCIS与BIDP的磁共振动态增强表现均以非肿块样强化为主，DCIS主要表现为段样强化或区域状强化，多不伴导管扩张，BIDP主要表现为沿乳腺导管分布的小结节状强化及导管样强化，多伴导管扩张。DCIS TIC常表现为Ⅰ、Ⅱ型，以Ⅱ型居多；BIDP TIC常表现为Ⅱ型、Ⅲ型，以Ⅱ型

居多。

[关键词] 乳腺；磁共振成像；导管内原位癌；导管内乳头状瘤

[中图分类号] R737.9 [文献标识码] B [文章编号]

1673-9701（2015）29-0099-04

Value of MRI in differential diagnosis of breast intraductal papillomatosis and ductal carcinoma in situ

ZHANG Yaping1 ZHAO Zhenhua1 LIU Fang2 HUANG

Liming3 YANG Liming1 MENG Liwei3

1.Radiology Department，Shaoxing City People's Hospital，Shaoxing Hospital of Zhejiang University，Shaoxing 312000，China；

2.Pathology Department，Shaoxing City People's Hospital，Shaoxing Hospital of Zhejiang University，Shaoxing 312000，China；

3.Breast Surgery Department，Shaoxing City People's Hospital，Shaoxing Hospital of Zhejiang University，Shaoxing 312000，China

[Abstract] Objective To analyze the imaging features of ductal carcinoma in situ and breast intraductal papillomatosis，to investigate the value of MRI in differential diagnosis of DCIS and BIDP. Methods A total of 50 patients with DCIS and 48 patients with BIDP confirmed by pathologically were collected

from January 2012 to December 2014，the quantity，distribution，morphology，signal intensity，enhancement pattern and time-signal intensity curve （TIC）types of lesions were analyzed according to breast imaging reporting and data system （BI-RADS）. Results During dynamic enhanced scan of 98 patients，4 cases （4.1%）with focal point and focal lesion，81 cases （82.7%）with non mass-like enhancement，13 cases （13.3%）with mass-like enhancement. Two patients （4.0%）showed punctate/focal enhancement，43 patients （86.0%）non-mass-like enhancement and 5 patients （10.0%）mass-like enhancement in group DCIS. Two patients （4.2%）showed punctate/focal enhancement，38 patients （79.2%）

non-mass-like enhancement and 8 patients （16.7%）mass-like enhancement in BIDP group. As for TIC，13 patients （26.0%）showed type Ⅰ，28 patients （56.0%）of type Ⅱ，and 9 patients （18.0%）of type Ⅲin DCIS group. 9 patients （18.8%）showed type I，27 patients （56.3%）of type Ⅱ，and 12 patients （25.0%）of type Ⅲin BIDP group. There was no significantly difference （P>0.05）. Conclusion Both DCIS and BIDP demonstrate non-mass-like enhancement during dynamic enhancement. DCIS mainly demonstrate segmental or regional enhancement without ductal ectasia. BIDP mainly demonstrate