磁共振对超声阴性而乳腺X线检出BI-RADS4类以上钙化灶的诊断价值分析

doi:10.16150/j.1671-2870.2021.05.003

摘要/Abstract

摘要：

目的：评估磁共振成像（magnetic resonance imaging, MRI）对超声（ultrasound, US）检查阴性、乳腺X线摄影（mammography, MG）发现的BI-RADS 4类以上钙化灶的诊断价值。 方法：回顾性分析2020年1月至2020年12月US阴性、经MG发现的BI-RADS 4类以上可疑形态钙化灶126个,均行乳腺MRI检查。分析上述可疑形态钙化灶的MG、MRI表现,以活检病理结果为金标准,评价MRI对其的诊断价值。 结果：病灶总数126个,其中良性100个（79.37%）,恶性26个（20.63%）。MG表现为良性钙化灶形态以模糊无定形为主,占68.00%（68/100）;恶性钙化灶形态以粗糙不均质为主,占53.85%（14/26）。恶性钙化灶MRI表现均有异常强化,以肿块强化为主（61.54%）,较良性钙化的肿块强化更多见（61.54%比22.00%,P<0.001）,而67.00%的良性钙化灶MRI表现为无异常强化（P<0.001）。钙化灶MRI增强时间信号强度曲线（time-signal intensity curve, TIC）表现为上升型时提示良性病变可能性大（63.60%比11.54%,P<0.001）,而表现为流出型时提示恶性病变可能大（73.08%比0,P<0.001）。对于US检查阴性、经MG发现的BI-RADS 4类以上可疑形态钙化灶的诊断,MG及MG联合MRI检查的灵敏度分别为15.4%和92.3%（P均<0.001）,准确率分别为80.2%和96.8%（P<0.001）,阴性预测值分别为81.5%和98.0%（P<0.001）。 结论：MG联合MRI检查比单纯MG检查对于乳腺可疑形态钙化病变具有更高的灵敏度、准确率和阴性预测值,可提高诊断效能,优化临床处置方案。

关键词: 磁共振成像, 乳腺X线摄影, 钙化, 诊断

Abstract:

Objective: To assess the diagnostic value of magnetic resonance imaging (MRI) for diannosing suspicious calcification which were BI-RADS≥4 on mammography (MG) and negative on ultrasound. Methods: A total of 126 suspicious calcification lesions were included in the study. Those calcifications were classified as BI-RADS≥4 category and negative on ultrasound between January 2020 and December 2020, and lesions were examined with breast magnetic resonance imaging (MRI). Performance of MRI for diagnosing suspicious calcification was assessed based on biopsy pathologic results. Results: There was 100 benign lesions (79.37%), and 26 malignant lesions 26(20.63%). Benign calcifications were mostly presented as amorphous calcifications 68%（68/100）, while malignant calcifications were mostly presented as coarse heterogeneous calcifications 53.85%（14/26）. In malignant calcifications, 61.54% lesions were presented as mass enhancement, and mass enhancement were more common in malignant lesions than in benign lesions (61.54% vs 22.00%,P<0.001). 67.00% benign calcifications had no abnormal enhancement (P<0.001). Persistent time-signal intensity curve (TIC) suggested benign lesions (63.60% vs 11.54%, P<0.001) while wash-out curve suggested malignant lesions (73.08% vs 0%,P<0.001). The detection sensitivity of MG and MG+MRI for ultrasound-negative calcifications were 15.4% and 92.3% (P<0.001), with accuracy of 80.2%, 96.8% (P<0.001), respectively. The negative predictive value for MG and MRI+MG were 81.5% and 98.0% (P<0.001). Conclusions: MRI combined with MG has higher sensitivity, accuracy and negative predictive value than mammography alone in diagnosing suspicious calcifications of ultrasound negative results.

Key words: Magnetic resonance imaging, Mammography, Calcifications

中图分类号:

R541.7

朱乃懿, 姜奕歆, 柴丽, 柴维敏. 磁共振对超声阴性而乳腺X线检出BI-RADS4类以上钙化灶的诊断价值分析[J]. 诊断学理论与实践, 2021, 20(05): 439-444.

ZHU Naiyi, JIANG Yixin, CHAI Li, CHAI Weimin. Diagnostic values of magnetic resonance imaging in mammography detected BI-RADS≥4 category calcifications with negative ultrasound results[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(05): 439-444.

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MG BI-RADS	总计	良性	恶性	P值
4A类	86	80（93.02）	6（6.98）	<0.001
4B类	33	17（51.52）	16（48.48）
4C类及以上	7	3	4
总计	126	100	26

MRI BI-RADS	总计	良性	恶性	P值
2~3类	65	63（96.92）	2（3.08）	<0.001
4类及以上	61	37（60.66）	24（39.34）
总计	126	100	26

MG特征	良性	恶性	P值
钙化形态			<0.001
模糊无定形	68（68.00）	8（30.77）	<0.001
粗糙不均质	30（30.00）	14（53.85）	0.003
细小多形性	2（2.00）	2（7.69）
线状分支状	0（0）	2（7.69）	<0.001
钙化分布			0.032
区域	5（5.00）	1（3.85）
集群样	89（89.00）	17（65.38）
段样	6（6.00）	7（26.92）
线样	0（0）	1（3.85）
伴随征象			<0.001
单纯钙化	95（95.00）	21（80.77）
钙化伴肿块/不对称/ 结构扭曲	5（5.00）	5（19.23）

诊断参数	MG	MG+MRI	P值
灵敏度（%）	15.4（4/26）	92.3（24/26）	<0.001
特异度（%）	97.0（97/100）	98.0（98/100）	0.651
准确率（%）	80.2（101/126）	96.8（122/126）	<0.001
阳性预测值（%）	57.1（4/7）	85.7（24/28）	0.021
阴性预测值（%）	81.5（97/119）	98.0（98/100）	<0.001