乳房MR扩散加权成像：比较正常乳腺组织与良性和恶性乳腺病变表观扩散系数值dwi-adc.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Diffusion-weighted MR imaging of the breast:Comparison of apparent diffusion coefficient values of normal breast tissue with benign and malignant breast lesions,乳房MR扩散加权成像：比较正常乳腺组织与良性和恶性乳腺病变表观扩散系数值,XIA WANJUN,The specificity of conventional magnetic resonance(MR)imaging is lower than its high sensitivity.,传统的磁共振（MR）成像灵敏度低。,Diffusion-weighted imaging(DWI),based on alterations in the microscopic motion of water molecules,promises improved specificity for breast MR imaging.In this study,we aimed to determine the diagnostic potential of DWI to differentiate between benign and malignant breast lesions and normal breast tissue.弥散加权成像（DWI）的基础是水分子的微观运动，是特殊的乳腺磁共振成像技术。本项研究的目的是探讨DWI对区分良性和恶性乳腺病变及正常乳腺组织的潜在诊断性。,Dynamic contrast-enhanced breast MR imaging and DWI were applied to 108 women.Apparent diffusion coefficient(ADC)values were obtained for normal breast tissue(n=183),benign lesions(n=66)and malignant lesions(n=58).The results were compared with the patients final diagnoses.,对108名妇女进行动态对比增强乳腺磁共振成像和弥散加权成像。对正常乳腺组织（N=183例），良性病变组（n=66例），恶性病变,（N=58例）分别进行表观扩散系数（ADC）值测定。然后与患者的最终诊断结果进行比较。,On histopathological examination,58 lesions proved to be malignant in 42 patients:invasive ductal carcinoma(IDC)n=31;invasive lobular carcinoma(ILC)n=1;mixed invasive lobular and ductal carcinoma(IDC+ILC)n=3;ductal carcinoma in situ n=2;mix IDC+mucinous carcinoma n=1;IDC and pleomorphic carcinoman=1;medullary carcinoma n=1;,对42位患者58例病变进行病理组织学检查，发现恶性乳腺浸润性导管癌（IDC）31位患者，浸润性小叶癌（ILC）1位患者，浸润性导管癌和浸润性小叶癌（IDC+ILC）3位患者;导管原位癌2位患者;浸润性导管癌+黏液腺癌 1位患者;浸润性导管癌和多形性癌1例，髓样癌1位患者，,malignant phyllodes tumour n=1;diffuse leukaemic infiltration of the breast n=1.,恶性叶状肿瘤1位患者，弥漫性白血病浸润乳腺1位患者。,The mean size of the malignant lesions was 41.3 34.3 mm.,恶性病变的平均大小为41.334.3毫米。,A total of 66 benign lesions in 44 patients were included in the study.,44位患者66例良性病变的研究。,35 lesions were histopathologically diagnosed as benign fibroadenoma(n=18),cystosarcoma phyllodes tumour(n=2),fibrocystic changes(n=4),seroma(n=6),fat necrosis(n=2),ductal hyperplasia(n=1),papilloma(n=1)and haematoma(n=1).,35例病变组织病理学诊断为良性纤维腺瘤18例，分叶状囊肉瘤2例，纤维囊性变4例，血清肿组6例，脂肪坏死2例，导管上皮增生1例，乳头状瘤1例和血肿1例。,31 benign lesions had typical BI-RADS(Breast Imaging Reporting and Data System)2 findings on DCE-MRI and were diagnosed as cyst(n=7),fibroadenoma(n=20)and intramammarian lymph node(n=4).,DCE-MRI检查对31例典型的良性病变定BI-RADS分级（乳腺影像报告和数据系统）2，并诊断为囊肿7例，纤维腺瘤20例和乳房淋巴结4例。,Conclusion DWI of the breast can help differentiate benign and malignant breast lesions from normal breast tissue.,结论 乳房DWI检查可以帮助区分良性、恶性乳腺病变与正常乳腺组织。,DWI,which can be easily introduced into standard breast MR imaging protocols without increasing imaging times,promises to increase the accuracy of breast MR imaging without contrast media.。,DWI在不增加成像时间，通常作为常规的乳房MR成像检查方法之一，增加乳腺磁共振成像的准确性而无需造影剂。,DWI is an advanced MR imaging technique based on the diffusion signal of tissues,which reflects the amount of random motion of water molecules into tissues due to thermal agitation(Brownian motion).,DWI是一种先进的磁共振成像技术，基于组织的扩散信号，反映了组织中水分子的随机热运动（布朗运动）。,DWI was first introduced for acute cerebral infarction,for which it has become one of the primary imaging modalities.,DWI最初引入急性脑梗塞，并已成为主要成像方式之一。,DWI has been reported to be a useful technique for the discrimination of benign and malignant lesions.已报道DWI是一种区别良性和恶性病变有用的技术。,Malignant lesions with tightly packed cells have a reduced extracellular space,resulting in decreased diffusion of water.The result is a high DWI signal intensity and a lower ADC value,indicating restricted diffusion on an ADC map(Figs.13).,恶性病变的细胞排列紧密，减少外的空间，从而降低水的扩散。其结果是高DWI信号强度和低ADC值，ADC图（图1-3）上显示扩散受限制。,（图1-3）,1a,Fig.1 Histopathological f indings in a 43-year-old woman with invasive ductal carcinoma浸润性导管癌.(a)Postcontrast T1-W fat-saturated sagittal image and(b)MIP image of the breast in the axial plane show an enhancing BI-RADS 5 lesion with irregular margins(arrows).(c)DWI with b=600 and(d)ADC map show a mass with restricted diffusion that was hyperintense on DWI and hypointense on ADC map(arrows).Mean ADC value=0.95 10,3,mm,2,/s.ADC:apparent diffusion coefficient;BI-RADS:B reast Imaging Repor t ing and Data System;DWI:diffusion-weighted imaging;MIP:maximum intensity projection,1b,1c,1d,Fig.2 Histopathological f indings in a 43-year-old woman with locally advanced invasive ductal carcinoma浸润性导管癌.Sagittal MIP reconstructions obtained from the f irst series of post-contrast dynamic images(a)before and(b)after neoadjuvant chemotherapy show minimal decrease in the size of tumour,axillary lymph nodes and vascularity.ADC maps of DWI(c)before(b=0)and(d)af ter(b=600)neoadjuvant chemotherapy are also seen(black and white arrows show the margin of the lesion).Mean ADC value:before,0.93 10,3,mm,2,/s;after,1.08 103,3,mm,2,/s.Post-therapy measurements were not included in the study.ADC:apparent dif fusion coef ficient;DWI:dif fusion-weighted imaging;MIP:maximum intensity projection,2a,2b,2c,2d,（图4和图5）。,3a,3b,3c,3d,Fig.3 Histopathologicalf indings in a 32-year-old woman showing leukemic infiltration 白血病浸润of the breast.(a)T2-W sagittal and(b)post-contrast T1-W fat-saturated subtracted sagit tal images show a huge lesion with central areas of necrosis坏死.(c)DWI with b=600 and(d)ADC map show solid portions of the mass with restricted dif fusion that were hyperintense on DWI and hypointense on ADC map.Mean ADC value=0.31 10,3,mm,2,/s.The necrotic central part of the tumour,with relatively higher diffusion,was not included in the ROI during measurements.ADC:apparent diffusion coefficient;DWI:dif fusion-weighted imaging;ROI:region of interest,On the contrary,benign lesions with a larger extracellular space have water molecules that are more mobile,and thus higher ADC values(Figs.4&5).,相反，良性病变有更大范围内的细胞外的空间有更多的水分子移动，因此ADC值增高（图4和图5）。,Fig.5 Histopathological f indings in a 61-year-old woman with intramammarian lymph node乳房淋巴结.(a)A xial STIR image shows an intramammarian lymph node(arrow),with a typical hilar notch,that was stable on screening mammograms.(b)ADC map shows a mean ADC value=2.14 10,3,mm,2,/s of the lymph node(arrow).ADC:apparent diffusion coefficient;STIR:shor t tau inversion recovery,5a,5b,Similar to the findings of other reports in the literature,our finding,which was based on the ADC values of 58 malignant lesions,66 benign lesions and 183 normal breast tissues,supports the consensus that DWI can successfully differentiate between benign and malignant lesions,与其他文献报告相似，我们对58个恶性病变，66个良性病变和183例正常乳腺组织的ADC值的研究，也发现，DWI可以很好的区分良性和恶性病变。,The mean ADC values of normal breast tissue in our study were in the range of 1.51 10,3,mm,2,/s to 2.37 10,3,mm,2,/s.The mean ADC value for malignant lesions was found to be 1.04 10,3,0.29 10,3,mm,2,/s,which was compatible with that reported in the literature.,我们的研究正常乳腺组织的ADC值的范围为1.5110,3,mm,2,/s到2.3710,3,mm,2,/s。恶性病变平均ADC值被认为1.0410,3,0.2910,3,mm,2,/s，这是与在文献中报告相相似。,The findings of statistical analysis in our series were similar to those in the literature.The mean ADC of benign lesions in our study also showed a value within the reported range,although it was at the higher end.,统计分析的结果，与该系列其它文献相似。,虽然良性病变平均ADC高，但也是在我们的研究结果的范围内。,It is possible that the inclusion of patients with fibrocystic changes and seromas in the study population may have increased the mean ADC value slightly.纤维囊性变和血清肿可能稍增加病灶的平均ADC值。,On the contrary,the mucinous and medullary carcinomas in our series exhibited low ADC values.,但是相反，我们的研究，粘液性和髓样癌ADC值低。,As ADC values have been reported to be higher in the central necrotic areas of malignant tumours,they were measured from the periphery of necrotic tumours in our series.,由于已报道中恶性肿瘤中央坏死ADC值是较高的，而我们的研究中坏死区在肿瘤周边。,The microscopic movement of biological tissues consist of molecular diffusion in the extracellular compartment and microcirculation of blood in the capillary network(flow).Therefore,perfusion is another factor that affects ADC values.,生物组织的微观运动包括在细胞外和微循环的血液中的毛细管网络的水分子扩散（流量）。因此，灌注是另一个影响ADC值的因素。,ADC values also differ with various b-values,as seen in the literature.Images with low b-values result in less diffusion-weighted images,as a lower gradient is applied.文献报道ADC值因b值的不同而不同。图像的低b值，导致扩散加权图像较低的梯度。,Also,the extension of microvascular structures in malignant lesions may increase the perfusion effect on ADC values in images with low b-values.,此外，在恶性病变微血管结构灌注增加可能会影响低b值的ADC值。,However,the signal-to-noise ratio in these images is higher than that in diffusion images with high b-values.,低b值的信号噪声比高于高b值所在扩散图像。,Pereira et al,however,reported no significant difference between the ADC values of benign and malignant lesions when different combinations of b-values were used,and thus concluded that using multiple b-values in a DWI sequence was unnecessary.,但是Pereira等人报告，不同的b值测量D的不同ADC值,对区别良性和恶性病变没有明显差异。因而认为，使用多个b值在DWI序列是不必要的。,Wood hams et al reported that b 750 mm,2,/s was highly efficient detecting breast masses.Woodhams等报道，B 750 mm,2,/s可以高效检测乳腺肿块。,The diagnostic accuracy of DWI for breast can only be ascertained once technical parameters and post-processing procedures are standardised for the modality.,DWI对乳腺的诊断准确率在于技术参数和后处理程序方法的标准化。,Major technical limitations associated with it are distortion of the images secondary to susceptibility,chemical shift,motion artefacts and low spatial resolution.,与它相关的主要技术限制是敏感性低的失真的图像，化学位移，运动伪影和低空间分辨率。,Even under optimal circumstances,small lesions may not be visualised on ADC maps,as Kinoshita et al have reported that lesions 10 mm in diameter cannot be demonstrated by DWI.,即使在最理想的情况下，小的病灶可能不会ADC图上可见，木下等人报道，病灶直径10毫米的病灶DWI显示欠佳。,Another limitation is that of nonmass-like enhancing lesions that form large and non-compact lesions with normal parenchyma intervening within the tumour.,另一个限制是非肿块型增强的病变，该病变肿瘤细胞排列不紧密，病灶范围广中间夹杂正常组织成分。,Non-IDCs,lobular carcinoma in situ,atypical ductal hyperplasia,papillomas,hormonal changes and fibrocystic disease may show this type of enhancement.非乳腺浸润性导管癌，小叶原位癌，导管上皮不典型增生，乳头状瘤，荷尔蒙的变化和纤维囊性疾病，可能会出现该类型的强化。,According to Guo et al and Sinha et al,the mean ADC value is inversely proportional to cellular density,and therefore,these lesions may exhibit less restriction of diffusion.根据Guo和Sinha等的研究，平均ADC值是与细胞密度成反比，因此，这些病变较少表现出限制扩散。,When the range of ADC values was considered,a slight overlap was observed in the ADC values of benign and malignant lesions,both in the literature and in our series.,无论文献还是我们的研究发现，良性和恶性病变的ADC值的范围有一个轻微的重叠。,Some benign conditions,such as haematomas,abscesses,fibrosis and inflammatory lesions,are known to exhibit low ADC values.,一些良性病灶，如血肿，脓肿，纤维化和炎症改变具有低ADC值。,The Finally,it should be noted that DWI cannot replace dynamic breast MR imaging with contrast,but can be used as a complementary technique to evaluate breast masses.,最后，应注意的是，DWI不能取代动态乳腺MR成像当做增强对比，但可以用作一个互补的技术来评估乳腺肿块。,DWI may also provide a useful alternative in cases where contrast media is contraindicated for patients.,DWI对造影剂禁忌患者可以做一种替代检查。,To summarise,DWI is a valuable tool that can be used to analyse the molecular characteristics of tissue in vivo.,总之，DWI是一个有价值的工具，它可用于分析在体内组织的分子特征。,It visualises and quantifies the random motions of molecules and provides additional diagnostic information for the differential diagnosis of enhancing breast lesions.它可视化和量化的分子的随机运动，乳腺病变鉴别诊断提供更多的诊断信息。,Short acquisition times and no need for contrast material make it an easy adjunct to standard breast MR imaging protocol.采集时间短，无需材质的对比，是一个简单的辅助标准乳腺MR检查,With an ADC cut-off value of 1.46 10,3,mm,2,/s in the ROC analysis,we were able to achieve a sensitivity of 95%and specificity of 85%when differentiating between benign and malignant lesions in our study population using DWI.如果以ADC 值为1.4610,-3,mm,2,/s作为界定良恶性病灶的标准，敏感性为95，特异性为85。,The ADC values obtained from our study were compatible with those in the literature.,我们研究中有关ADC值的结果与其它文献相似。,Our results support the consensus that DWI of the breast has the diagnostic potential to differentiate benign and malignant lesions of the breast from normal breast tissue.,研究结果支持，DWI对区分乳房良性和恶性病变及正常乳腺组织有诊断潜力。,THANK YOU!,