The Application Value Of Multi-modality Magnetic Resonance Imaging In The Diagnosis Of Benign And Malignant Lesions

Background and Objective MRI has played a very important role in the diagnosis ofbenign and malignant breast lesions now, especially diffusion-weighed imaging,dynamic contrast-enhanced imaging and magnetic resonance spectroscopy, which hasdeveloped much faster. To evaluate the clinical value of multi-modality magneticresonance imaging on breast lesions, this study was carried out.Materials and Methods1.With56women with breast lesions collected, age22-74average age45.4, all caseswere post-surgery or puncture pathology within two days to two weeks.30cases weremalignant focal lesions, including18infiltrating ductal carcinoma,6intraductalcarcinoma,3infiltrating lobular carcinoma,2ductal carcinoma in situ,1mucinouscarcinoma.30benign lesions, included12fibroadenosis,9fiber adenoma,2papilloma，3mammitis，4lobular hyperplasia.2.All participants performed MR routine, diffusion and dynamic enhancement check.38patients with breast lesions were examined by1H-MRS. The morphology and the typeof TIC were observed and the apparent diffusion coefficient values，the maximum signalintensity，the time to peak and the slope of signal intensity-time curve in the regions ofinterest were measured, and then the average value of ADC、rADC、SImax、SId、TTPand SSmax calculated, and the maximum intensity projections obtained bypost-processing. The vessel number, size, length, and conspicuity were recorded andthen scored. Whether Cho peak appeared or not at3.22ppm in1H-MRS. Pairwise comparison was conducted with two-group independent t-test, and analyzed with χ2test data. Statistical software SPSS17.0was used to analyze to determine whetherdifferences (P<0.05) were significant between groups. The receiver-operating curve wasused to determine the threshold value of ADC、rADC、TTP and Ssmax.Results1.Malignant lesions is irregular, leaf edges and the boundary is not clear. Benign lesionsis circular, smooth and the boundary is clear. Morphology played a very important rolein the diagnosis of breast lesions, with sensitivity78.9%and the specificity86.2%.2.ADC、rADC value have statistically significant differences between benign andmalignant lesions. The average ADC of benign lesions and malignant lesions is (1.30±0.25) mm2/s、(0.88±0.19) mm2/s, respectively. The average rADC of benign andmalignant lesions is0.79±0.18and0.56±0.13, respectively. The threshold of ADCvalue is1.04x10-3mm2/s with the sensitivity92.4%and the specificity82.3%; Thethreshold of rADC value is0.62with the sensitivity83.6%and the specificity87.5%.Areas under the curve of ADC，rADC are0.915and0.947, respectively.3.There are no malignant lesions in typeⅠ,6malignant lesions in typeⅡ,24malignantlesions in type Ⅲ,18benign lesions in typeⅠ,8benign lesions in typeⅡ,4benignlesions in type Ⅲ. Statistical differences are significant between TIC curve type ofbenign and that of malignant lesions. Type Ⅱand type Ⅲ become malignant diseasediagnosis standard with the sensitivity95.4%and the specificity67.8%.4.The average time to peak of benign and malignant lesions is (488.0±166.7)s and(206.9±81.0)s，respectively. Statistically differences are significant between groups ofbenign and malignant lesions. The threshold of TTP is370s, with the sensitivity88.9%,and the specificity96.0%, and area under the curve of TTP is about0.907.5.The average slope of signal intensity-time curve of benign and malignant lesions are14.12±7.44and20.50±6.87, respectively. There are statistically significantdifferences between two groups of benign and malignant lesions. Ssmax=10.44is made as benign and malignant lesions diagnosis threshold, the sensitivity with92.6%and thespecificity87.8%, and area under the curve is about0.911.6.The average maximum signal intensity of benign and malignant lesions are2572.14±427.94and2475.10±406.50, respectively. The average SId of benign andmalignant lesions are1863.40±427.08and1763.07±334.91, respectively. The meanvalues of SImax and SId are no significant difference between two groups.7.30benign lesions are collected, with the zero MIP score in four, the1MIP score ineight, the2MIP scores in fourteen, and the3MIP scores in four patients.30malignantlesions, the2MIP scores in24, the3MIP scores in6patients. But there is nostatistically significant differeence for the mean MIP scores between benign andmalignant breast lesions. The ipsilaterally increased vascularity is made as breastcarcinoma diagnosis standard with the sensitivity, specificity, positive predictive value,negative predictive value100%,40%,70%,62.5%,100%, respectively.8.Among20malignant lesions, Cho peak at3.22ppm appears in17items and no Chopeak in3items. Among18benign lesions, Cho peak at3.22ppm appears in2items andno Cho peak in the other16benign lesions. There is statistically significant differencebetween the two groups.Conclusions1. Both DWI and DCE-MRI play important roles in the diagnosis of benign andmalignant breast lesions.2.ADC，rADC，Ssmax and TTP have better diagnosis values than the other parameters.3. Vascularity increases in ipsilateral breast carcinoma, while the mean MIP scores haveno statistically significant difference between two groups of benign and malignantbreast lesions.4.(1)~H-MRS have a certain practical value on differentiating benign and malignant breastlesions.