Clinical Value Of Magnetic Resonance Diffusion Kurtosis Imaging Combined With Dynamic Contrast-enhanced Scanning In The Diagnosis Of Benign And Malignant Breast Lesions

ObjectiveTo investigate the diagnostic value of diffusional kurtosis imaging（DKI）combined with dynamic enhanced scan（DCE-MRI）in benign and malignant breast tumors.MethodsThe subject of our study is to analyze MRI images and pathological data of 54 patients with breast lesions who were confirmed by surgery and pathological biopsy from September 2019 to June 2020 in our hospital retrospectively.There are a total of 54 lesions in 54 patients,including 23malignant lesions,which are made up of 4 ductal carcinomata in situ,11non-special type invasive ductal carcinomata,and 8 invasive lobular carcinomata.Another are 31 benign lesions,which consist of 8 breast inflammatory lesions,18 breast fibroadenomas,and 5 breast adenomas.All patients underwent routine MRI scan with bilateral breast,which include dynamic enhanced scan（DCE）and DKI sequences.And through the Functool post-processing software,we measured the average kurtosis（MK）,mean diffusivity（MD）and apparent diffusion coefficient（ADC）of the benign lesion and malignant lesion group.Meanwhile taking the normal distribution test of the results obtained.The statistical differences among MK value,MD and ADC values between the two groups of benign and malignant lesions were evaluated via the Mann-Whitney U rank.The receiver operating characteristic（ROC）curve was used to assess the diagnostic performance of the above parameters in benign and malignant breast lesions.While computing the time signal intensity curve（TIC）of benign and malignant breast lesions.54 cases of breast lesions were classified according to DCE-TIC and DKI combined TIC methods.Chi-square test was used to compare the difference of time-signal intensity curve（TIC）type and DKI combined with TIC in benign and malignant breast lesions,and to compare the diagnostic efficacy of the two methods..Results（1）there were differences in MK,MD and ADC between benign and malignant breast lesions（P<0.05）.The median MD of malignant breast lesions was 1.660(10^-3mm²/s),[（1.213）2.310(10^-3mm²/s)]was lower than that of benign lesions(1.990(10^-3mm²/s),[1.820 2.290(10^-3mm²/s)].The median value of MK in malignant lesion group was 0.698（0.399～0.786）higher than that in benign lesion group 0.489（0.421～0.550）.The median ADC value in breast malignant lesion was 0.000984(10^-3mm²/s),[0.000886～0.00154(10^-3mm²/s)]was lower than that in benign lesion group(0.00154(10^-3mm²/s),[0.00134～0.00168(10^-3mm²/s)].The area under the ROC curve of the above parameters（AUC）is 0.88/0.95/0.74（MD/MK/ADC）,and the cutoff value for benign and malignant diagnosis is 1.670(10^-3mm²/s)/0.551/1.08(10^-3mm²/s),respectively.The sensitivity was 52.17%,65.22%and 56.52%,and the specificity was90.32%,77.42%and 90.77%,respectively.The accuracy,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio were 70.40%,74.1%,79.62%,76.92%,69.56%,92.85%,68.29,77.41,5.3988,17.49,0.53,0.44 and 0.41,respectively,with a positive predictive value,a negative predictive value,a positive likelihood ratio of 74.1%,a positive likelihood ratio of 74.1%.（2）All breast lesions were classified into benign or malignant lesions according to the DCE-TIC type.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio of breast malignant lesions were 56.52%,83.87%,72.22%,72.22%,72.22%,3.5,0.51,respectively.According to the classification of all breast lesions by DKI and DCE-TIC,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio of breast malignant lesions were 91.30%,96.77%,94.44%,95.45%,96.75%,28.26 and 0.089,respectively.Conclusion（1）MK and MD value,which are related to DKI scan sequence parameters,have shown promisingly certain value in the diagnosis of benign and malignant breast lesions,and the diagnostic efficiency of MK value is significantly higher than MD value.（2）The performance of DKI scan combined with DCE-TIC is higher than that of other parameters used separately in the diagnosis of benign and malignant breast lesions,and its clinical application value is greater...