Evaluation Of Diagnosis Value Of Combined1H-MRS And DCE With ADC In Breast Benign And Malignant Leision

Background and purposeBreast cancer, a serious threat to women’s health one of malignant, is the second larger cause of cancer death. So how early screening and early diagnosis breast cancer, how to choose the best of the early treatment, has been our medical workers face an important subject, especially early diagnosis is particularly important.In recent years, as people health consciousness enhancement and modern medical equipment development progress, ultrasound, X-ray mammography photography because it has some limitations, already cannot satisfy the clinic diagnosis of breast lesions needs, especially along with the rapid development of computer technology, breast imaging diagnosis has also the changing, and MRI (magnetic resonance imaging) check the emergence of the technology, because its no radiation, high contrast of soft tissue and multi-dimensional, many parameters, accurate, and noninvasive imaging, and many other advantages in mammary gland disease diagnosis show infinite broad application prospect, make it become the breast cancer X-ray and ultrasound examination of the important supply inspection method. The magnetic resonance imaging T1WI, T2WI flat, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion weighted imaging (DWI) to mammary gland benign and malignant disease accurate qualitative diagnosis value, with1.5T high field magnetic resonance put into application, make mammary gland magnetic resonance spectroscopy(1H-MRS) check possible, further improve the diagnostic accuracy of breast lesions.This article through the proton magnetic resonance spectroscopy (1H-MRS) combine dynamic enhance scanning and diffusion of weighted imaging ADC values to discuss:(1)1-MRS diagnosis of breast benign and malignant lesions sensibility, specificity, accuracy and advantages and disadvantages;(2) DCE and ADC values to mammary gland benign and malignant disease diagnosis value;(3) the strengthening of the breast cancer and morphological features;(4)1H-MRS combine DCE and ADC values to mammary gland benign and malignant lesions diagnostic value and Kappa statistics evaluation;(5) H-MRS of the influencing factors; So as to further improve breast benign and malignant lesions diagnosis accuracy.Materials and methodsCollect first affiliated hospital zhengzhou university from August2010to December2011with clear pathology results of breast tumors venereal change39cases (including malignant22cases, benign17cases); All patients were on the conventional flat with dynamic and breast enhancement scanning, monomer element1H-MRS acquisition and ADC values measurement.An MRI use the Germany Siemens production of3.0T Trio high field magnetic resonance scanner, special double hole mammary gland phased array surface coil. Scanning sequence according to the horizontal axis of a T1-weighted images, the horizontal axis of a pressure fat T2-weighted images, diffusion weighted imaging, the horizontal axis of the6issue a dynamic increase scan (the second phase of a MIP figure after scanning) or the fake color picture scan in turn. The scan images spread to Syngo workstation, carries on the post-processing, measure and record the Time dynamic enhance signal strength curve (TIC) type and apparent diffusion coefficient (ADC) value. The patient go back to the ward or rest six hours to contrast agents after basic emptying, did MRS breast check, take a prone, bilateral breast natural overhang at breast in a coil, scanning process could remain static. Regular MRI flat and the localization, the single element spectrum (SVS) check, some resolution spectral analysis (point resolved spectroscopy, PRESS) in data collection, well field by magnetic resonance imaging (MRI) scanner automatically.1H-MRS the data collected by workstation software post-processing. Main observation of the wave have choline (Cho) peak, lipids (lip) peak and water peak.The statistics SPSS17.0statistical software, respectively in ADC values (ADC greater than or less than1.203X10-3mm2/s) size distribution of benign and malignant statistics; According to the spectrum were without choline peak for benign and malignant statistical distribution: Time-signal strength curve, by the curve shape benign and malignant statistical distribution; And calculate ADC values, MRS, DIC curve of malignant change good judgment sensitivity, specificity and accuracy, the positie predictie alue and negative predictive value. Three methods of analysis in benign and malignant detection, whether there is difference to P<0.05as a statistically significant difference. At the same time the consistency test (Kappa inspection), Kappa value calculation, determine the three benign and malignant assessment of how the standard consistency.Results39cases lesions, malignant22cases; Benign17cases.17cases benign lesions, in ADC chart shows for the low or iso signals, the biggest ADC values for1.665X10-3mm2/s, the minimum ADC values for1.097×10-3mm2/s, averages1.297±0.352X10-3mm2/s; Four cases of less than1.203X10-3mm2/s,13cases of more than1.203X10-3mm2/s.22patients with malignant lesions, in ADC chart shows for the low signal, the biggest ADC values for1.343X10’3mm2/s, the minimum ADC values for0.588X10-3mm2/s, averages1.087±0.212×10-3mm2/s; There are17cases of less than1.203X10-3mm2/s,5cases more than1.203X10-3mm2/s. With pathology diagnosis result for the gold standard,1.203×10-3mm2/s for diagnosis of breast benign and malignant lesions critical value, sensitivity was77.3%(17/22),a specificity of76.5%(13/17), the accuracy is76.9%(30/39).17cases benign lesions, the performance for the I curve of12patients, Ⅱ type curve in5patients, and III type in0.22patients with malignant lesions, III performance curve of the13cases, Ⅱ type curve in7cases, Ⅰ type curve in2cases. Benign lesions to I curve in the majority, about70.6%, malignant lesions in III curve and Ⅱ curve in the majority, account for59.1%and31.8%respectively. With pathology results for gold standard, in order to I curve for benign, Ⅱ type, Ⅲ curve for malignant and benign breast malignant lesions in the diagnosis of sensitivity of90.9%(20/22), a specificity of70.6%(12/17), the accuracy is82.1%(32/39).According to the breast lesions that strengthening the uniformity of the divided into uniform nodular strengthen and uneven ring strengthen two; And according to the lesions marginal form smooth, shallow points into the leaf and the irregular, burr,4kinds of form; The lesions or shallow points leaves smooth edges and uniform nodular improved positioning benign, the lesion irregular or burr shape and edge uneven ring strengthening as malignant, with pathology results for gold standard, the diagnosis of breast malignant change good sensitivity and specificity were90.9%(20/22),70.6%(12/17).MIP picture, the benign lesions performance for borders, signal is low, no obvious vascular shadow around, no increase lymph nodes, more I level to give priority to, a part of the Ⅱ level, this study of17cases benign lesions, the performance for the I level in13, Ⅱ level3cases, III level in1, and accounted for76%,18%and6%. Malignant lesions performance for boundary is not clear, signal is higher, more have overt vascular shadow around, with or without increasing lymph nodes in22patients with malignant lesions, III performance level in14cases, Ⅱ magnitude6cases, I level2cases, respectively63.6%,27.2%and9.1%.22patients with malignant lesions, have14cases in3.23ppm place can be obviously Cho peak, including infiltrating ductal carcinoma11cases, infiltrating lobular carcinoma in2cases, mucus adenocarcinoma in1;8cases in3.23ppm place has not seen the obvious Cho peak.17cases benign lesions,5cases fiber adenoma in 3.23ppm place shows Cho peak. With pathology results for gold standard, in order to identify whether Cho peak mammary gland benign and malignant lesions of sensitivity was63.6%(14/22). specific degrees was70.6%(12/17), and the accuracy is66.7%(26/39), the positie predictie alue was73.7%(14/19), negatie predictie alue was60%(12/20).MRS, TIC and ADC values between the three in benign and malignant detection, P=0.000<0.05, there are statistically significant differences; The three assessment of benign and malignant standards, dynamic enhance curve parting TIC with DWI-ADC values of the size of the Kappa value=0.836>0.75,indicating that the both good consistency; Dynamic enhance curve TIC and MRS without choline peak Kappa value of0.565, tip the identity between the two is better; DWI-ADC values size and MRS whether the peak of choline Kappa value is0.478, tip the identity between the two is better.Three good accuracy in diagnosing malignant tumor, dynamic enhancement and DWI were82.1%and76.9%, higher than the66.7%MRS. Dynamic enhancement and the DWI sensitive and specific also higher than MRS.The three combine application, the sensitivity and specificity, accuracy, and the positie predictie alue,negatie predictie alue were95.5%,88.2%,92.3%,91.3%and93.8%; The three combination of diagnosis of breast cancer indexes are higher than the used alone one check, the Kappa value of0.897,and pathological diagnosis good consistency.Conclusion1、 Dynamic enhance TIC curve, DWI-ADC values, and MRS have choline peak in good the diagnosis of malignant change on a statistically significant difference.2、Dynamic enhance TIC curve, DWI-ADC values the sensitivity of the diagnosis of breast cancer and accuracy is higher, MRS the accuracy of the diagnosis of breast cancer is low.3、Good for the judgement of malignant change, dynamic enhanced with DWI-ADC values of good consistency.4、3D-MIP chart of benign and malignant lesions judge has important role.5、Dynamic enhance the TIC curve, DWI ADC values and MRS combination can obviously increase the accuracy of the diagnosis.6、1H-MRS diagnosis of breast cancer is mainly due to the sensitivity of the low peak detection by Cho caused by many factors influence (such as gland tumor size, type and technical factors, etc).