Comparative Study On The Diagnostic Value Of Contrast Enhancement Spectral Mammography And Dynamic Contrast-Enhanced Magnetic Resonance Imaging In Breast Diseases

Objective : To investigate the diagnostic value of contrast enhancement spectral mammography(CESM)and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in breast diseases.Methods : A total number of 179 patients with 185 breast lesions confirmed pathologically at the affiliated hospital of zunyi medical university between September2017 and September 2018 were enrolled.All the patients were female,age range from 26 to70 years old,mean age 46 years old.CESM and DCE-MRI were performed before surgery or biopsy.GE Senographe Essential digital mammography was used in CESM examination to record breast glands classification,lesion location,morphology,number,margin,and whether it was accompanied with calcification and its classification,with or without structural distortion or asymmetric density,enhancement pattern and so on.DCE-MRI was performed by the GE 3.0T Signa HDxt superconducting MR scanner to record breast glands classification,lesion morphology,signal,number,margin,enhancement pattern,time intensity curve,etc.CESM and DCE-MRI images were analyzed by two radiologists and the lesions were classified by breast imaging reporting and data system(BI-RADS).The results of pathological results were used as the gold standard,then the detection rate,correct diagnosis rate,sensitivity and specificity of the two methods for diagnosing breast lesions were calculated.The receiver operating characteristic(ROC)curve was drawn and the diagnostic efficiency of CESM and DCE were analyzed.P<0.05 was considered as statistically significant difference.Results:A total number of 185 breast lesions were enrolled in the study,125 malignant lesions and 60 benign lesions.The total detection rates of CESM and DCE-MRI in breast lesions were 95.7% and 97.3%,respectively.The detection rate of CESM for malignant lesions was 98.4%,and that of MRI was 100%.The detection rate of CESM in benign lesions was 90.0%,and it was 91.7% of DCE-MRI.The correct diagnosis rates of CESM and DCE-MRI in malignant lesions were 94.4% and 96.8%,respectively.The correct diagnosis rate of CESM for benign lesions was 88.3%,and the correct diagnosis rate for benign lesions of DCE-MRI was 86.7%.There was no significant difference between these two methods in the total detection rate and the correct diagnosis rate.CESM and DCE-MRI had no significant difference on the BI-RADS classification in benign and malignant breast lesions.The sensitivity and specificity of CESM for breast lesions were94.4% and 88.3%,those of DCE-MRI were 96.8% and 86.7%,respectively.There was no significant difference between the sensitivity and specificity of the two methods.Taking the pathological results as the gold standard,the area under the ROC curve of CESM and DCE-MRI was 0.92 and 0.95,respectively,and the difference was no statistically significance.The Kappa values of the diagnosis in benign and malignant breast lesions analyzed by two radiologists using CESM and DCE-MRI alone were 0.853 and 0.878,respectively,therefore the consistency of CESM and DCE-MRI in diagnosing the benign and malignant lesions of the breast is good.Conclusion:The diagnostic value of CESM and DCE-MRI in differentiating benign and malignant of breast diseases is equal.The diagnostic accuracy of CESM for benign breast diseases is slightly higher than that of DCE-MRI.CESM can provide comprehensive information about the shape and blood supply of lesions,it is a valuable breast imaging method.