目的探讨动态增强磁共振成像 (DCE-MRI)结合扩散加权成像(DWI对乳腺 非肿块样强化(NMLE)的良恶性病变的鉴别 诊断价值。方法 搜集乳腺DCE-MRI表现 为非肿块样强化病变的患者105例，均经 病理证实。记录病灶分布特征、内部强 化方式、时间信号曲线类型及ADC值，应 用χ2 检验、Fisher确切概率法、t检验及 ROC曲线作统计学分析。结果 所有病变 中，恶性88例，良性17例。节段分布及簇 状强化多见于恶性病变(P<0.05)，分别占 50.0%(44/88)和56.8%(50/88)；弥漫分布 及斑点样强化多见于良性病变(P<0.05)， 分别占29.4%(5/17)和29.4%(5/17)；良恶 性病变的ADC值分别为(1.20±0.22)×10- 3 mm2 /s和(1.03±0.17)×10-3mm2 /s，差异有 统计学意义(P＜0.05)，以1.08×10-3mm2 / s作为ADC值诊断淋巴结转移的阈值，灵敏 度和特异度分别为63.6%、76.5%；而时间 信号曲线类型在良恶性病变之间的差异无 统计学意义(P>0.05)。结论 通过分析MRI 表现中的病变分布特征、内部强化方式及 ADC值大小,可有效地鉴别乳腺非肿块样强 化病变的良恶性。

Obiective To investigate the differential value of dynamic contrast-enhanced MRI combined with diffusion-weighted imaging in diagnosing benign and malignant breast lesions presented as non-mass-like enhancement. Methods 105 cases diagnosed as breast cancers by pathologic examination underwent magnetic resonance prior to surgery. All cases performed non-mass-like enhancement in dynamic contrast-enhanced MR imaging. The morphological distribution, internal enhancement manner, the type of time-signal curve and ADC value were recorded,which were analyzed by chi-square test and Fisher's exact test,t test and ROC. Results Among the 105 cases of NMLE,malignant and benign lesions were 88 and 17,respectively.Segmental and clumped lesion were commonly observed in malignant cases(P<0.05),which were about 50.0%(44/88) and56.8% (50/88),respectively. Diffuse and stippled lesion were commonly observed in benign cases(P<0.05),which were about 29.4%(5/17) and 29.4%(5/17),respectively. The ADC value of benign and malignant lesion were (1.20±0.22)×10-3mm2 / s and(1.03±0.17)×10-3mm2 /s,respectively,the differences of which had statistical significance (P<0.05). With the threshold ADC value of 1.08×10-3mm2 /s for diagnosing benign and malignant lesion, the sensitivity and specificity were 63.6% and 76.5%, respectively.However, the differences of the type of time-signal curve between benign and malignant lesions had no statistical significance (P>0.05). Conclusions Benign and malignant property can be identified by the morphological distribution characteristics ,internal enhancement manner and ADC value of MRI in breast lesions presented as non-mass-like enhancement.