3.0 T磁共振扩散加权成像在乳腺良恶性病变鉴别中的价值及较优b值下ADC值与预后因子相关性研究

摘要 目的：研究3.0 T磁共振扩散加权成像在乳腺良恶性病变鉴别中的价值及较优b值下ADC值与预后因子的相关性。方法：选取2017年11月～2019年11月于我院接受诊治的乳腺病变患者50例进行研究，将其按照良恶性差异分成恶性组40例与良性组10例，另取同期于我院体检的健康志愿者50例作为对照组。对所有人员均进行3.0 T磁共振扩散加权成像，比较不同b值下ADC值在不同乳腺组织中的差异，比较不同b值下诊断乳腺良恶性病变的效能，分析较优b值下ADC值和乳腺癌患者各项预后因子的相关性。结果：对照组、良性组、恶性组在不同b值下的ADC值均呈逐渐降低趋势（P＜0.05）；对照组、良性组、恶性组b值为1000 s/mm²下的ADC值均低于b值为600 s/mm²（P＜0.05）。b值为1000 s/mm²时诊断乳腺恶性病变的敏感度、特异度、准确度分别为92.50%、100.00%、94.00%，高于b值为600 s/mm²的70.00%、60.00%、68.00%（P＜0.05）。b值为1000 s/mm²下雌激素受体、孕激素受阳性患者的ADC值低于阴性患者，而人类表皮生长因子受体2阳性患者的ADC值高于阴性患者（P＜0.05）。经Spearman相关性分析可得，b值为1000 s/mm²下ADC值与雌激素受体、孕激素受体阳性表达均呈负相关关系，而与人类表皮生长因子受体2阳性表达呈正相关关系（P＜0.05）。结论：3.0 T磁共振扩散加权成像在乳腺良恶性病变鉴别中的价值较高，且以b值为1000 s/mm²的诊断能效较优。此外，b值下ADC值和乳腺癌部分预后因子表达状态密切相关。

The Value of 3.0T Mr Diffusion-weighted Imaging in the Differentiation of Benign and Malignant Breast Lesions and the Correlation between ADC Value and Prognostic Factors Under better b Value

ABSTRACT Objective: To study the value of 3.0T diffusion-weighted magnetic resonance imaging in the differentiation of benign and malignant breast lesions and the correlation between ADC value and prognostic factors under better b value. Methods: Fom November 2017 to November 2019, 50 patients with breast lesions to be treated in our hospital were selected for the study. The patients were divided into 40 cases in the malignant group and 10 cases in the benign group according to the difference between benign and malignant. Another 50 healthy volunteers of the same period were taken as control group. Diffusion-weighted 3.0T magnetic resonance imaging was performed on all subjects. The ADC values in different breast tissues with different b values were compared. The efficacy of different b values in the diagnosis of benign and malignant breast lesions were compared. The correlation between ADC value and prognostic factors in breast cancer patients with better b value were analyzed. Results: ADC values of the control group, the benign group and the malignant group showed a gradually decreasing trend under different b values(P<0.05). ADC values in the control group, the benign group and the malignant group in the b value of 1000 s/mm2 were all lower than those when the b value of 600 s/mm2 (P<0.05). The sensitivity, specificity and accuracy of diagnosing malignant breast lesions with b value of 1000 s/mm2 were 92.50%, 100.00% and 94.00%, respectively, which were significantly higher than that with b value of 600 s/mm2 of 70.00%, 60.00% and 68.00%(P<0.05). ADC values of estrogen receptor and progesterone positive patients with a b value of 1000 s/mm2 were lower than those of negative patients, while ADC values of human epidermal growth factor receptor 2 positive patients were higher than those of negative patients (P<0.05). Spearman correlation analysis showed that ADC value at b value of 1000 s/mm2 was negatively correlated with positive expression of estrogen receptor and progesterone receptor, while positively correlated with positive expression of human epidermal growth factor receptor 2 (P<0.05). Conclusion: 3.0T diffusion-weighted magnetic resonance imaging is of high value in the identification of benign and malignant breast lesions, and b value of 1000 s/mm2 is of better diagnostic efficiency. In addition, ADC value under b value is closely related to the expression state of some prognostic factors in breast cancer.