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目的利用BI-RADS MRI探讨MR检查对病理性乳头溢液的诊断价值。方法应用乳腺专用磁共振AURORA-MR检查61例病理性乳头溢液患者,根据BI-RADS-MRI分析其影像征象包括形态学特征、强化曲线及分类评估并与术后病理诊断对照。结果 61例病理性乳头溢液MR检查发现62个病灶,术后恶性病灶16个,包括导管原位癌(DCIS)及导管原位癌伴微浸润(DCIS-MI)12个,DCIS伴黏液腺癌1个及浸润性导管癌(IDC)3个,术前均为BI-RADS4～5级评估,恶性检出率100%;良性病变共46个,包括导管内乳头状瘤(IP)伴不典型增生(ADH)15个,IP10个,多发IP7个,导管上皮乳头瘤样增生12个及纤维囊性乳腺病2个,术前MR评估BI-RADS1～3级31个,BI-RADS4～5级15个,良性诊断符合率为67.4%,MRI高估的病变包括交界性质病变IP伴ADH8个,多发IP4个,IP2个和导管上皮乳头瘤样增生1个。增强图像的形态学特征仅段样强化对鉴别良恶性有意义,阳性预测值达73.3%,其易出现在恶性病变中(68.8%vs.8.7%,P<0.05);内部强化特征以成群结节样强化对提示恶性有意义(56.3%vs.10.9%,P<0.05),其阳性预测值为64.3%;内部点状强化更易出现在良性病变中(6.3%vs.37.0%,P<0.05)。恶性病灶的时间-信号曲线常见为流出型,其在良恶性病灶中的分布具有统计学差异(56.3%vs.17.4%,P<0.05),阳性预测值为52.4%。结论恶性乳头溢液在MRI上表现具有一定的特点,MR检查为诊断病理性乳头溢液提供了非常有用的信息,有助于提高诊断准确率。
Objective To evaluate the diagnostic value of MR examination for pathological nipple discharge by BI-RADS MRI. Methods Sixty-one patients with pathological papillary discharge diagnosed by magnetic resonance imaging (AURORA-MR) were included in this study. According to the results of BI-RADS-MRI, morphological features, enhancement curves, classification and evaluation were compared with postoperative pathological diagnosis. Results Sixty-six lesions and 16 postoperative malignant lesions were found in 61 cases with pathologic papillary discharge, including DCIS, DCIS-MI, DCIS with mucosal gland 1 with carcinoma and 1 with invasive ductal carcinoma (IDC). All patients were evaluated by BI-RADS grade 4 to 5 preoperatively and the detection rate was 100%. A total of 46 benign lesions including intraductal papilloma (IP) There were 15 typical hyperplasia (ADH), IP10, multiple IP7, ductal papilloma-like hyperplasia and 2 fibrocystic breast disease. Preoperative MR assessment included 31 BI-RADS grade 1-3, BI-RADS 4-5 Grade 15, the coincidence rate of benign diagnosis was 67.4%, MRI-over-estimated lesions included borderline lesions with IP with ADH8, multiple IP4, IP2 and ductal papilloma-like hyperplasia. The enhancement of the morphological features of the image only segment-like enhancement of the differential diagnosis of benign and malignant meaningful, positive predictive value of 73.3%, which is prone to malignant lesions (68.8% vs.8.7%, P <0.05); internal strengthening features in groups Nodular enhancement was suggestive of malignancy (56.3% vs.10.9%, P <0.05), and its positive predictive value was 64.3%. Internal enhancement was more likely to occur in benign lesions (6.3% vs.37.0%, P < 0.05). The time-signal curves of malignant lesions were common outflow type. The distribution of malignant lesions in benign and malignant lesions was statistically different (56.3% vs.17.4%, P <0.05), and the positive predictive value was 52.4%. Conclusion Malignant nipple discharge has certain features on MRI. MR examination provides very useful information for the diagnosis of pathological nipple discharge, which can help improve the diagnostic accuracy.