Page 109 - 南京医科大学学报自然科学版

第42卷第1期 南京医科大学学报（自然科学版）
2022年1月 Journal of Nanjing Medical University（Natural Sciences） ·103 ·

·影像研究·

超声造影与MRI鉴别诊断乳腺钙化性病变良恶性的对比研究

丁 炎，周锋盛 ，朱巧英，吴鹏西
*
无锡市人民医院超声医学科，江苏 无锡 214023

［摘 要］ 目的：比较基于超声（ultrasound，US）、超声造影（contrast⁃enhanced ultrasound，CEUS）和MRI的BI⁃RADS分类在鉴别
诊断乳腺良恶性钙化性病变中的价值。方法：对60例乳腺钙化性病变患者行US、CEUS和MRI检查，分析US及MRI图像特征
并根据第五版BI⁃RADS标准进行相应分类得到US⁃BI⁃RADS和MRI⁃BI⁃RADS，根据乳腺病变的US⁃BI⁃RADS分类结合CEUS图
像特征重新分类得到CEUS⁃BI⁃RADS分类。将3种技术的3、4A类病变判定为良性，4B类及以上病变判定为恶性，以组织病理
学为金标准，构建受试者工作特征（receiver operating characteristic，ROC）曲线评估比较3种影像学方法对乳腺良恶性钙化性病
变的诊断效能。结果：在60例乳腺钙化性病变中，良性37例（61.67%），恶性23例（38.33%）。US⁃BI⁃RADS、MRI⁃US⁃RADS 和
CEUS⁃BI⁃RADS 的误诊率分别为 18.3%、15.0%和 8.3％。CEUS⁃BI⁃RADS 对 4A 和 4B 病变的诊断准确性高于 US⁃BI⁃RADS 和
MRI⁃BI⁃RADS。CEUS⁃BI⁃RADS 在鉴别乳腺良恶性钙化性病变的诊断性能方面显示：灵敏度和 AUC（91.3%、0.915）高于
US⁃BI⁃RADS（87.0%、0.819）和 MRI⁃BI⁃RADS（87.0%、0.851），但差异均无统计学意义（P > 0.05）；CEUS⁃BI⁃RADS 的特异度和
约登指数（91.9%、0.832）高于 US⁃BI⁃RADS（78.4%、0.654）和 MRI⁃BI⁃RADS（83.8%、0.708），差异均有统计学意义（P < 0.05）。
结论：CEUS和MRI对乳腺良恶性钙化性病变的鉴别诊断均有重要价值，CEUS的诊断效能优于MRI。
［关键词］ 超声造影；BI⁃RADS；MRI；乳腺；钙化
［中图分类号］ R737.9 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）01⁃103⁃05
doi：10.7655/NYDXBNS20220119

BI⁃RADS classification based on contrast⁃enhanced ultrasound and MRI for differentiating
benign from malignant calcified breast lesions

*
DING Yan，ZHOU Fengsheng ，ZHU Qiaoying，WU Pengxi
Department of Medical Ultrasound，Wuxi People’s Hospital of Nanjing Medical University，Wuxi 214023，China

［Abstract］ Objective：To compare the diagnostic efficacy of ultrasound（US），contrast⁃enhanced ultrasound（CEUS）and MRI in the
differential diagnosis of benign and malignant calcified breast lesions. Methods：Sixty patients with calcified breast lesions were
examined by US，CEUS and MRI. The characteristics of US and MRI images were analyzed and the corresponding BI ⁃ RADS
classifications were performed to obtain US⁃BI⁃RADS and MRI⁃BI⁃RADS. The CEUS⁃BI⁃RADS classification was obtained according
to the US⁃BI⁃RADS classification of breast lesions combined with CEUS image characteristics. BI⁃RADS 3 and 4A lesions were judged
as benign and BI⁃RADS 4B and above lesions were judged as malignant，and histopathology was used as the gold standard to construct
receiver operating characteristic（ROC）curves to assess and compare the diagnostic efficacy of the three imaging methods for benign
and malignant breast calcified lesions. Results：The misdiagnosis rates of US⁃BI⁃RADS，MRI⁃US⁃RADS and CEUS⁃BI⁃RADS were
18.3%，15.0% and 8.3% respectively. The diagnostic accuracy of CEUS⁃BI⁃RADS for lesions in 4A and 4B was higher than that of US⁃
BI⁃RADS and MRI⁃BI⁃RADS. The specificity and Youden index of CEUS⁃BI⁃RADS（91.9%，0.832）were higher than those of US⁃BI⁃
RADS（78.4% ，0.654）and MRI ⁃ BI ⁃ RADS（83.8% ，0.708），and the differences were statistically significant（P < 0.05 for all）.
Conclusion：Both CEUS and MRI are of great value in the differential diagnosis of benign and malignant calcified breast lesions，and
the diagnostic efficacy of CEUS is superior to that of MRI.
［Key words］ contrast⁃enhanced ultrasound；BI⁃RADS；MRI；breast；calcification
［J Nanjing Med Univ，2022，42（01）：103⁃107］

［基金项目］ 江苏省卫计委妇幼健康科研项目（F201567）；太湖人才双百后备拔尖人才（HB2020001）
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通信作者（Corresponding author），E⁃mail：zhoufs@wuxiph.com