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经过20余年的相关研究,MRI现已成为临床公认的用于检出和诊断乳腺疾病的影像检查手段之一。笔者简要阐述了乳腺动态增强(DCE)磁共振成像技术及其临床应用。详细介绍了动态增强中有关药代动力学的测量方法、各种相关参数的定性分析、以及Ktrans和kep等反应药代动力学特征参数的定量分析。笔者不但就当前“是否有必要对每位患者进行动脉输入函数进行测量”等有争议的话题进行了讨论,还在对当前广泛应用的各种动态增强MRI后处理软件进行了较详尽的描述之后,进一步对动态增强MRI在乳腺癌的诊断及疗效监测等方面的临床应用情况进行了详尽的回顾。作者认为:总体来讲,对于乳腺癌的诊断,关键在于关注病灶中最具侵袭性部分的MRI特征。而对于乳腺癌疗效的监测,则应该对整个病灶进行分析。最后,笔者就乳腺MRI对乳腺癌高危人群的筛查以及风险的处理等问题进行了讨论。笔者预测乳腺MRI在女性乳腺疾病尤其是乳腺癌的筛查、诊断、治疗及疗效监测等一系列问题上将继续发挥不可替代的重要作用。
After more than 20 years of relevant research, MRI has become a clinically recognized means for the detection and diagnosis of breast disease, one of the means of imaging. The author briefly describes the breast dynamic enhancement (DCE) magnetic resonance imaging technology and its clinical application. The methods of dynamic measurement of pharmacokinetics, qualitative analysis of various related parameters and the quantitative analysis of pharmacokinetic parameters such as Ktrans and kep were introduced in detail. The author discussed not only the current controversial topics such as “Is it necessary to measure the arterial input function in each patient”, but also the current extensively used dynamic enhanced MRI post-processing software in more detail After the description, we further reviewed the clinical application of dynamic contrast-enhanced MRI in the diagnosis and treatment of breast cancer. The authors conclude that in general, the key to the diagnosis of breast cancer is to focus on the MRI features of the most aggressive part of the lesion. For the monitoring of breast cancer efficacy, the entire lesion should be analyzed. Finally, the author discusses the breast MRI screening of high-risk groups of breast cancer risk and other issues were discussed. I predict breast MRI in breast cancer in women, especially breast cancer screening, diagnosis, treatment and efficacy monitoring and a series of issues will continue to play an irreplaceable important role.