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目的:探讨磁共振成像(magnetic resonance imaging,MRI)对超声检查阴性乳腺钙化灶的诊断价值。方法:回顾性分析2011年1月至2014年3月209例因乳腺X线检查发现226个BI-RADS 4-5级钙化灶(超声检查阴性)而接受活检病人的MRI检查表现,并与病理结果对比分析。226个钙化灶中,42个为恶性,184个为良性。结果:对于超声检查阴性钙化灶恶性的判断,乳腺X线检查和MRI的灵敏度分别为69.0%和85.7%(P=0.068),特异度分别为64.7%和88.0%(P<0.001)。与单用乳腺X线检查相比,MRI检查联合乳腺X线摄影可明显提高对钙化灶诊断的灵敏度(χ2=15.4,P<0.001),且阴性预测值从90.2%提高到100.0%。恶性钙化灶中,78.6%(33/42)表现为非肿块样强化,11.9%(5/42)在MRI上无强化表现;而78.3%(144/184)的良性钙化灶在MRI上无强化表现,其比例明显高于恶性钙化灶(P<0.001)。MRI检查表现为流出型非肿块样强化提示恶性可能大,所有恶性肿块样强化均为流出型。恶性钙化灶中50%(21/42)为浸润癌,50%(21/42)为原位癌。结论:MRI检查对乳房钙化病变的良、恶性判断具有较高的灵敏度和特异度。对于乳腺X线检查发现的超声阴性钙化灶,结合MRI检查可提高诊断的灵敏度。
Objective: To investigate the diagnostic value of magnetic resonance imaging (MRI) in the diagnosis of negative breast calcification by ultrasound. Methods: A retrospective analysis of 209 cases of biopsies from 226 patients with BI-RADS grade 4-5 calcifications (negative by ultrasonography) detected by mammography from January 2011 to March 2014 was retrospectively analyzed and compared with pathology Results of comparative analysis. Of the 226 calcifications, 42 were malignant and 184 were benign. Results: The sensitivity of mammography and MRI were 69.0% and 85.7% (P = 0.068) and specificity of 64.7% and 88.0%, respectively (P <0.001) for sonographic examination of malignant calcifications. Compared with single mammography, MRI combined with mammography can significantly improve the sensitivity of calcification (χ2 = 15.4, P <0.001), and the negative predictive value increased from 90.2% to 100.0%. Malignant calcification, 78.6% (33/42) showed non-mass-like enhancement, 11.9% (5/42) showed no enhancement on MRI, while 78.3% (144/184) of benign calcification on MRI without enhancement Performance, the proportion was significantly higher than the malignant calcification (P <0.001). MRI examination showed that the outflow-like non-mass-like enhancement of malignancy may be large, all the malignant mass enhancement are efflux type. Malignant calcification in 50% (21/42) of invasive carcinoma, 50% (21/42) of carcinoma in situ. Conclusion: MRI has good sensitivity and specificity for judging benign and malignant breast calcification. For mammographic findings of ultrasound-negative calcifications, combined with MRI can improve diagnostic sensitivity.