乳腺影像学诊断(imaging examinations of breasts).ppt

Imaging examinations of breasts Department of radiology Question How to choose a proper examination for screening and diagnosis What examinations we could use Breast cancer Higher incident rate of breast cancer for recent years Risk factors: procreation, family history, environment, hormone Clinic findings：mass，skin changes The survival rate based on the stage of breast cancer Screening：ductal carcinoma in situ Anatomy 1518 lobes Lobules: Terminal Ductal Lobular Units (TDLUs) Anatomy TDLU：12mm Drained by a terminal duct attached to the main duct system Most breast diseases arise in TDLU Imaging methods Mammography Ultrasound MRI Projection ： CC MLO Mammography Mammographic characters Calcification Mass Calcification PO43- Calcium phosphat Ca+ Calcification The main value : detection necrotic tissues Form: Casting type, powderish, granular type Differentiation between malignant and benign: distribution, form, density Calcification Calcification Calcification Calcification Mass Proliferation and invasion Stellate lesion with spicules and ill-defined borders Differentiation between malignant and benign is difficult Mass Mass Mass Mass Characteristics of mammography Sensitive to the malignant calcification even microcalcifications Differentiation between benign and malignant mass is difficult Characteristics of Ultrasound Exam Allows significant freedom in obtaining images from almost any orientation excellent at imaging cysts and solid mass young women at high risk of the disease Guide biopsy Limited of ultrasound Though ultrasound has excellent contrast resolution, it lacks the detail (spatial resolution) Operator and equipment factors unable to image microcalcifications Benefits of MRI Exam Allows breast images to be taken in any plane and from any orientation highly sensitive to small abnormalities, could show multi-focal tumor Determining the extent of breast cancer, can help indicate treatment An excellent at imaging the augmented breast Limited of MRI Exam Too expensive Couldnt find the microcalcification Ductal Carcinoma in Situ Intraductal carcinoma: cancer cells are confined to an intact basementmembrane Appearances: microcalcification (85%) microcalcification and mass (10%) mass or architectural dist