乳腺癌的影像学诊断.ppt

Epidemiology,At present, China accounts for female breast cancer incidence rate of incidence of the first. 发病率高 On womens physical and mind damage the most. 身心损伤大 Diagnosis and treatment more difficult.诊断及治疗较困难,Pathological type,1. Differentiation of low breast cancer:分化低的乳腺癌1) hardware carcinoma硬癌2) medullary carcinoma髓样癌3) diffuse carcinoma (also known as inflammatory cancer)弥漫性癌(亦称炎性癌) 4) mucinous carcinoma (also known as colloid carcinoma) 粘液癌(亦称胶样癌),Pathological type,2. Highly differentiated breast cancer:分化高的乳腺癌 1) adenocarcinoma腺癌2) ductal carcinoma (also known as tube cancer)导管癌(亦称管内癌) 3)papillary carcinoma (also known as papillary adenocarcinoma)导管癌(亦称管内癌) 4) eczema-like cancer (also known as Pagets nipple disease)湿疹样癌(亦称Paget氏乳头病),Clinical manifestations,Breast lumps 乳房肿块 Nipple discharge 乳头溢液 Changes in the breast skin and contour乳房皮肤及轮廓改变,Inspection methods,Ultrasound Mammography 钼靶X线 MRI Near infrared scanning 近红外线扫描 Positron emission tomography (PET) Enhanced CT,Ultrasound,Solid hypoecho低回声Without capsule无包膜 Border clearance边界清 Heterogeneous不均匀internal echo Strong echo can be seen clustered calcifications钙化,mammography,See the upper outer quadrant mass in shallow leaf浅分叶肿块影 Less clear boundary See clusters of calcification 其内见成簇钙化,“MRI should no longer be regarded as an adjunct to mammography but as a distinct breast cancer in its earliest stage.“,“MRI 不再是钼靶X线的辅助方法，而是作为乳腺癌早期诊断的独立检查方法。”,MRI Features（ breast cancer）,T1WI low signal T2WI Increased signal,MRI Features,Irregular不规则mass Lobulated分叶状 edges Blur模糊, rough毛糙 Crab-like growth呈蟹足样生长 Ill-defined,MRI Features,Liquefaction necrosis液化坏死seen in the larger lesions,MRI Features,Quick significantly明显enhanced Rapid clearance廓清 Around the beginning of the spread of the disease centers 向心性强化 Liquefaction necrosis and bleeding液化坏死及出血has always been part of no enhancement,Time - intensity curves（TIC）,Type,Clearance type,type,持续型,平台型,廓清型,Time - intensity curves（TIC）,Most of the benign lesions showed “persistent“持续型to enhance Most malignant lesions showed “clearance-type“廓清型enhanced “Platform-type“平台型can be benign lesions, but also for malignant lesions.,Diagnosis of breast cancer BI-RADS classification 分级,Level 0: assessed评估is not complete, to further assess the need for other imaging Level 1: no abnormal findings无异常发现 Level 2: Benign found良性发现- routine follow-up Level 3: Possible positive findings可能良性发现- short-term follow-up Level 4: Low - Moderate suspicious malignant低-中度可疑恶性- consider biopsy Level 5: highly suspected malignancy高度怀疑恶性- Level 6: malignant lesions biopsy confirm 已活检证实的恶性病变,Differential鉴别Diagnosis 1,Breast fibroadenoma：纤维腺瘤 Often occurs in young female， Mass often smooth光滑edge，Similar density and glands腺体，Coarse calcification within the visible，Strengthen even, slow, was eccentric.,Differential Diagnosis 2,Hyperplasia增生 ：Local gland increased, edges blur模糊Enhanced with a slow, progressive渐进性enhancement，In the late enhancement, lesion degree of enhancement increasing trend,Differential Diagnosis 3,Breast cyst囊肿 ：appear as significant long T1 and long T2 singal intensity,Photo Review,纤维腺瘤,1a）show low T1WI signal mass at the left breast 1b） show high T2WI signal mass, edge clear,Photo Review,纤维腺瘤,2a）T2WI mass signal was slightly lower 2b）Enhanced scan mass lesion in the breast deep, sharp edges and strengthen a more even,Photo Review,纤维腺瘤,3a）Enhanced mass in the right breast showed a more homogeneous均匀enhancement 3b）Curve for the lesion type type curve for the normal glands,Photo Review,浸润性导管癌,4a）Mass within the left breast was significantly明显enhanced 4b）Dynamic enhancement curves of the type (clearance type),Photo Review,浸润性导管癌,5a）X-ray image Right breast near the chest wall see the mass 5b）Significantly enhanced lesions, irregular不规则margin,Photo Review,浸润性导管癌,6a） X-ray image Large calcified lesions in the breast 6b）The outer upper quadrant lesions within the chip heterogeneous不均匀enhancement,Photo Review,乳腺囊肿,Photo Review,乳腺增生,Summary,Middle-aged women with multiple多