乳腺癌的影像学诊断.ppt

Epidemiology,Atpresent,Chinaaccountsforfemalebreastcancerincidencerateofincidenceofthefirst.发病率高Onwomensphysicalandminddamagethemost.身心损伤大Diagnosisandtreatmentmoredifficult.诊断及治疗较困难,Pathologicaltype,1.Differentiationoflowbreastcancer:分化低的乳腺癌1)hardwarecarcinoma硬癌2)medullarycarcinoma髓样癌3)diffusecarcinoma(alsoknownasinflammatorycancer)弥漫性癌(亦称炎性癌)4)mucinouscarcinoma(alsoknownascolloidcarcinoma)粘液癌(亦称胶样癌),Pathologicaltype,2.Highlydifferentiatedbreastcancer:分化高的乳腺癌1)adenocarcinoma腺癌2)ductalcarcinoma(alsoknownastubecancer)导管癌(亦称管内癌)3)papillarycarcinoma(alsoknownaspapillaryadenocarcinoma)导管癌(亦称管内癌)4)eczema-likecancer(alsoknownasPagetsnippledisease)湿疹样癌(亦称Paget氏乳头病),Clinicalmanifestations,Breastlumps乳房肿块Nippledischarge乳头溢液Changesinthebreastskinandcontour乳房皮肤及轮廓改变,Inspectionmethods,UltrasoundMammography钼靶X线MRINearinfraredscanning近红外线扫描Positronemissiontomography(PET)EnhancedCT,Ultrasound,Solidhypoecho低回声Withoutcapsule无包膜Borderclearance边界清Heterogeneous不均匀internalechoStrongechocanbeseenclusteredcalcifications钙化,mammography,Seetheupperouterquadrantmassinshallowleaf浅分叶肿块影LessclearboundarySeeclustersofcalcification其内见成簇钙化,MRIshouldnolongerberegardedasanadjuncttomammographybutasadistinctbreastcancerinitsearlieststage.,“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。”,MRIFeatures（breastcancer）,T1WIlowsignalT2WIIncreasedsignal,MRIFeatures,Irregular不规则massLobulated分叶状edgesBlur模糊,rough毛糙Crab-likegrowth呈蟹足样生长Ill-defined,MRIFeatures,Liquefactionnecrosis液化坏死seeninthelargerlesions,MRIFeatures,Quicksignificantly明显enhancedRapidclearance廓清Aroundthebeginningofthespreadofthediseasecenters向心性强化Liquefactionnecrosisandbleeding液化坏死及出血hasalwaysbeenpartofnoenhancement,Time-intensitycurves（TIC）,Type,Clearancetype,type,持续型,平台型,廓清型,Time-intensitycurves（TIC）,Mostofthebenignlesionsshowedpersistent持续型toenhanceMostmalignantlesionsshowedclearance-type廓清型enhancedPlatform-type平台型canbebenignlesions,butalsoformalignantlesions.,DiagnosisofbreastcancerBI-RADSclassification分级,Level0:assessed评估isnotcomplete,tofurtherassesstheneedforotherimagingLevel1:noabnormalfindings无异常发现Level2:Benignfound良性发现-routinefollow-upLevel3:Possiblepositivefindings可能良性发现-short-termfollow-upLevel4:Low-Moderatesuspiciousmalignant低-中度可疑恶性-considerbiopsyLevel5:highlysuspectedmalignancy高度怀疑恶性-Level6:malignantlesionsbiopsyconfirm已活检证实的恶性病变,Differential鉴别Diagnosis1,Breastfibroadenoma：纤维腺瘤Oftenoccursinyoungfemale，Massoftensmooth光滑edge，Similardensityandglands腺体，Coarsecalcificationwithinthevisible，Strengtheneven,slow,waseccentric.,DifferentialDiagnosis2,Hyperplasia增生：Localglandincreased,edgesblur模糊Enhancedwithaslow,progressive渐进性enhancement，Inthelateenhancement,lesiondegreeofenhancementincreasingtrend,DifferentialDiagnosis3,Breastcyst囊肿：appearassignificantlongT1andlongT2singalintensity,PhotoReview,纤维腺瘤,1a）showlowT1WIsignalmassattheleftbreast1b）showhighT2WIsignalmass,edgeclear,PhotoReview,纤维腺瘤,2a）T2WImasssignalwasslightlylower2b）Enhancedscanmasslesioninthebreastdeep,sharpedgesandstrengthenamoreeven,PhotoReview,纤维腺瘤,3a）Enhancedmassintherightbreastshowedamorehomogeneous均匀enhancement3b）Curveforthelesiontypetypecurveforthenormalglands,PhotoReview,浸润性导管癌,4a）Masswithintheleftbreastwassignificantly明显enhanced4b）Dynamicenhancementcurvesofthetype(clearancetype),PhotoReview,浸润性导管癌,5a）X-rayimageRightbreastnearthechestwallseethemass5b）Significantlyenhancedlesions,irregular不规则margin,PhotoReview,浸润性导管癌,6a）X-rayimageLargecalcifiedlesionsinthebreast6b）Theouterupperquadrantlesionswithinthechipheterogeneous不均匀enhancement,PhotoReview,乳腺囊肿,PhotoReview,乳腺增生,Summary,Middle-agedwomenwithmulti