乳腺癌的影像學(xué)診斷.ppt

Epidemiology,At present, China accounts for female breast cancer incidence rate of incidence of the first. 發(fā)病率高 On womens physical and mind damage the most. 身心損傷大 Diagnosis and treatment more difficult.診斷及治療較困難,Pathological type,1. Differentiation of low breast cancer:分化低的乳腺癌1) hardware carcinoma硬癌2) medullary carcinoma髓樣癌3) diffuse carcinoma (also known as inflammatory cancer)彌漫性癌(亦稱炎性癌) 4) mucinous carcinoma (also known as colloid carcinoma) 粘液癌(亦稱膠樣癌),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)導(dǎo)管癌(亦稱管內(nèi)癌) 3)papillary carcinoma (also known as papillary adenocarcinoma)導(dǎo)管癌(亦稱管內(nèi)癌) 4) eczema-like cancer (also known as Pagets nipple disease)濕疹樣癌(亦稱Paget氏乳頭病),Clinical manifestations,Breast lumps 乳房腫塊 Nipple discharge 乳頭溢液 Changes in the breast skin and contour乳房皮膚及輪廓改變,Inspection methods,Ultrasound Mammography 鉬靶X線 MRI Near infrared scanning 近紅外線掃描 Positron emission tomography (PET) Enhanced CT,Ultrasound,Solid hypoecho低回聲Without capsule無包膜 Border clearance邊界清 Heterogeneous不均勻internal echo Strong echo can be seen clustered calcifications鈣化,mammography,See the upper outer quadrant mass in shallow leaf淺分葉腫塊影 Less clear boundary See clusters of calcification 其內(nèi)見成簇鈣化,“MRI should no longer be regarded as an adjunct to mammography but as a distinct breast cancer in its earliest stage.“,“MRI 不再是鉬靶X線的輔助方法，而是作為乳腺癌早期診斷的獨(dú)立檢查方法?！?MRI Features（ breast cancer）,T1WI low signal T2WI Increased signal,MRI Features,Irregular不規(guī)則mass Lobulated分葉狀 edges Blur模糊, rough毛糙 Crab-like growth呈蟹足樣生長 Ill-defined,MRI Features,Liquefaction necrosis液化壞死seen in the larger lesions,MRI Features,Quick significantly明顯enhanced Rapid clearance廓清 Around the beginning of the spread of the disease centers 向心性強(qiáng)化 Liquefaction necrosis and bleeding液化壞死及出血has always been part of no enhancement,Time - intensity curves（TIC）,Type,Clearance type,type,持續(xù)型,平臺(tái)型,廓清型,Time - intensity curves（TIC）,Most of the benign lesions showed “persistent“持續(xù)型to enhance Most malignant lesions showed “clearance-type“廓清型enhanced “Platform-type“平臺(tái)型can be benign lesions, but also for malignant lesions.,Diagnosis of breast cancer BI-RADS classification 分級,Level 0: assessed評估is not complete, to further assess the need for other imaging Level 1: no abnormal findings無異常發(fā)現(xiàn) Level 2: Benign found良性發(fā)現(xiàn)- routine follow-up Level 3: Possible positive findings可能良性發(fā)現(xiàn)- short-term follow-up Level 4: Low - Moderate suspicious malignant低-中度可疑惡性- consider biopsy Level 5: highly suspected malignancy高度懷疑惡性- Level 6: malignant lesions biopsy confirm 已活檢證實(shí)的惡性病變,Differential鑒別Diagnosis 1,Breast fibroadenoma：纖維腺瘤 Often occurs in young female， Mass often smooth光滑edge，Similar density and glands腺體，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漸進(jìn)性enhancement，In the late enhancement, lesion degree of enhancement increasing trend,Differential Diagnosis 3,Breast cyst囊腫 ：appear as significant long T1 and long T2 singal intensity,Photo Review,纖維腺瘤,1a）show low T1WI signal mass at the left breast 1b） show high T2WI signal mass, edge clear,Photo Review,纖維腺瘤,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,纖維腺瘤,3a）Enhanced mass in the right breast showed a more homogeneous均勻enhancement 3b）Curve for the lesion type type curve for the normal glands,Photo Review,浸潤性導(dǎo)管癌,4a）Mass within the left breast was significantly明顯enhanced 4b）Dynamic enhancement curves of the type (clearance type),Photo Review,浸潤性導(dǎo)管癌,5a）X-ray image Right breast near the chest wall see the mass 5b）Significantly enhanced lesions, irregular不規(guī)則margin,Photo Review,浸潤性導(dǎo)管癌,6a） X-ray image Large calcified lesions in the breast 6b）The outer upper quadrant lesions within the chip heterogeneous不均勻enhancement,Photo Review,乳腺囊腫,Photo Review,乳腺增生,Summary,Middle-aged women with multiple多