乳腺癌的影像学诊断.ppt

1、 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 carcinom

2、a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 cance

3、r)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 metho

4、ds 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 quad

5、rant 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 T2

6、WI 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 diseas

7、e 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） Persistent Platform Type 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 lesi

8、ons 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: Benig

9、n 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 Bre

10、ast 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

11、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 Pho

12、to 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 glan

13、ds 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

14、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多发 Was infiltrating浸润 the surrounding tissue invasion aptitude Mass of edge the rough rf毛糙 Enhance the rapid clearance was quickly apparent Strengthen the Mind Mass examination hard, poor activity活动度 差