乳腺疾病影像診斷課件

乳腺影像診斷醫(yī)學(xué)影像科ImagingModalities1.5TMRIGEsignagemsow0.5TMRIGEsignagalactographyCTComputedtomographyplainscan,enhancedscan(iodine)Imaging-GuidedPercutaneousBiopsy

supplyspecimensforpathologicexaminationFineneedleaspirationbiopsy(FNAB)Needlecorebiopsy(NCB)InterventionalTherapyLaserRadiofrequencyEmbolizationandsoon乳腺發(fā)育胚胎4-6周開始發(fā)育從兩側(cè)腋窩發(fā)出的對稱的兩條乳線每條線上有7個乳點(diǎn)三個月后乳點(diǎn)大部分退化，僅留第四對乳點(diǎn)生長發(fā)育8個月后乳腺管腔發(fā)育完成，可以看到很小乳暈和乳頭，直到整個兒童期乳腺X線檢查BasicImagingSignsofBreastLesionMass/LumpCalcificationARCHITECTURALDISTORTIONASYMMETRICDENSITYThickeningandretractionofregionalskinRetractionofnippleEnlargementorabnormalityofbloodvesselsLymphnodesEnhancedmanifestationsMass/Lumpshape:

round,oval,regular/irregularmargin:

clearorambiguous,spiculationorsmoothdensityorsignalintensity:

high/low/intermediatewithorwithoutcalcificationSite:Number:

solitaryormultipleCalcificationSize:largeormicroShape:ring-like,nodularorsalt-like,branchingDistribution:scatteredorclusteredwithorwithoutmass

benign/malignantThickeningandRetractionofRegionalSkinFrequentlyfoundinmalignanttumorsSometimesduetopostsurgicalscars.RetractionofNippleCongenital-dysplasiaAcquired-malignanttumorEnlargementorAbnormalityofBloodVesselMostlyinmalignanttumorduetoincreaseofbloodsupplyEnlargementofLymphNodesAxillaryorintramammarylymphnodesAdministrationofContrastAgentsforBreastLesionsImplicationofthelesion’shemodynamicswashouttype--malignantlinear--benignplateau--malignant/benignCommonDiseasesinBreastFibroadenomahyperplasiaCancer纖維腺瘤易發(fā)生于青年女性，無痛性腫物，邊界清，活動。X線：腫瘤呈圓形、卵圓形或分葉狀，密度均勻，邊緣清，有時可見細(xì)窄的透明暈。X線測量的尺寸常較臨床測量的數(shù)據(jù)大。有時由于血運(yùn)障礙組織壞死出現(xiàn)鈣化，腫物中心或周圍可見環(huán)狀、塊狀及斑點(diǎn)狀大小不等的粗鈣化影。主要與囊腫、導(dǎo)管內(nèi)乳頭狀瘤及小葉增生等鑒別，可結(jié)合B超檢查。FibroadenomaoverviewFrequency:mostcommontumorofbreast(benign)Age:below30yrsDistribution:unilateralorbilateralSourcetissue:connectivetissueandglandulartissueSite:upper-outerquadrantSize:<5cmSurface:smooth,movableImagingFindingsofFibroadenomaX-rayUSMRIX-rayFindingsRound,lobularorovalmassornodule,smoothnoduleinhighdensitywiththinring/haloinlowdensityCompressionofsurroundingtissueLargecalcification:alwaysdominatedatthecenteroftumor纖維腺瘤與乳腺癌的主要鑒別纖維腺瘤在2cm以下時以圓形為主。邊緣光滑，境界清楚，不粘連，但可出現(xiàn)擠壓性改變巨大纖維腺瘤可出現(xiàn)分葉或其他形態(tài)的改變，也可能與周圍組織粘連，須與乳腺癌鑒別腫塊較致密、均勻不合并其他間接征象致密型乳腺背景下，纖維腺瘤外包膜呈現(xiàn)圓弧形透亮區(qū)，較窄，呈線狀鈣化為圓點(diǎn)狀或斑片狀，區(qū)別乳腺癌重要指征乳腺增生腺性小葉增生部位多為雙側(cè)，腺體呈片狀、團(tuán)塊狀改變，范圍廣，密度增高，邊緣不規(guī)則且模糊不清囊性小葉增生，腺體呈大小不等的囊性結(jié)節(jié)影X線表現(xiàn)(形態(tài)、密度和結(jié)構(gòu))小片狀、小球形或半圓形致密團(tuán)—密度較高，瘤樣增生表現(xiàn)。大片狀、肥厚型—以高致密為主，密度不均勻，邊界清或部分清，腺體向皮下脂肪膨突，形成對周圍的擠壓改變。

結(jié)節(jié)狀—孤立、密集或散在的結(jié)節(jié)，平均直徑在3-4mm，密度與腺體相似或稍高于腺體，這種圖象以腺小葉增生為主。腫瘤型—容易與纖維腺瘤混淆，區(qū)別在于腫塊型增生密度不均勻。瘤樣增生與纖維腺瘤和惡性腫瘤的主要鑒別：瘤樣增生與纖維腺瘤類似，但其基底部與腺體相連，無明確的界限，密度略低于纖維腺瘤臨床上可觸到腫物，但影像學(xué)上看不到完整的腫塊邊界周圍組織不發(fā)生浸潤、粘連等改變。不合并其他間接征象。條索狀—導(dǎo)管增生的表現(xiàn)串珠狀—重度增生、非典型增生，癌發(fā)生率最高的類型

乳房懸韌帶增粗變形—增生累及到乳房懸韌帶和周圍的纖維組織，增生程度較重，病理切片可能出現(xiàn)非典型增生改變BreastCanceroverviewmostfrequentmalignancyinwomen1‰inadultwomeninChina34.4/100thousandin198939.7/100thousandin199346/100thousandin199752.98/100thousandinwomenofShanghaiin2001over100/100thousandinwomeninEuropeandUSABreastCanceroverviewAge:40-60yrs,inChina1/5are<35yrsGender:female(male)Clinicalmass:unmovablemass,skin,orange-peel-like,retractionachingretraction/dischargeofnippleenlargementofbloodvesselsstiffnessofbreastlymphnodesBreastCanceroverviewPathologyInvasiveductalcarcinoma 65-80%Intraductalcarcinoma 15%Lobularcarcinoma(invasive/insitu) 5%Specialtypes 10%X-rayFindingsofBreastCancer(1)Irregular/regularmassAmbiguousborderSpiculationsHeterogeneousdensity,mostlyhigherthantheSurroundingtissueSite:over50%atupper-outerquadrantX-rayfindingsofbreastcancer(2)Calcification:clusteredsalt-likemicrocalcificationin1/3casesinside/outsidethemass,sometimesonlythemicrocalcificationsobservedRetractionofnippleThickeningofskinAbnormalbloodvesselLargepatchyregioninhighdensity乳腺惡性腫瘤X線征象約40%乳腺癌有毛刺征象。多位于腫塊或浸潤性陰影的邊緣，光芒狀向四周輻射的細(xì)長或粗長毛刺病理切片可見毛刺大致由三帶構(gòu)成

1）毛刺根部為癌床帶，以癌細(xì)胞為主

2）中段為炎性細(xì)胞滲出帶

3）尖部為纖維組織增生帶腫塊>2cm癌細(xì)胞數(shù)量相對增加毛刺不僅鑒別良惡性，而且毛刺的性質(zhì)和長短確定治療方案和手術(shù)方式毛刺樣腫物分葉腫物與透亮環(huán)分葉腫物與透亮環(huán)模糊腫物良惡性鈣化的鑒別惡性良性形狀小叉狀或U形小桿狀，長度約1-2mm泥沙樣，顆粒細(xì)微均勻團(tuán)簇狀，多種形狀混合圓點(diǎn)狀或圓圈形、長條形、雙軌樣、片狀、團(tuán)球形等，有時見少量或散在泥沙樣、珍珠狀鈣化。密度密度偏低且均勻密度偏高不太均勻數(shù)量一類數(shù)量多、密集難以記數(shù)，如泥沙樣鈣化一類顆粒少，數(shù)顆或十幾顆，如小叉狀和小桿狀鈣化顆粒稀少，僅珍珠樣鈣化數(shù)量多，但分布松散部位發(fā)生在乳腺實(shí)質(zhì)內(nèi)泥沙樣鈣化發(fā)生在小葉腺胞內(nèi)小桿狀多發(fā)生在導(dǎo)管內(nèi)小叉狀發(fā)生在末支小導(dǎo)管內(nèi)多發(fā)生在纖維組織、脂肪、血管、大汗腺、皮膚等乳腺間質(zhì)。乳腺實(shí)質(zhì)內(nèi)較少出現(xiàn)。惡性鈣化花瓣型腫物囊壁腫物圓形腫物異常血管相正常乳房血管大多雙側(cè)呈鏡面像，由內(nèi)外兩側(cè)支及肋間支血管向乳暈延伸。癌細(xì)胞產(chǎn)生促血管生長因子，毛細(xì)血管叢生。一種直接從腫瘤向外生長，血管密集，血管內(nèi)有癌栓，形成血管型毛刺。另一種是腫塊牽拉附近血管，呈向心性集中，使血管失去正常走向。惡性異常血管應(yīng)與肝病或心臟病血管曲張進(jìn)行鑒別，另外，大乳房、哺乳期等血管擴(kuò)張不應(yīng)誤為異常血管。異常血管相

乳頭收縮漏斗征合并征象大導(dǎo)管相和漏斗征厚皮征皮膚收縮合并征象牛角征多中心癌多中心癌腋窩淋巴結(jié)轉(zhuǎn)移腋下淋巴結(jié)合并征象關(guān)于報告中的主觀因素特殊投照體位的重要性早癌MRIFindingsofBreastCancerSignalintensity:T1WISE,low;T2WIFSE,low,intermediate,inhomogeneous;STIR,intermediateSpiculation:irregularmass(lobular)Enhancement:time-signalintensitycurveComparisonofDifferentImagingModalitiesforDetectionandCharacterizationofBreastCancerMolybdenumX-rayradiography:mostimportant,widestused,mostuseful—notverysensitivetothesmalllesionatveryearlystageindensebreast;butdigitalmammographycansolvetheproblemtogreatextentUSGCysticorsolidLowspatialresolutionLimitedabilitytoDifferentiatebenign/malignantCTWidecoverageforviewing,sensitivetocysticchange,hemorrhageandcalcificationVeryusefulfordetectionandcharacterizationofmasses,especiallyintheenhancedscan,butcan’tdefinitelyviewthemicrocalcificationMuchmoreradiation,expensiveMRIHighsoftresolutionBetterdifferentiationforbenign/malignantWidercoverageWithoutradiationHighcostNotsensitivetocalcificationCTC-CTC+MRC+CombinationofVaryingImagingModalitiesAcquiretherichestinformationAppropriatenessinapplicationCost-effectivenessBestdiagnosis,timelycorrecttherapy,betterhealth乳腺影像報告和數(shù)據(jù)系統(tǒng)

BreastImagingReportingandDataSystem(BI-RADS)

第三版

美國放射學(xué)會

報告系統(tǒng)乳腺分型病變描述總體印象病變描述

部位－象限或