乳腺疾病影像诊断.pptx

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,长海医院,医学影像科,乳腺影像诊断,医学影像科,郝强,Imaging Modalities,1.5T MRI,GE signa gemsow,0.5T MRI,GE signa,X-ray Examination,Mammograpy,X-ray radiography (molybdenum X rays,rhodium X rays):MLO,CC,etc.,Galactography-demonstrates the ducts and ductule or their abnormalities.,galactography,MRI,Magnetic Resonance Imaging,high resolution for soft tissue,different tissue,different signal,enhanced scan,The others,Infrared thermal imaging,Computer diaphanography imaging,电脑近红外线增强显影,Imaging-Guided Percutaneous Biopsy,supply specimens for pathologic examination,Fine needle aspiration biopsy(FNAB),Needle core biopsy(NCB),Interventional Therapy,Laser,Radiofrequency,Embolization,and so on,Accessory Breast Tissue,The most common site is axilla,乳腺发育,胚胎,4,-,6,周开始发育,从两侧腋窝发出的对称的两条乳线,每条线上有,7,个乳点,三个月后乳点大部分退化，仅留第四对乳点生长发育,8,个月后乳腺管腔发育完成，可以看到很小乳晕和乳头，直到整个儿童期,乳腺,X,线检查,脂肪型,少量腺体型,多量腺体型,致密型,乳腺分型,Basic Imaging Signs of Breast Lesion,Mass/Lump,Calcification,ARCHITECTURAL DISTORTION,ASYMMETRIC DENSITY,Thickening and retraction of regional skin,Retraction of nipple,Enlargement or abnormality of blood vessels,Lymph nodes,Enhanced manifestations,Mass/Lump,shape:,round,oval,regular/irregular,margin:,clear or ambiguous,spiculation or smooth,density or signal intensity:,high/low/intermediate with or without calcification,Site:,Number:,solitary or multiple,Calcification,Size:,large or micro,Shape:,ring-like,nodular or salt-like,branching,Distribution:,scattered or clustered with or without mass,benign,/,malignant,Thickening and Retraction of Regional Skin,Frequently found in malignant tumors,Sometimes due to postsurgical scars.,Retraction of Nipple,Congenital-dysplasia,Acquired-malignant tumor,Enlargement or Abnormality of Blood Vessel,Mostly in malignant tumor due to increase of blood supply,Enlargement of Lymph Nodes,Axillary or intramammary lymph nodes,Administration of Contrast Agents for Breast Lesions,Implication of the lesions hemodynamics,washout type-malignant,linear-benign,plateau-malignant/benign,Common Diseases in Breast,Fibroadenoma,hyperplasia,Cancer,纤维腺瘤,易发生于青年女性，无痛性肿物，边界清，活动。,X,线：肿瘤呈圆形、卵圆形或分叶状，密度均匀，边缘清，有时可见细窄的透明晕。,X,线测量的尺寸常较临床测量的数据大。有时由于血运障碍组织坏死出现钙化，肿物中心或周围可见环状、块状及斑点状大小不等的粗钙化影。,主要与囊肿、导管内乳头状瘤及小叶增生等鉴别，可结合,B,超检查。,Fibroadenoma,overview,Frequency:,most common tumor of breast(benign),Age:,below 30 yrs,Distribution:,unilateral or bilateral,Source tissue:,connective tissue and glandular tissue,Site:,upper-outer quadrant,Size:,5cm,Surface:,smooth,movable,Imaging Findings of Fibroadenoma,X-ray,US,MRI,X-ray Findings,Round,lobular or oval mass or nodule,smooth nodule in high density with thin ring/halo in low density,Compression of surrounding tissue,Large calcification:,always dominated at the center of tumor,纤维腺瘤与乳腺癌的主要鉴别,纤维腺瘤在,2cm,以下时以圆形为主。边缘光滑，境界清楚，不粘连，但可出现挤压性改变,巨大纤维腺瘤可出现分叶或其他形态的改变，也可能与周围组织粘连，须与乳腺癌鉴别,肿块较致密、均匀,不合并其他间接征象,致密型乳腺背景下，纤维腺瘤外包膜呈现圆弧形透亮区，较窄，呈线状,钙化为圆点状或斑片状，区别乳腺癌重要指征,乳腺增生,腺性小叶增生部位多为双侧，腺体呈片状、团块状改变，范围广，密度增高，边缘不规则且模糊不清,囊性小叶增生，腺体呈大小不等的囊性结节影,X,线表现,(,形态、密度和结构,),小片状、小球形或半圆形致密团,密度较高，瘤样增生表现。,大片状、肥厚型,以高致密为主，密度不均匀，边界清或部分清，腺体向皮下脂肪膨突，形成对周围的挤压改变,。,结节状,孤立、密集或散在的结节，平均直径在,3-4mm,，密度与腺体相似或稍高于腺体，这种图象以腺小叶增生为主。,肿瘤型,容易与纤维腺瘤混淆，区别在于肿块型增生密度不均匀。,瘤样增生与纤维腺瘤和恶性肿瘤的主要鉴别：,瘤样增生与纤维腺瘤类似，但其基底部与腺体相连，无明确的界限，密度略低于纤维腺瘤,临床上可触到肿物，但影像学上看不到完整的肿块边界,周围组织不发生浸润、粘连等改变。,不合并其他间接征象。,条索状,导管增生的表现,串珠状,重度增生、非典型增生，癌发生率最高的类型 乳房悬韧带增粗变形,增生累及到乳房悬韧带和周围的纤维组织，增生程度较重，病理切片可能出现非典型增生改变,Breast Cancer,overview,most frequent malignancy in women,1 in adult women in China,34.4/100 thousand in 1989,39.7/100 thousand in 1993,46/100 thousand in 1997,52.98/100 thousand in women of Shanghai in 2001,over 100/100 thousand in women in Europe and USA,Breast Cancer,overview,Age:,40-60yrs,in China 1/5 are 2cm,癌细胞数量相对增加,毛刺不仅鉴别良恶性，而且毛刺的性质和长短确定治疗方案和手术方式,毛刺样肿物,分叶肿物与透亮环,分叶肿物与透亮环,模糊肿物,良恶性钙化的鉴别,恶性,良性,形状,小叉状或,U,形,小杆状，长度约,1-2mm,泥沙样，颗粒细微均匀,团簇状，多种形状混合,圆点状或圆圈形、长条形、双轨样、片状、团球形等，有时见少量或散在泥沙样、珍珠状钙化。,密度,密度偏低且均匀,密度偏高不太均匀,数量,一类数量多、密集难以记数，如泥沙样钙化,一类颗粒少，数颗或十几颗，如小叉状和小杆状,钙化颗粒稀少，仅珍珠样钙化数量多，但分布松散,部位,发生在乳腺实质内,泥沙样钙化发生在小叶腺胞内,小杆状多发生在导管内,小叉状发生在末支小导管内,多发生在纤维组织、脂肪、血管、大汗腺、皮肤等乳腺间质。乳腺实质内较少出现。,恶性钙化,花瓣型肿物,囊壁肿物,圆形肿物,异常血管相,正常乳房血管大多双侧呈镜面像，由内外两侧支及肋间支血管向乳晕延伸。,癌细胞产生促血管生长因子，毛细血管丛生。一种直接从肿瘤向外生长，血管密集，血管内有癌栓，形成血管型毛刺。另一种是肿块牵拉附近血管，呈向心性集中，使血管失去正常走向。,恶性异常血管应与肝病或心脏病血管曲张进行鉴别，另外，大乳房、哺乳期等血管扩张不应误为异常血管。,异常血管相,乳头收缩,漏斗征,合并征象,大导管相和漏斗征,厚皮征,皮肤收缩,合并征象,牛角征,多中心癌,多中心癌,腋窝淋巴结转移,腋下淋巴结,合并征象,关于报告中的主观因素,特殊投照体位的重要性,早 癌,MRI Findings of Breast Cancer,Signal intensity:T1WI SE,low;T2WI FSE,low,intermediate,inhomogeneous;STIR,intermediate,Spiculation:irregular mass(lobular),Enhancement:time-signal intensity curve,Comparison of Different Imaging Modalities for Detection and Characterization of Breast Cancer,Molybdenum X-ray radiography:,most important,widest used,most usefulnot very sensitive to the small lesion at very early stage in dense breast;but digital mammography can solve the problem to great extent,USG,Cystic or solid,Low spatial resolution,Limited ability to Differentiate benign/malignant,CT,Wide coverage for viewing,sensitive to cystic change,hemorrhage and calcification,Very useful for detection and characterization of masses,especially in the enhanced scan,but cant definitely view the microcalcification,Much more radiation,expensive,MRI,High soft resolution,Better differentiation for benign/malignant,Wider coverage,Without radiation,High cost,Not sensitive to calcification,CT C,-,CT C,+,MR C,+,Combination of Varying Imaging Modalities,Acquire the richest information,Appropriateness in application,Cost-effectiveness,Best diagnosis,timely correct therapy,better health,乳腺影像报告和数据系统,Breast Imaging Reporting and Data System(,BI-RADS),第三版,美国放射学会,报告系统,乳腺分型,病变描述,总体印象,病变描述,部位象限或钟面定位,外上、外下、内上、内下、乳晕区、中央区、尾叶区,深度前、中、后,总体印象,评估分类,先评估，后分类,0,类,需要进一步其他影像评价,（,不完全评估,）,完全评估,I,类,阴性,II,类,良性发现,III,类,可能是良性发现，建议短期,随访（,0-2,）,IV,类,可疑异常，要考虑,活检（,3-94,）,V,类,高度怀疑恶性，临床要采取适当,措施（,95,）,VI,类：,已经由病理证实为恶性病变,肿块,两个投照体位都显示的病变,1.,形状,:,圆形、卵圆形分叶形、不规则形,2.,边缘,:,清晰、小分叶、模糊、浸润、星芒状,3.,密度,:,高密度、等密度、低密度、含脂肪密度,4.,大小,:,圆形,卵圆型,分叶型,不规则型,形状,边缘,清晰,小分叶,模糊,浸润,星芒状,高密度,等密度,低密度,含脂肪密度,密度,大小,浸润性导管癌,1cm,部位,乳腺内或皮肤上,大小,-0.5mm 1mm,数量,-5/cm,3,形态：典型良性钙化、高度恶性可能钙化、不定性钙化,分布：簇状、线形、段样、区域性、弥漫或散在,钙化,典型良性钙化,皮肤钙化,血管钙化,粗钙化,粗棒状钙化,圆形或点状,环状钙化,中空状钙化,牛奶样钙化,缝线钙化,营养不良钙化,不定性钙化,高度恶性可能钙化,多形性钙化颗粒点状钙化,线样分支状钙化,簇状,线状,段样,区域性,弥漫分布,分布,结构扭曲,从一点发出的放射状影,局灶性收缩或实质的边缘扭曲,无确定的肿块可见,结构扭曲,浸润性导管癌,硬化性乳腺病,手术后疤痕,Thank You,