乳腺影像學(xué)課件

BreastImaging

BasicCourseForMedicalCollegeStudent

Introduction“Breastcancerisoneofthebeststudiedhumantumors,butitremainspoorlyunderstood”

“Asinallmedicalendeavors,thepractitionershould,wheneverpossible,usetheresultsofscientificstudiestoguideclinicaldecision”Andtheimagingmodalitiesimplementedinclinicalpracticeforbreastcaremustbeservedasthetoolsfordetectionandcharacterizationofbreastlesions.Asweexpect,theyareveryimportantfordiagnosisandtreatment.ImagingModalities1.5TMRI

GEsignagemsow0.5TMRI

GEsignaSys#MRSShanghai2ndMedicalUniversityRuiJinHospitalX-rayExamination

MammograpyX-rayradiography(molybdenumXrays,rhodiumXrays):MLO,CC,etc.Galactography--demonstratestheductsandductuleortheirabnormalities.galactographyUSGUltrasonography(ultrasound)B-modeUSDopplerUSCTComputedtomographyplainscan,enhancedscan(iodine)MRIMagneticResonanceImaginghighresolutionforsofttissuedifferenttissue,differentsignalenhancedscanTheothersInfraredthermalimagingComputerdiaphanographyimaging,etc.Imaging-GuidedPercutaneousBiopsy

supplyspecimensforpathologicexaminationFineneedleaspirationbiopsy(FNAB)Needlecorebiopsy(NCB)InterventionalTherapyLaserRadiofrequencyEmbolizationandsoonAccessoryBreastTissueThemostcommonsiteisaxillaBasicImagingSignsofBreastLesionMass/LumpCalcificationThickeningandretractionofregionalskinRetractionofnippleEnlargementorabnormalityofbloodvesselsLymphnodesEnhancedmanifestationsMass/Lumpshape:

round,oval,regular/irregularmargin:

clearorambiguous,spiculationorsmoothdensityorsignalintensity:

high/low/intermediatewithorwithoutcalcificationsite:

upper-outerquadrantbreast,upper-innerquadrantbreast,lowerouterquadrantbreast,lower-innerquadrantbreast,nipple,centralportionbreast,axillarytailbreast.Number:

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

benign/malignantThickeningandRetractionofRegionalSkinFrequentlyfoundinmalignanttumorsSometimesduetopostsurgicalscars.RetractionofNippleCongenital-dysplasiaAcquired-malignanttumorEnlargementorAbnormalityofBloodVesselMostlyinmalignanttumorduetoincreaseofbloodsupplyEnlargementofLymphNodesAxillaryorintramammarylymphnodesAdministrationofContrastAgentsforBreastLesionsImplicationofthelesion’shemodynamicswashouttype--malignantlinear--benignplateau--malignant/benignCommonDiseasesinBreastFibroadenomaCystLobularhyperplasiaCancerFibroadenoma

overviewFrequency:mostcommontumorofbreast(benign)Age:below30yrsDistribution:unilateralorbilateralSourcetissue:connectivetissueandglandulartissueSite:upper-outerquadrantSize:<5cmSurface:smooth,movableImagingFindingsofFibroadenomaX-rayCTMRIX-rayFindingsRound,lobularorovalmassornodule,smoothnoduleinhighdensitywiththinring/haloinlowdensityCompressionofsurroundingtissueLargecalcification:alwaysdominatedatthecenteroftumorCTFindingsRoundsmoothmass/noduleValueofCTsimilartonormalglandulartissueCalcificationIntermediateenhancement,lineartypeorplateau,relativelylongdurationofenhancementBreastCancer

overviewmostfrequentmalignancyinwomen1%inadultwomeninChina34.4/100thousandin198939.7/100thousandin199346/100thousandin199752.98/100thousandinwomenofShanghaiin2001over100/100thousandinwomeninEuropeandUSABreastCancer

overviewAge:40-60yrs,inChina1/5are<35yrsGender:female(male)Clinicalmass:unmovablemass,skin,orange-peel-like,retractionachingretraction/dischargeofnippleenlargementofbloodvesselsstiffnessofbreastlymphnodesBreastCancer

overviewPathologyInvasiveductalcarcinoma 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,sometimesonlythemicrocalcificationsobservedRetractionofnippleThickeningofskinAbnormalbloodvesselLargepatchyregioninhighdensityCTFindingsofBreastCancer(1)Mass:irregular/ill-shaped,coarsemargin,spiculation,CTvalue:25-56HU,higherthanthenormalbreast,necrosisatthecenterofthelargemass(mostly>=5cm)Skin,nippleInfiltrationintothepectoralismajormuscleCTFindingsofBreastCancer(2)OccupyingofretromammaryspaceEnlargementoflymphnodes,axillary/retromammaryAdministrationofcontrastagentsquickenhancement(washin)atearlyphasethepeakofenhancementoccurwithin50s~1minquickwashouttime-signalintensitycurve——washouttypeMRIFindingsofBreastCancerSignalintensity:T1WISE,low;T2WIFSE,low,intermediate,inhomogeneous;STIR,intermediateSpiculation:irregularmass(lobular)Enhancement:time-signalintensitycurveComparisonofDifferentImagingModalitiesforDetectionandCharacterizationofBreastCancerMolybdenumX-rayradiography:mostimportant,widestused,mostuseful—notverysensitivetothesmalllesionatveryearlystageindensebreast;butdigitalmammographycansolvetheproblemtogreatextentUSGCysticorsolidLowspatialresolutionLimitedabilitytoDifferentiatebenign/malignantCTWidecoverageforviewing,sensitivetocysticchange,hemorrhageandcalcificationVeryusefulfordetectionandcharacterizatio