中文摘要：

目的研究1H-MRS和动态增强成像在乳腺疾病诊断与鉴别诊断的价值。方法对72例女性乳腺病变患者计74个病灶（经手术病理证实）行双侧乳腺磁共振常规扫描,其中45例患者47个病灶行磁共振动态增强检查,54例患者54个病灶行单体素氢质子波谱分析。观察病灶形态学特征,绘制时间-信号强度曲线,计算增强后120s的早期增强率;测量乳腺病灶复合胆碱峰的SNR值。结果恶性病灶多表现为形态不规则（72.4%）、边缘欠清（75.9%）,良性病灶多表现为形态规则（66.7%）、边缘清晰（77.8%）。常规MRI乳腺良恶病灶的总检出率为81.1%,动态增强成像诊断乳腺良恶性病灶的敏感性为89.6%,特异性为72.2%,阳性预测值为83.8%,阴性预测值为81.2%,准确性为83.0%。氢质子磁共振波谱的敏感性为37.5%,特异性和阳性预测值均为100%,阴性预测值为47.4%,准确性为60.0%。动态增强联合1H-MRS诊断的敏感性为76.9%,特异性为82.3%,阳性预测值为86.9%,阴性预测值为70.0%,准确性为79.1%。结论乳腺磁共振动态增强有利于乳腺病灶的早期发现;动态增强成像与1H-MRS联合应用可提高乳腺疾病诊断的特异性。

英文摘要：

Abstract：Objective To investigate the value of ^1 H--MRS and dynamic contrast--enhanced MRI （DCE--MRI） in diagnosis and differential diagnosis of breast diseases. Methods Conventional magnetic resonance imaging（MRI）of breast lesions in 72 female patients （74 lesions） verified hy pathology were performed before operation. Of them,45 patients with 47 lesions underwent DCE-- MRI and 54 patients with 54 lesions underwent^1 Iq--MRS examination. Morphological features,initial enhancement rate, time--sin- gal intensity cuvre patterns and the signal to noise ratio of choline peak of breast lesions were analyzed. Results Most of the breast lesions with irregular shape （ 72.4% ） and undefined margin （ 75.9% ） were malignant,while that with regular shape（ 66.7% ） and limpid margin （ 77.8%） were benign. The total detecting rate of breast benign and malignant lesions by conventional MRI was 81.1%. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 89.6%, 72.2%, 83.8 % ,81.2 % and 83.0 % respectively with DCE-- MRI, and were 87.5 ~, 100 %, 100%, 47.4 % and 60.0 % respectively with1 H MRS,while were 76.9% ,82.3% ,86.9%/00,70.0% and 79.1% respectively by DCE--MRI in combination withI H--MRS. Conclusion The DCE-- MRI is useful in early detection for breast lesions. DCE-- MRI in combination with^1 H-- MRS can improve the diagnostic specificity of breast tumors.