中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (10): 755-761.doi: 10.19401/j.cnki.1007-3639.2018.10.006

• 论著 • 上一篇    下一篇

乳腺X线摄影辐射剂量、乳腺密度及体成分三者间的相关性研究

沈茜刚,顾雅佳,郑晓静,陈 超,李瑞敏,肖 勤,周良平,彭卫军   

  1. 复旦大学附属肿瘤医院放射诊断科,复旦大学上海医学院肿瘤学系,上海200032
  • 出版日期:2018-10-30 发布日期:2018-11-12
  • 通信作者: 顾雅佳 E-mail:cjr.guyajia@vip.163.com

The correlation study among mammographic radiation dose, breast density and body composition in breast cancer

SHEN Xigang, GU Yajia, ZHENG Xiaojing, CHEN Chao, LI Ruimin, XIAO Qin, ZHOU Liangping, PENG Weijun   

  1. Department of Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
  • Published:2018-10-30 Online:2018-11-12
  • Contact: GU Yajia E-mail:cjr.guyajia@vip.163.com

摘要: 背景与目的:全数字化乳腺X线摄影(full-field digital mammography,FFDM)不仅是乳腺的常规检查项目,而且是国内外公认的乳腺癌筛查的首选检查方法,但乳腺组织对X线较敏感,受到电离辐射会有致癌风险。本研究旨在探讨FFDM的辐射剂量、乳腺密度及体成分三者之间的相关性。方法:回顾性分析2016年1月—2016年12月期间104例在复旦大学附属肿瘤医院同时进行乳腺X线摄影检查和骨密度检查的乳腺癌患者,收集乳腺密度、压迫厚度、辐射剂量和图像信噪比(signal-noise ratio,SNR)等乳腺影像相关数据。同时记录患者的体质量、身高、体质量指数(body mass index,BMI)、体表面积、脊柱和大腿肌肉百分比,分析两种投照体位下各型乳腺密度的管电流、管电压、辐射剂量、压迫厚度及SNR情况,并分析各型乳腺密度与体质量、BMI、脊柱和大腿肌肉百分比及主观图像质量情况,进一步分析各项体格指标与辐射剂量的相关性。结果:104例受检者中,乳腺密度a型17例、b型31例、c型40例和d型16例。各型乳腺密度组头尾位(carnio-caudal view,CC)的管电流、管电压及SNR的结果差异有统计学意义(P<0.05),其中乳腺密度c型的SNR为3.75±0.96,明显低于乳腺密度a型的5.21±1.36、乳腺密度b型的4.81±1.09及乳腺密度d型的4.71±1.34。各型乳腺密度组内外侧斜位(medial lateral oblique view,MLO)的管电压及压迫厚度差异有统计学意义(P<0.05),乳腺密度c型的SNR同样为各型密度中最低。各型乳腺密度的体格指标,包括体质量、体表面积、BMI、脊柱和大腿肌肉百分比组内差异均有统计学意义(P<0.05),并随乳腺密度的增加,体质量、体表面积、BMI呈递减趋势,脊柱和大腿肌肉百分比呈递增趋势。相关性分析可见CC位的辐射剂量与腿部肌肉百分比的相关程度最高,呈中度负相关(r=-0.311);MLO位的辐射剂量与BMI的相关程度最高(r=0.492),其次为与腿部肌肉百分比(r=-0.418),均呈中度相关。结论:乳腺密度c型的辐射剂量最高、SNR最低,图像质量较低,同时腿部肌肉百分比与乳腺密度及辐射剂量关系密切,为今后辐射防护开辟新的研究方向。

关键词: 乳腺X线摄影, 肌肉百分比, 辐射剂量, 乳腺密度, 体质量指数, 信噪比

Abstract: Background and purpose: Full-field digital mammography (FFDM) is not only a routine examination of breast, but also the preferred method of breast cancer screening recognized at home and abroad. But breast tissue is sensitive to X-ray, and exposing to ionizing radiation can raise the risk of cancer. This paper aimed to discuss the relationship among the radiation dose of FFDM, breast density and body composition. Methods: A total of 104 breast cancer patients were retrospectively analyzed with breast mammography and bone density examination in Fudan University Shanghai Cancer Center from Jan. 2016 to Dec. 2016. Then we collected the breast image data on breast density, compression thickness, radiation dose, signal-to-noise ratio (SNR), and so on. We recorded the weight, height, body mass index (BMI), body surface area, spine and thigh muscle percentage at the same time, and analyzed the tube current, tube voltage, radiation dose, compression thickness and SNR at two different projection positions of each type of breast density. Each type of breast density with weight, BMI, spine and thigh muscle percentage and subjective image quality were analyzed. The correlation between physical indexes and radiation dose was further analyzed. Results: In all of the 104 subjects, there were 17 cases of type a breast density, 31 cases of type b, 40 cases of type c and 16 cases of type d. There were significant diferences in tube current, tube voltage and SNR in carnio-caudal (CC) view between the groups (P<0.05), especially in patients with type c breast density whose SNR was 3.75 + 0.96, significantly lower than that of type a (5.21+1.36), type b (4.81+1.09) and type d (4.71+1.34) patients. There were significant differences in tube voltage and compression thickness in medial lateral oblique (MLO) view between the groups with various types of breast density (P<0.05). The SNR of type c breast density was the lowest among all types of density, which was close to statistical significance. There were significant differences in physical indexes of each type of breast density, including weight, body surface area, BMI, spine and thigh muscle percentage (P<0.05), and with the increase of breast density, the weight, body surface area and BMI showed a decreasing trend, while the spine and thigh muscle percentage increased. Correlation analysis showed that radiation dose and thigh muscle percentage had the highest correlation in CC view with a moderate negative correlation (r =-0.311). The radiation dose and BMI had the highest correlation in MLO view (r=0.492), followed by the correlation of radiation dose and thigh muscle percentage (r=-0.418), and both showed a moderate correlation. Conclusion: Patients with type c breast density have the highest radiation dose, the lowest SNR and relatively low image quality. The thigh muscle percentage is closely related to breast density and radiation dose, which opens up a new research direction for radiation protection in the future.

Key words: Mammography, Muscle percentage, Radiation dose, Breast density, Body mass index, Signal-noise ratio