摘要目的:比较乳腺同时多层单次激发平面回波成像（SMS+SS-EPI）和分段读出平面回波（RESOLVE）扩散加权成像（DWI）的图像质量及其诊断乳腺恶性病灶的效能。方法:该研究为横断面研究。前瞻性分析2021年3月至2023年2月宁波大学附属第一医院因乳腺病变而接受MRI检查并最终经病理证实的102例患者的临床及影像资料。所有患者均接受乳腺MRI常规扫描以及横断面RESOLVE和SMS+SS-EPI序列DWI，评估2种序列成像的图像质量。主观评价采用5分法，评价内容包括乳腺的几何畸变、伪影模糊、脂肪抑制、整体图像质量和病灶显著性；客观评价包括病灶信噪比（SNR）、对比噪声比（CNR）、病灶表观扩散系数（ADC）值。采用Wilcoxon符号秩和检验比较2种序列成像的主、客观评价指标。最后采用受试者操作特征曲线及曲线下面积（AUC）评估2种序列图像上病灶ADC值诊断乳腺恶性病灶的效能。结果:102例患者均为单发病变，均为女性患者，年龄25~68岁。乳腺恶性病灶60例，良性病变42例。SMS+SS-EPI序列成像的采集时间为1 min 50 s，RESOLVE序列成像的采集时间为3 min 43 s。SMS+SS-EPI和RESOLVE序列成像的图像质量主观评分均≥3分，RESOLVE序列图像的几何畸变、伪影模糊、整体图像质量评分均高于SMS+SS-EPI序列（ P均<0.001）。SMS+SS-EPI序列的DWI图像和ADC图像的总体病灶显著性评分、恶性病灶显著性评分、良性病灶的显著性评分均高于RESOLVE序列（ P均<0.05）。SMS+SS-EPI和RESOLVE序列DWI图像乳腺病灶的SNR、CNR、总体ADC值及恶性病灶ADC值、良性病灶ADC值差异均无统计学意义（ P均>0.05）。RESOLVE序列成像的病灶ADC值诊断乳腺恶性病灶的AUC为0.973，灵敏度为0.929，特异度为0.915；SMS+SS-EPI序列成像的病灶ADC值诊断乳腺恶性病灶的AUC为0.956，灵敏度为0.977，特异度为0.850。 结论:在乳腺DWI中，SMS+SS-EPI图像质量主观评分能基本满足诊断要求且病变显著性好于RESOLVE序列。两者诊断乳腺恶性病灶效能均较好。

abstractsObjective:To compare the image quality and the diagnostic efficiency for breast malignant lesions using simultaneous multi-slice single shot echo planar imaging (SMS+SS-EPI) and readout segment of long variable echo trains (RESOLVE) for breast diffusion-weighted imaging (DWI).Methods:This study was a cross-sectional study. Clinical and imaging data of 102 patients with breast lesion from March 2021 to February 2023 in the First Hospital Affiliated to Ningbo University were prospectively analyzed. All patients underwent routine breast MRI scans and cross-sectional RESOLVE and SMS+SS EPI sequence DWI, and the image quality of 2 types sequences of DWI was evaluated. The subjective evaluation was based on a 5-point scale, including geometric distortion, artifact blurring, fat suppression, overall image quality, and lesion conspicuity of the breast. The objective evaluation included signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) value of the lesion. Wilcoxon signed rank sum test was used to compare the subjective and objective parameters between the two sequences. Finally, the receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the effectiveness of ADC values for diagnosing breast malignant lesions based on two sequence images.Results:All 102 female patients had single lesions, aged from 25 to 68 years and 60 lesions were malignant and 42 were benign. The acquisition time for SMS+SS-EPI sequence imaging was 1 min 50 s, and the acquisition time for RESOLVE sequence imaging was 3 min 43 s.The subjective scores from both SMS+SS-EPI and RESOLVE sequence were over than 3 points. The geometric distortion, artifact blurring, and overall image quality scores of RESOLVE sequence images were higher than those of SMS+SS-EPI (all P<0.001). The overall lesion conspicuity score, malignant lesion conspicuity score, and benign lesion conspicuity score of DWI and ADC images combined with SMS+SS-EPI sequence were higher than those of the RESOLVE sequence (all P<0.05). There were no statistically difference in SNR, CNR, overall ADC value, malignant ADC value, and benign ADC value between SMS+SS-EPI and RESOLVE sequence DWI images of breast lesions (all P>0.05). The AUC of RESOLVE sequence ADC value in diagnosis of breast cancer was 0.973, the sensitivity was 0.929, and the specificity was 0.915; The AUC of SMS+SSC-EPI sequence ADC value in diagnosis of breast cancer was 0.956, the sensitivity was 0.977, and the specificity was 0.850. Conclusions:In breast DWI, the subjective score of SMS+SS EPI image quality can basically meet the diagnostic requirements and the conspicuity of lesions is better than that of the RESOLVE sequence. Both have good diagnostic efficacy for malignant breast lesions.