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目的探讨MRI敷霜征鉴别乳腺良恶性小肿块的价值，并分析其病理组织学改变。方法回顾性收集2016年6月~2020年9月我院行MRI检查并经病理证实的554例最大径线≤2 cm的乳腺小肿块患者资料（恶性291例，良性263例）。将患者的临床和MR特征进行单因素及多因素回归分析，筛选乳腺癌独立危险因素。基于独立危险因素构建两个诊断模型（模型1包含敷霜征，模型2不包含敷霜征）。采用ROC曲线评估两个模型的诊断效能。观察所有小肿块瘤周组织的病理学改变，分析敷霜征的病理学基础。结果恶性组199例（68.4%）、良性组25例（9.5%）出现敷霜征，两组间差异具有统计学意义（P＜0.05）。单因素及多因素回归分析显示，年龄、病灶径线、边缘、ADC值、时间-信号强度曲线类型、敷霜征为乳腺癌的独立危险因素，OR估计值分别为1.065、4.515、2.811、0.013、3.487和13.894，OR 95%CI分别为（1.034， 1.097）、（2.368， 8.608）、（1.954， 4.045）、（0.004， 0.049）、（2.087， 5.826）和（7.026， 27.477）。模型1（包含敷霜征）对乳腺小肿块的鉴别诊断效能优于模型2（不包含敷霜征）（AUC： 0.938 vs. 0.897，P＜0.05）。病理组织学分析显示敷霜征与瘤周炎性细胞浸润、血管增生相关。结论MRI敷霜征有助于乳腺良恶性小肿块的鉴别诊断，其病理组织学基础可能为瘤周炎性细胞浸润、血管增生。

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