小乳癌影像学研究
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摘要
目的：着重探讨二维B超显像联合超声造影剂注射后肿块内血流分级、血流动力学检测和显影时间对诊断小乳癌的作用。
材料与方法：分析79例B超测量最大径不超过2cm乳腺肿块(恶性肿瘤45例，良性肿块34例)的二维B超声像图，X线钼靶摄影图像以及超声造影剂注射后肿块血流动力学指标：动脉血流Vmax，阻力指数RI，血流信号分级以及显影时间并以病理对照分析。
结果：45例小乳癌二维B超的诊断的敏感性为57.8％(26／45)，特异性为82.3％(28／34)，准确性为68.3％(54／79)；钼靶X线片的诊断敏感性为75.5％(34／45)，特异性为70.6％(24／34)，准确性为73.4％(58／79)；二维B超+彩色多普勒的诊断的敏感性为84.4％(38／45)，特异性为85.3％(29／34)，准确性为84.4％(67／79)。
79例良恶性乳腺病灶注射微泡超声造影剂前后血流动力学改变如下：
造影剂注射前：良性组82.3％为0—Ⅰ级血流，Vmax为12.02±8.78cm／s，RI为0.73±0.20；恶性组71.1％为Ⅱ—Ⅲ级血流，Vmax为20.12±8.46cm／s，RI为0.67±0.13。良恶性组血流分级，Vmax有显著性差异(P＜0.05)。RI无显著性差异(P＞0.05)。造影剂注射后：良性组84.3％为0—Ⅱ级血流，Vmax为11.43±8.94cm／s，RI为0.75±0.19，恶性组82.3％为Ⅲ—Ⅳ级血流，Vmax为19.45±5.91cm／s，RI为0.71±0.16，良恶性血流分级，Vmax有显著性差异(P＜0.05)，RI无显著性差异(P＞0.05)。良、恶性组造影剂注射后血流分级亦有显著性差异(P＜0.05)，Vmax、RI无差异(P＞0.05)。超声造影剂注射后显影时间在良、恶性组分别为274±148秒，132±44秒，两组之间有显著性差异(P＜0.05)。
二维超声显像联合超声造影剂增强血流成像检测对小乳腺癌的诊断敏感性、特异性、准确性分别为93.9％(42／45)，91.2％(31／34)，92.4％(73／79)，明显优于二维B超显像，X线钼靶摄影及二维B超显像联合未增强肿块内血流分级及动力学检测(P＜0.05)。
结论：超声造影血管造影能提高小乳腺肿块内血流的显示率，更准确地反映肿块血供情况，对检测低速少血供的肿瘤有较大帮助。二维B超显像联合超声造影剂增强血流成像检测，提高对小乳癌诊断敏感性、特异性、准确性，有助于良恶性肿瘤的鉴别。
Objective
To explore a parameter for diagnosis of small breast tumor with the hemodynamics detected by Contrast Enhanced Color Doppler Ultrasound.
Method
Collected 79 cases of small breast tumors (malignant 45 cases, benign 34 cases), the size of which were within 2cm in diameter to evaluate hemodynamic parameters of tumoral vessels determined by the images of those breast tumors of ultrasound, mammography, pre-and post contrast medium: Arterial Maximum Velocity(Vmax), Resistance Index(RI), blood flow signal density and opacity interval time. Finally, all the above mentioned parameters were controlled by pathological diagnosis.
Result
For Ultrasound the sensitivity, specificity and diagnostic accuracy of the 45 cases small breast tumors is 57.8%(26/45), 82.3%(28/34) and 68.3%(54/79) respectively; for mammography's is 75.5%(34/45), 70.6%(24/34) and 73.4%(58/79) for Color Doppler Ultrasound's is 84.4%(38/45), 85.3%(29/34) and 84.4%(67/79); for contrast enhanced color Doppler Ultrasound's is 93.9%(42/45), 91.2%(31/34), 92.4%5(73/79).
The pre- and post-contrast enhanced hemodynamics parameters of the 79 cases small breast tumors are the following:
Before contrast medium was injected: in benign group, 82.3% were in Grade 0-1 blood flow, Vmax was 12.02 ± 8.78m/s, RI was 0.73±0.20; in malignant group, 71.1% was in Grade II-III blood flow, Vmax was 20.12± 8.46 cm/s, RI was 0.67± 0.13. There was significant difference in blood flow signal density, PSV between benign and malignant group (P<0.05) but no significant difference in RI (P>0.05). After contrast medium was injected, in benign group, 84.3% was in Grade O-II blood flow, Vmax was 11.4±8.94cm/s, RI was 0.75±0.19; in malignant group, 82.3% was in Grade III-IV blood flow, Vmax was 19.45±5.91cm/s, RI was 0.71±0.16. There was significant difference in blood flow signal density, Vmax between benign and malignant group (P<0.05) but no significant difference in RI (P>0.05). There was also significant difference in blood flow signal density (P<0.05) but no significant difference in Vmax and RI (P>0.05) between pre- and post-contrast medium injection in malignant group. After contrast medium was injected, the opacity interval time of benign and malignant groups were 274±148s and 132±44s respectively and there was significant difference between two groups (P<0.05). The detection of hemodynamics by Contrast Enhanced Color Doppler Ultrasound is more sensitive, specific and accurate than by traditional ultrasound, mammography and Color Doppler Ultrasound in the diagnosis of small breast tumor(P<0.05).
Discussion
Ultrasound Contrast Medium can enhance detection rate of tumor blood flow, reflect the blood supply of tumor more accurately, especially in tumor with low velocity and hypo-vascularity and help the differential diagnosis of benign and malignant tumor.
材料与方法：分析79例B超测量最大径不超过2cm乳腺肿块(恶性肿瘤45例，良性肿块34例)的二维B超声像图，X线钼靶摄影图像以及超声造影剂注射后肿块血流动力学指标：动脉血流Vmax，阻力指数RI，血流信号分级以及显影时间并以病理对照分析。
结果：45例小乳癌二维B超的诊断的敏感性为57.8％(26／45)，特异性为82.3％(28／34)，准确性为68.3％(54／79)；钼靶X线片的诊断敏感性为75.5％(34／45)，特异性为70.6％(24／34)，准确性为73.4％(58／79)；二维B超+彩色多普勒的诊断的敏感性为84.4％(38／45)，特异性为85.3％(29／34)，准确性为84.4％(67／79)。
79例良恶性乳腺病灶注射微泡超声造影剂前后血流动力学改变如下：
造影剂注射前：良性组82.3％为0—Ⅰ级血流，Vmax为12.02±8.78cm／s，RI为0.73±0.20；恶性组71.1％为Ⅱ—Ⅲ级血流，Vmax为20.12±8.46cm／s，RI为0.67±0.13。良恶性组血流分级，Vmax有显著性差异(P＜0.05)。RI无显著性差异(P＞0.05)。造影剂注射后：良性组84.3％为0—Ⅱ级血流，Vmax为11.43±8.94cm／s，RI为0.75±0.19，恶性组82.3％为Ⅲ—Ⅳ级血流，Vmax为19.45±5.91cm／s，RI为0.71±0.16，良恶性血流分级，Vmax有显著性差异(P＜0.05)，RI无显著性差异(P＞0.05)。良、恶性组造影剂注射后血流分级亦有显著性差异(P＜0.05)，Vmax、RI无差异(P＞0.05)。超声造影剂注射后显影时间在良、恶性组分别为274±148秒，132±44秒，两组之间有显著性差异(P＜0.05)。
二维超声显像联合超声造影剂增强血流成像检测对小乳腺癌的诊断敏感性、特异性、准确性分别为93.9％(42／45)，91.2％(31／34)，92.4％(73／79)，明显优于二维B超显像，X线钼靶摄影及二维B超显像联合未增强肿块内血流分级及动力学检测(P＜0.05)。
结论：超声造影血管造影能提高小乳腺肿块内血流的显示率，更准确地反映肿块血供情况，对检测低速少血供的肿瘤有较大帮助。二维B超显像联合超声造影剂增强血流成像检测，提高对小乳癌诊断敏感性、特异性、准确性，有助于良恶性肿瘤的鉴别。
Objective
To explore a parameter for diagnosis of small breast tumor with the hemodynamics detected by Contrast Enhanced Color Doppler Ultrasound.
Method
Collected 79 cases of small breast tumors (malignant 45 cases, benign 34 cases), the size of which were within 2cm in diameter to evaluate hemodynamic parameters of tumoral vessels determined by the images of those breast tumors of ultrasound, mammography, pre-and post contrast medium: Arterial Maximum Velocity(Vmax), Resistance Index(RI), blood flow signal density and opacity interval time. Finally, all the above mentioned parameters were controlled by pathological diagnosis.
Result
For Ultrasound the sensitivity, specificity and diagnostic accuracy of the 45 cases small breast tumors is 57.8%(26/45), 82.3%(28/34) and 68.3%(54/79) respectively; for mammography's is 75.5%(34/45), 70.6%(24/34) and 73.4%(58/79) for Color Doppler Ultrasound's is 84.4%(38/45), 85.3%(29/34) and 84.4%(67/79); for contrast enhanced color Doppler Ultrasound's is 93.9%(42/45), 91.2%(31/34), 92.4%5(73/79).
The pre- and post-contrast enhanced hemodynamics parameters of the 79 cases small breast tumors are the following:
Before contrast medium was injected: in benign group, 82.3% were in Grade 0-1 blood flow, Vmax was 12.02 ± 8.78m/s, RI was 0.73±0.20; in malignant group, 71.1% was in Grade II-III blood flow, Vmax was 20.12± 8.46 cm/s, RI was 0.67± 0.13. There was significant difference in blood flow signal density, PSV between benign and malignant group (P<0.05) but no significant difference in RI (P>0.05). After contrast medium was injected, in benign group, 84.3% was in Grade O-II blood flow, Vmax was 11.4±8.94cm/s, RI was 0.75±0.19; in malignant group, 82.3% was in Grade III-IV blood flow, Vmax was 19.45±5.91cm/s, RI was 0.71±0.16. There was significant difference in blood flow signal density, Vmax between benign and malignant group (P<0.05) but no significant difference in RI (P>0.05). There was also significant difference in blood flow signal density (P<0.05) but no significant difference in Vmax and RI (P>0.05) between pre- and post-contrast medium injection in malignant group. After contrast medium was injected, the opacity interval time of benign and malignant groups were 274±148s and 132±44s respectively and there was significant difference between two groups (P<0.05). The detection of hemodynamics by Contrast Enhanced Color Doppler Ultrasound is more sensitive, specific and accurate than by traditional ultrasound, mammography and Color Doppler Ultrasound in the diagnosis of small breast tumor(P<0.05).
Discussion
Ultrasound Contrast Medium can enhance detection rate of tumor blood flow, reflect the blood supply of tumor more accurately, especially in tumor with low velocity and hypo-vascularity and help the differential diagnosis of benign and malignant tumor.
引文
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