超声造影在乳腺肿瘤诊断中的临床应用价值

发布时间：2018-08-26 20:15

【摘要】：目的通过分析乳腺良、恶性肿块超声造影(Contrast-Enhanced Ultrasound,CEUS)的声像图特征及CEUS定量参数,找出定量参数的诊断界值并探讨CEUS技术在乳腺良、恶性肿块中的临床应用价值。方法选取经常规超声检查诊断为乳腺实质性占位的患者,共76例(80个肿块),患者均为女性,年龄19~79岁,肿块直径6.00~57.00mm。所有病例在术前均进行超声造影检查,术后均进行病理组织学检查。使用东芝Aplio500型彩色超声诊断仪,造影剂选用声诺维(Sono Vue),注射量为2.4ml/次。造影过程中动态观察病灶的声像图表现,并全程储存原始动态数据,造影结束后进行回放分析。超声造影声像图特征(定性参数)包括:1)病灶的增强强度;2)造影剂增强模式;3)造影后肿块边界;4)造影剂分布形式;5)周边穿入、扭曲血管或放射状增强;6)病灶内灌注缺损区。超声造影定量参数包括:1)造影前、后病灶的面积,二者的面积比(AR);2)造影时间-强度曲线(Time-Intensity Curve,TIC):始增时间(Arrival Time,AT)、峰值时间(Time To Peak,TTP)、峰值强度(Peak Intensity,PI)。综合以上定性及定量参数对每个肿块进行造影综合评分。数据分析应用SPSS 19.0统计软件,计量资料以均数士标准差(c±s)表示,采用t检验,分类变量采用卡方(χ2)检验,以P0.05为差异有统计学意义。应用ROC曲线找出各定量参数的诊断界值。结果1.术后病理学结果:共80个乳腺肿块,其中恶性肿块34个,良性肿块46个。2.超声造影(CEUS)定性分析结果:1)34例恶性病灶CEUS声像图特征:高增强24例;不均匀增强25例;边界不清26例;肿块周边放射状增强20例;病灶内灌注缺损18例。2)46例良性病灶CEUS声像图特征:低或等增强29例;增强较均匀34例;增强后肿块边界清晰33例。3)良性病灶与恶性病灶在增强强度,造影剂分布形式,边界,周边穿入血管或放射状增强,病灶内灌注缺损之间比较,差异均具有统计学意义(P0.05)。4)上述六种超声造影定性征象中,灵敏度较高的为:造影后肿块边界,造影剂分布形式,增强强度,灵敏度分别为76.47%,73.53%,70.59%;特异度较高的为:周边放射状增强,病灶内充盈缺损,特异度分别为86.96%,82.61%。3.超声造影定量分析结果:1)恶性病灶组:造影前面积(1.98±1.23)cm2,造影后面积(2.97±1.79)cm2,二者差异有统计学意义(t=3.54,P0.05);良性病灶组造影后/前的面积比(AR)为(1.18±0.22),恶性病灶组AR为(1.48±0.27),二者差异有统计学意义(t=4.18,P0.05)。说明乳腺恶性肿块超声造影后病灶面积明显大于造影前,良性肿块无明显增大。2)时间-强度曲线:良、恶性组病灶的PI分别为(2.99±1.36)×10-5AU,(5.00±2.19)×10-5AU,二者差异有统计学意义(t=3.91,P0.05)。说明乳腺恶性肿块的PI较良性肿块更高。3)以病理结果为金标准,构建AR及PI的ROC曲线,曲线下面积(AUC)分别为0.81、0.78,约登指数最大值时对应的界值分别为1.24、4.55×10-5AU,此时AR的灵敏度、特异度分别为81.80%、70.40%,PI的灵敏度、特异度分别为54.50%,88.90%。取AR=1.69,PI=6.25×10-5AU为界值,特异度为100%。4.超声造影定性及定量综合分析结果:超声造影定性及定量综合评分:1-3分定为良性肿块,共42个;4-5分定为恶性肿块,共38个;评分结果与病理结果比较:CEUS综合评分的灵敏度91.18%、特异度84.78%、准确率为87.50%。结论1.乳腺恶性病灶超声造影特征主要为:不均匀性高增强,增强后肿块边界不清,肿块周边可见穿入血管或放射状增强,病灶内可见灌注缺损区。2.乳腺良性病灶的超声造影特征主要为:低或等增强,造影剂分布较均匀,增强后肿块边界清晰。3.面积比(AR)及峰值强度(PI)诊断乳腺良、恶性病灶的最佳界值分别为AR=1.24,PI=4.55×10-5AU。4.超声造影综合评分诊断乳腺肿块的灵敏度、特异度及准确率分别91.18%、84.78%、87.50%。5.超声造影检查可为乳腺疾病的诊断提供更丰富的信息,对鉴别乳腺良、恶性肿块具有一定的临床应用价值。
[Abstract]:Objective To analyze the ultrasonographic characteristics and quantitative parameters of Contrast-Enhanced Ultrasound (CEUS) in benign and malignant breast masses, and to find out the diagnostic threshold of quantitative parameters and to explore the clinical value of CEUS in benign and malignant breast masses. 76 cases (80 masses) were female, aged 19-79 years, with a diameter of 6.00-57.00 mm. All cases underwent contrast-enhanced ultrasonography before operation and pathological examination after operation. Contrast-enhanced ultrasound features (qualitative parameters) include: 1) enhancement intensity of the lesion; 2) contrast agent enhancement pattern; 3) tumor margin after contrast; 4) contrast agent distribution pattern; 5) peripheral penetration, distortion of blood vessels or radiation enhancement; 6) intralesional perfusion. Quantitative parameters of contrast-enhanced ultrasound include: 1) the area of lesions before and after contrast-enhanced ultrasound, the area ratio of the two (AR); 2) time-intensity curve (TIC): initial time (AT), peak time (TTP), peak intensity (PI). All the above qualitative and quantitative parameters were combined for each mass. The statistical software SPSS 19.0 was used to analyze the data, and the measurements were expressed as mean standard deviation (c There were 34 malignant tumors and 46 benign tumors. 2. Qualitative analysis of contrast-enhanced ultrasonography (CEUS): 1) CEUS features of 34 malignant lesions: 24 cases of high enhancement; 25 cases of uneven enhancement; 26 cases of unclear boundary; 20 cases of peripheral radiographic enhancement; 18.2 cases of intralesional perfusion defect; 46 cases of benign lesions: 29 cases of low or equal enhancement; Thirty-four cases were homogeneous and 33 cases had clear boundary after contrast-enhanced. 3) The sensitivity of contrast-enhanced ultrasound for benign and malignant lesions was significant (P 0.05). The sensitivity was 76.47%, 73.53% and 70.59% respectively, and the specificity was 86.96% and 82.61% respectively. (t = 3.54, P 0.05). The area ratio (AR) of benign lesion group was (1.18 65 Intensity curves: The PI of benign and malignant lesions were (2.99 (1.36), 5.00 6550 The sensitivity and specificity of AR and PI were 81.80%, 70.40%, 54.50% and 88.90%, respectively. AR = 1.69, PI = 6.25 *10-5AU were taken as the boundary value and specificity was 100%. 4. The qualitative and quantitative comprehensive analysis of contrast-enhanced ultrasound: the qualitative and quantitative comprehensive score of contrast-enhanced ultrasound: 1-3 There were 42 benign lesions, 38 malignant lesions were classified as 4-5, and the sensitivity, specificity and accuracy of CEUS were 91.18%, 84.78% and 87.50% respectively. Benign breast lesions were characterized by low or equal enhancement, homogeneous distribution of contrast media, and clear margin after enhancement. 3. Area ratio (AR) and peak intensity (PI) were used to diagnose benign and malignant breast lesions. The optimal thresholds were AR = 1.24 and PI = 4.55 *10-5AU.4, respectively. The sensitivity, specificity and accuracy of the combined score in the diagnosis of breast masses were 91.18%, 84.78% and 87.50% respectively. 5. Contrast-enhanced ultrasonography can provide more information for the diagnosis of breast diseases, and has certain clinical value in differentiating benign and malignant breast masses.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R445.1;R737.9
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本文编号：2206037