【摘要】：目的通過分析乳腺良、惡性腫塊超聲造影(Contrast-Enhanced Ultrasound,CEUS)的聲像圖特征及CEUS定量參數(shù),找出定量參數(shù)的診斷界值并探討CEUS技術(shù)在乳腺良、惡性腫塊中的臨床應(yīng)用價值。方法選取經(jīng)常規(guī)超聲檢查診斷為乳腺實(shí)質(zhì)性占位的患者,共76例(80個腫塊),患者均為女性,年齡19~79歲,腫塊直徑6.00~57.00mm。所有病例在術(shù)前均進(jìn)行超聲造影檢查,術(shù)后均進(jìn)行病理組織學(xué)檢查。使用東芝Aplio500型彩色超聲診斷儀,造影劑選用聲諾維(Sono Vue),注射量為2.4ml/次。造影過程中動態(tài)觀察病灶的聲像圖表現(xiàn),并全程儲存原始動態(tài)數(shù)據(jù),造影結(jié)束后進(jìn)行回放分析。超聲造影聲像圖特征(定性參數(shù))包括:1)病灶的增強(qiáng)強(qiáng)度;2)造影劑增強(qiáng)模式;3)造影后腫塊邊界;4)造影劑分布形式;5)周邊穿入、扭曲血管或放射狀增強(qiáng);6)病灶內(nèi)灌注缺損區(qū)。超聲造影定量參數(shù)包括:1)造影前、后病灶的面積,二者的面積比(AR);2)造影時間-強(qiáng)度曲線(Time-Intensity Curve,TIC):始增時間(Arrival Time,AT)、峰值時間(Time To Peak,TTP)、峰值強(qiáng)度(Peak Intensity,PI)。綜合以上定性及定量參數(shù)對每個腫塊進(jìn)行造影綜合評分。數(shù)據(jù)分析應(yīng)用SPSS 19.0統(tǒng)計軟件,計量資料以均數(shù)士標(biāo)準(zhǔn)差(c±s)表示,采用t檢驗(yàn),分類變量采用卡方(χ2)檢驗(yàn),以P0.05為差異有統(tǒng)計學(xué)意義。應(yīng)用ROC曲線找出各定量參數(shù)的診斷界值。結(jié)果1.術(shù)后病理學(xué)結(jié)果:共80個乳腺腫塊,其中惡性腫塊34個,良性腫塊46個。2.超聲造影(CEUS)定性分析結(jié)果:1)34例惡性病灶CEUS聲像圖特征:高增強(qiáng)24例;不均勻增強(qiáng)25例;邊界不清26例;腫塊周邊放射狀增強(qiáng)20例;病灶內(nèi)灌注缺損18例。2)46例良性病灶CEUS聲像圖特征:低或等增強(qiáng)29例;增強(qiáng)較均勻34例;增強(qiáng)后腫塊邊界清晰33例。3)良性病灶與惡性病灶在增強(qiáng)強(qiáng)度,造影劑分布形式,邊界,周邊穿入血管或放射狀增強(qiáng),病灶內(nèi)灌注缺損之間比較,差異均具有統(tǒng)計學(xué)意義(P0.05)。4)上述六種超聲造影定性征象中,靈敏度較高的為:造影后腫塊邊界,造影劑分布形式,增強(qiáng)強(qiáng)度,靈敏度分別為76.47%,73.53%,70.59%;特異度較高的為:周邊放射狀增強(qiáng),病灶內(nèi)充盈缺損,特異度分別為86.96%,82.61%。3.超聲造影定量分析結(jié)果:1)惡性病灶組:造影前面積(1.98±1.23)cm2,造影后面積(2.97±1.79)cm2,二者差異有統(tǒng)計學(xué)意義(t=3.54,P0.05);良性病灶組造影后/前的面積比(AR)為(1.18±0.22),惡性病灶組AR為(1.48±0.27),二者差異有統(tǒng)計學(xué)意義(t=4.18,P0.05)。說明乳腺惡性腫塊超聲造影后病灶面積明顯大于造影前,良性腫塊無明顯增大。2)時間-強(qiáng)度曲線:良、惡性組病灶的PI分別為(2.99±1.36)×10-5AU,(5.00±2.19)×10-5AU,二者差異有統(tǒng)計學(xué)意義(t=3.91,P0.05)。說明乳腺惡性腫塊的PI較良性腫塊更高。3)以病理結(jié)果為金標(biāo)準(zhǔn),構(gòu)建AR及PI的ROC曲線,曲線下面積(AUC)分別為0.81、0.78,約登指數(shù)最大值時對應(yīng)的界值分別為1.24、4.55×10-5AU,此時AR的靈敏度、特異度分別為81.80%、70.40%,PI的靈敏度、特異度分別為54.50%,88.90%。取AR=1.69,PI=6.25×10-5AU為界值,特異度為100%。4.超聲造影定性及定量綜合分析結(jié)果:超聲造影定性及定量綜合評分:1-3分定為良性腫塊,共42個;4-5分定為惡性腫塊,共38個;評分結(jié)果與病理結(jié)果比較:CEUS綜合評分的靈敏度91.18%、特異度84.78%、準(zhǔn)確率為87.50%。結(jié)論1.乳腺惡性病灶超聲造影特征主要為:不均勻性高增強(qiáng),增強(qiáng)后腫塊邊界不清,腫塊周邊可見穿入血管或放射狀增強(qiáng),病灶內(nèi)可見灌注缺損區(qū)。2.乳腺良性病灶的超聲造影特征主要為:低或等增強(qiáng),造影劑分布較均勻,增強(qiáng)后腫塊邊界清晰。3.面積比(AR)及峰值強(qiáng)度(PI)診斷乳腺良、惡性病灶的最佳界值分別為AR=1.24,PI=4.55×10-5AU。4.超聲造影綜合評分診斷乳腺腫塊的靈敏度、特異度及準(zhǔn)確率分別91.18%、84.78%、87.50%。5.超聲造影檢查可為乳腺疾病的診斷提供更豐富的信息,對鑒別乳腺良、惡性腫塊具有一定的臨床應(yīng)用價值。
[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.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R445.1;R737.9
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本文編號：2206037