Renal masses: characterization with Doppler US.

The vascularity of indeterminate renal masses in 70 patients was investigated prospectively with duplex ultrasound. The peak-systolic Doppler shift frequency obtained from the renal mass was utilized to attempt distinction between benign and malignant lesions. With use of the criterion of a peak-systolic Doppler shift frequency of 2.5 kHz or greater as evidence of neovascularity, 26 of 37 malignant lesions demonstrated tumor signals (70% sensitivity). Thirty-one of 33 benign lesions lacked tumor signals (94% specificity). Both of the false-positive lesions were infections with inflammatory masses, with peak frequencies of 3.0 and 3.7 kHz. Tumor vascularity in most malignant renal mass lesions gives rise to abnormal, high-frequency, Doppler-shifted signals that can aid the differential diagnosis of renal masses.     

彩色多普勒能量图对卵巢肿瘤血流的研究

目的应用彩色多普勒能量图观察卵巢肿瘤的血流特征,以探讨其临床价值。材料与方法超声检查265例卵巢肿瘤患者293个病灶,所有病例均经手术获病理组织学证实。结果本组92.9％的卵巢癌显示肿瘤内血流,其中81.9％血流呈弥散分布。46.7％的卵巢良性肿瘤无血流显示,47.2％为包膜周边点状、带状单支规则血流。良恶性卵巢病灶的血流显示比较,相差极显著(P＜0.01)。结论彩色多普勒能量图能够直观地描述卵巢肿物的灌流状态,对于卵巢良恶性肿瘤的鉴别诊断有重要的参考价值。     

Power Doppler ultrasonography for the evaluation of skin tumors other than malignant melanoma

The purpose of this prospective study was to evaluate the value of power Doppler ultrasonography (PDUS) in assessing the vascularity of skin tumors other than malignant melanoma, and to investigate possible diagnostic criteria to help to distinguish malignant from benign tumors preoperatively. Seventy-one patients with the clinical diagnosis of a skin tumor were initially evaluated by ultrasonography. Then PDUS was performed and the presence and type of vascularity (peripheral or mixed) were investigated. Of the 19 benign and 52 malignant lesions, 3 could not be visualized with US. Forty-nine lesions were found to have vascularity (21 peripheral, 28 mixed-type) on PDUS. Of the malignant lesions, 26 showed mixed and 17 showed peripheral-type vascularity; for benign lesions these numbers were 2 and 4 respectively. The presence of vascularity correlated well with pathological behavior (malignant versus benign) (P = 0.00002), width (P = 0.0001), thickness (P = 0.001), dermal disruption (P = 0.0018), and subdermal extension (P = 0.002) of the tumor; however, the type of vascularity correlated only with thickness (P = 0.014). In relation to malignancy, the sensitivity of the presence of vascularity on PDUS was 88% and the specificity was 63%. These values were 93% and 40% respectively, for the mixed type of vascularity when it was accepted as a feature of malignancy. PDUS may help to distinguish malignant from benign skin tumors during preoperative evaluation.     

Color Doppler sonography of benign and malignant ovarian masses.

The use of transvaginal and transabdominal color Doppler sonography for the assessment of ovarian tumor vascularity was investigated in 62 cases of surgically excised and histologically examined ovarian masses. The modality was used to differentiate tumor neovascularity from normal arterioles (which contain smooth muscle in their media) on the basis of differences in the pulsatility observed in Doppler waveforms. Of the 25 malignant tumors in the series, 20 had low-impedance flow (pulsatility index of less than 1.0), and none had the diastolic notch seen in vessels in normal tissue. Three benign lesions, including two dermoid cysts and one tubo-ovarian abscess, also had low-impedance flow. The negative predictive value of color Doppler sonography was 98%, whereas the positive predictive value was 83%. Color Doppler sonography seems to be accurate for excluding malignancy, but some misdiagnosis may occur in cases of inflammatory and metabolically active benign masses.     

Evaluation of soft-tissue masses using segmented color Doppler velocity images: preliminary observations

OBJECTIVE: We report our initial experience with segmented color Doppler velocity-based estimates of tumor vascularity for various histogically proven soft-tissue masses. SUBJECTS AND METHODS: Color Doppler sonography of 23 histologically proven masses in 22 patients was performed. Digital color Doppler images were acquired directly off the scanner output or from video recordings and stored on a personal computer as 24-bit gray-scale and color composite images. A color Doppler velocity segmentation and analysis algorithm was applied to the digital images, from which we calculated the normalized percentage of color Doppler area. Normalization was determined by expressing color Doppler area as a percentage of the area enclosed by a preselected region of interest. We also calculated mean percentage, SD, and cumulative distribution of color Doppler area, relative to a fixed threshold, for the acquired image data sets. RESULTS: Estimates of mean percentage of color Doppler area showed a dynamic range of at least two or three orders of magnitude between lowest and highest values obtained. A scatterplot of mean percentage of color Doppler area versus SD of percentage of color Doppler area showed a linear monotonic relationship (r2 = .92), illustrating increasing vascular heterogeneity with mean vascularity. Preliminary data also suggest the presence of at least two distinct groups of masses (p < .0001) based on these vascularity estimates. One group corresponds to high-grade lesions in which tumor angiogenesis is expected to be important in predicting biologic behavior. The second group appeared to have little or no relationship to tumor vascularity or was of an intermediate (or lower) histologic grade. CONCLUSION: Quantitative color Doppler estimates of tumor vascularity can be obtained over a wide dynamic range. Such estimates provide a mechanism to assess vascular heterogeneity of soft-tissue tumors. Preliminary data suggest that two biologically distinct groups of masses may be separable on the basis of quantitative velocity-based estimates of tumor vascularity as obtained from color Doppler sonography.     

收缩期流速峰值对鉴别乳腺肿物的价值

目的探讨乳腺肿物中收缩期流速峰值(PSV)能否鉴别乳腺的良性与恶性肿物。方法133例经手术或病理证实的乳腺疾病患者,其中,乳腺癌46例,乳腺良性病变87例(包括纤维瘤58例,炎性包块7例及增生性病灶22例),均经二维超声检查,彩色多普勒血流显像(CDFI)测量PSV,对所有病人的超声表现进行回顾性分析,并重点地比较了乳腺癌与乳腺良性病变之间的PSV差异。结果46例乳腺癌的47个病灶中检出血流信号42个,58例纤维瘤的69个病灶中检出血流信号41个,7例炎性包块和22例增生性病灶中均检出血流信号。乳腺癌与乳腺良性病变的PSV比较,未见显著性差异(P>0.05)。结论单独用PSV鉴别乳腺的良恶性肿物是不可靠的,因PSV与多种因素有关。     

Ultrasound guided core biopsy of suspicious mammographic calcifications using high frequency and power Doppler ultrasound

AIM: The pre-operative diagnosis of suspicious mammographic microcalcifications usually requires stereotactic needle biopsy. The aim of this study was to evaluate if high frequency 13 MHz ultrasound (HFUS) and power Doppler (PD) can aid visualization and biopsy of microcalcifications. MATERIALS AND METHODS: Forty-four consecutive patients presenting with microcalcifications without associated mammographic or palpable masses were examined with HFUS and PD. Ultrasound-guided core biopsy (USCB) was performed where possible. Stereotactic biopsy was carried out when US-guided biopsy was unsuccessful. Surgery was performed if a diagnosis of malignancy was made on core biopsy or if the repeat core biopsy was non-diagnostic. RESULTS: Forty-one patients (93%) had ultrasound abnormalities corresponding to mammographic calcification. USCB was performed on 37 patients. In 29/37, USCB obtained a definitive result (78.4%). USCB was non-diagnostic in 4/9 benign (44.4%) and 4/28 (14.3%) malignant lesions biopsied. The complete and absolute sensitivities for malignancy using USCB were 85.7% (24/28) and 81% (23/28), respectively. USCB correctly identified invasive disease in 12/23 (52.2%) cases. There was no significant difference in the presence of abnormal flow on PD between benign and malignant lesions. However, abnormal PD vascularity was present in 43.5% of invasive cancer and was useful in directing successful biopsy in eight cases. CONCLUSION: The combination of high frequency US with PD is useful in the detection and guidance of successful needle biopsy of microcalcifications particularly where there is an invasive focus within larger areas of DCIS.     

Diagnosis of thyroid nodules by Doppler ultrasonography: a comparison between color Doppler and power Doppler ultrasonography

The purpose of this study was to assess the usefulness of color and power Doppler imaging in thyroid nodules. The following 4 items were compared between malignant thyroid nodules (34 cases) and benign nodules (51 cases): 1) vascularity; 2) distribution of tumor vessels (none, marginal, peripheral, central); 3) nature of tumor vessels (tortuosity, interruption); and 4) FFT analysis. The distribution of tumor vessels on color Doppler images, nature of tumor vessels on power Doppler images, and the indices of PI, RI, and ATI in FFT analysis were useful in making the differential diagnosis between malignant and benign nodules. In terms of vascularity, including the distribution of tumor vessels on power Doppler images and nature of tumor vessels on color Doppler images, no statistically significant differences were found between malignant and benign nodules. Power Doppler images depicted tumor vessels in more detail than color Doppler images and were considered to extend the application of FFT analysis.     

二维及彩色多普勒超声诊断乳腺包块的临床价值

目的：探讨二维及彩色多普勒超声诊断乳腺包块的临床价值。方法应用高频探头对85例各种原因引起的乳腺包块进行检查,所有病例均经手术及病理证实,并与超声诊断对照分析。结果85例乳腺包块经病理证实良性者32例,二维＋多普勒超声准确诊断30例,诊断符合率为93．8％;恶性者53例,二维＋多普勒超声准确诊断50例,诊断符合率为94．3％,且无论良性或恶性,二维＋多普勒超声诊断符合率均较单纯二维声像图诊断率高。结论二维声像图结合彩色多普勒检查可大大提高诊断的正确率,对乳腺疾病的早期发现及良恶性鉴别具有重要意义。     

Renal masses: quantitative analysis of enhancement with signal intensity measurements versus qualitative analysis of enhancement with image subtraction for diagnosing malignancy at MR imaging

PURPOSE: To retrospectively compare quantitative and qualitative methods of assessing magnetic resonance (MR) imaging contrast enhancement as the basis for diagnosing renal malignancy. MATERIALS AND METHODS: MR imaging was performed by using a gadolinium-enhanced breath-hold fat-suppressed three-dimensional T1-weighted gradient-echo sequence in 71 patients (48 men and 23 women; mean age, 62 years; age range, 26-87 years) with 93 renal lesions for which pathologic correlation was available. For quantitative measurements of enhancement, the relative increase in signal intensity values was measured by one investigator with manually defined regions of interest, and the threshold of an increase of 15% or greater was used to distinguish malignant from benign masses. For qualitative assessment, two investigators independently reviewed the subtracted images of all lesions and subjectively determined whether enhancement was present or absent. The sensitivity, specificity, and positive and negative predictive values for each method were calculated and compared. Mean (+/- standard deviation) and median values of relative enhancement were also calculated for benign and malignant lesions. RESULTS: At pathologic analysis, 74 (80%) of the 93 lesions were malignant, and 19 (20%)-including seven oncocytomas-were benign. For diagnosing malignancy based on enhancement alone, sensitivity and specificity, respectively, were 95% (70 of 74 lesions) and 53% (10 of 19 lesions) at quantitative analysis and 99% (73 of 74 lesions) and 58% (11 of 19 lesions) at qualitative analysis. All seven oncocytomas were considered to be malignant with both methods. When the oncocytomas were excluded, specificities increased to 83% (10 of 12 lesions) and 92% (11 of 12 lesions) for the quantitative and qualitative evaluations, respectively. Three of the four malignant lesions incorrectly characterized as benign at quantitative assessment were hyperintense on unenhanced MR images; all were diagnosed correctly at qualitative evaluation. CONCLUSION: Image subtraction enables accurate assessment of renal tumor enhancement, particularly in the setting of masses that are hyperintense on unenhanced MR images.     

高频超声对乳腺小肿块鉴别诊断的价值

目的:评价高频超声二维征象及彩色多普勒血流指标在乳腺小肿块鉴别诊断中的价值。方法:使用高频超声诊断仪观察196个长径小于2 cm的乳腺肿块的二维超声特征(包括病灶形态,病灶内部,病灶后方有无衰减及有无微小钙化灶),然后使用彩色多普勒对病变进行多普勒血流参数测定(包括血流丰富度、PSV、RI、PI)。比较二维超声征象及彩色多普勒血流参数在乳腺良、恶性肿块中的差异并对其诊断敏感性、特异性加以分析。结果:病灶形态、病灶内部、病灶后方及有无微小钙化灶良、恶性病变间均有显著性差异。恶性肿块PSV、RI、PI值均明显高于良性肿块。结论:彩色多普勒超声血流参数测定对乳腺良、恶肿块的鉴别诊断具有重要的参考价值,与肿块的二维声像图征象相结合可提高乳腺肿块的超声诊断准确率。     

Doppler power with contrast media in the characterization of renal masses

PURPOSE: To report the results of a prospective study investigating the potentials of contrast-enhanced power Doppler in the diagnosis of expansive renal lesions. MATERIAL AND METHODS: From 1997 to October 30, 1999, we studied 59 expansive renal lesions (28 malignant, 31 benign) in 48 patients (mean age 55 years, range 10-79) with power Doppler US before and after the administration of an echo-enhancing agent (Levovist, Schering AG, Berlin, Germany). We identified 5 patterns of vascular architecture of the lesions, both before and after contrast agent administration, following the classification by Jinzaki e Coll. RESULTS AND DISCUSSION: Power Doppler US showed vascular structures in 34 patients. The administration of Levovist revealed vessels in 12/25 lesions which had none at baseline studies and in 6 cases vascularity was particularly evident. Color signals were enhanced in all the 34 vascularized lesions, which allowed better definition of vascular patterns. The characterization of vascular patterns with baseline power Doppler US helped improve diagnostic accuracy compared to gray-scale US (58% versus 32%) for hyperechoic lesions, complex cysts and pseudomasses. Independent of contrast agent administration, the integration of gray-scale and power Doppler modes increased diagnostic accuracy even further (76% correct diagnoses). CONCLUSIONS: In our series, the US contrast agent did not increase the diagnostic accuracy of power Doppler in the differential diagnosis of hyperechoic renal lesions; conversely, Levovist can be advantageous for the characterization of suspected pseudomasses and complex cysts.     

The use of unenhanced Doppler sonography in the evaluation of solid breast lesions

OBJECTIVE: The objectives of our study were to investigate differences in Doppler sonography features between benign and malignant breast lesions and between malignant lesions with different prognostic factors and to propose diagnostic criteria for Doppler sonography of breast lesions. SUBJECTS AND METHODS: We performed power and duplex Doppler sonography examinations in 826 breast lesions scheduled for sonographically guided core needle biopsy. Lesion vascularity, pulsatility index (PI), and resistive index (RI) of the vessels detected were analyzed and correlated with histologic results. RESULTS: Color flow was more frequently seen in malignant (237/348 lesions, 68%) than in benign (171/478, 36%) lesions (p < 0.001). However, sensitivity, specificity, and positive and negative predictive values for this sign were low (68%, 64%, 58%, and 73%, respectively). The RI and PI values were significantly higher (p < 0.001) in cancers. Although an overlap in these values between benign and malignant lesions was observed, all but one nodule with an RI of greater than 0.99 (those with null or inverted diastolic flow) or a PI of greater than 4 were malignant. No significant relationship was found between PI, RI, or flow visualization on power Doppler sonography and tumor grade or lymph node involvement in cancers. CONCLUSION: Flow visualization on power Doppler sonography indicates a higher possibility of malignancy but is not useful as the main sign for malignancy. However, any lesion with a vessel that has an RI value greater than 0.99 or a PI value greater than 4 within it must be considered as probably malignant regardless of any other sonography sign present. Doppler findings are not useful to predict tumor grade or lymph node involvement.     

64 Multidetector CT with multiplanar reformation in evaluation of bilateral ovarian masses

Purpose

To evaluate the role of 64 multidetector CT (MDCT) with multiplanar reformation in evaluation of bilateral ovarian masses and to correlate the findings with histopathological results and surgery.

Material and methods

MDCT was performed to 23 patients with sonographically detected bilateral ovarian masses. All scans were performed on a 64 row CT scanner at the oncology center, Mansoura University. The axial and reformatted images were evaluated for lesion characterization and the relationship to adjacent structures. The radiological findings were correlated with operative and pathological findings.

Results

There were 11 bilateral malignant lesions and 9 bilateral similar benign lesions. Three cases showed different benign lesions in both sides.All malignant lesions were read by MDCT as malignant, also all benign lesions were read by MDCT as benign except for one case with endometrioid cyst which was diagnosed as malignant tumor by CT.

Conclusion

64 Multidetector CT with MPR in different planes allows good visualization and characterization of bilateral ovarian masses with greater diagnostic accuracy and improves the detection of peritoneal metastases.     

Unusual benign solid neoplasms of the kidney: cross-sectional imaging findings

Kidney neoplasms are common diseases with varying prognoses depending on the subtype of the tumor. The most common solid lesion of the kidney is renal cell carcinoma, and the treatment is typically surgical removal. With increasing use of cross-sectional imaging in the last two decades, the detection of renal lesions has significantly increased, especially in asymptomatic patients who are scanned for other reasons. In this article, we present the imaging findings of rare solid benign primary kidney neoplasms including renal leiomyoma, reninoma, carcinoid tumor, metanephric adenoma, solitary fibrous tumor of the kidney, lipomatous hemangiopericytoma of the kidney, renal schwannoma, inflammatory myofibroblastic tumor of the kidney, extramedullary hematopoiesis in the kidney, and extranodal renal Rosai-Dorfman disease. Accurate preoperative or prebiopsy diagnoses of these lesions are unusual; however, informed radiologists may sometimes be able to favorably change the patient management and treatment.Kidney neoplasms are common clinical disorders now being detected in even greater numbers due to the widespread use of cross-sectional imaging. Benign kidney neoplasms, once thought to be highly unusual, are being diagnosed in ever increasing numbers. In one series, 16.1% of patients who underwent partial nephrectomy for a presumed solitary renal cell carcinoma turned out to have a benign diagnosis in the final pathological analysis (1). Recent developments on computed tomography (CT) and magnetic resonance imaging (MRI) have limited value in differentiation between benign and malignant renal masses. Diffusion MRI studies yielded significantly different apparent diffusion coefficient (ADC) values between benign and malignant renal masses. These studies mostly evaluated the different ADC values between oncocytoma/angiomyolipoma and renal cell carcinomas (2). The role of ADC values in differentiation between uncommon benign renal masses and malignant renal masses has not been well established due to the scarcity of the lesions that we present in this article. Perfusion CT has been reported for the assessment of tumor angiogenesis in renal cell carcinoma and in the evaluation of tumor response to antiangiogenesis drugs and cryoablative therapies (3). Despite all these promising new imaging techniques, conventional approach based on imaging findings and percutaneous/surgical tissue diagnosis remain as the mainstay for diagnosis of solid renal lesions. The aim of this pictorial essay is to give practicing radiologists an overview of the imaging findings of rare solid benign neoplasms of the kidney.     

彩色多普勒超声和多层螺旋CT在肾脏良恶性肿瘤诊断中的应用比较简

目的：比较彩色多普勒超声（US）和多层螺旋CT（MSCT）在诊断肾脏良恶性肿瘤中的临床应用价值。方法对35例肾肿瘤患者分别行超声和螺旋CT检查,将两者检查结果与手术后病理结果进行对比,比较两种检查方法的诊断准确率。结果肾良性肿瘤及病变25例,超声诊断准确率为84％,CT为88％;肾癌10例,超声诊断准确率为80％,CT检查为90％。结论 US和MSCT在诊断肾脏良恶性肿瘤中,超声是筛查肾脏肿瘤首选检查方法,其价格低廉,无电离辐射,简单易行,患者容易接受。MSCT检查在特异性和准确性方面要高于超声,但在敏感性方面超声要优于CT,两者都能较准确地判断肾脏肿瘤及病变的良恶性。     

Levovist超声造影剂在诊断胰腺肿瘤中的应用

目的：观察和分析Levovist超声造影剂对胰腺肿瘤血管显示能力,以此增加对胰腺良恶性肿瘤的诊断信心。材料和方法。对30例临床怀疑和超声均诊断为胰腺肿瘤的病例,由二维超声搜索和确定病灶。加用Doppler彩色血流图检测后,推注Levovist超声造影剂,观察图像变化。结果：超声诊断为胰腺癌28例,全部病灶内都显现血流信号。良性肿瘤2例,病灶内也显现少许血流信号。结论：Levovist超声造影剂对胰腺肿瘤血流的显示是令人满意的。对胰腺肿瘤的良恶性鉴别有一定帮助。     

Colour doppler sonography of breast masses: A multiparameter analysis

Objective:

To evaluate signals from breast lesions on both colour and spectral Doppler US, and to correlate findings with angiographic and histopathological features including microvessel density.

Materials and Methods:

One hundred and sixteen breast lesions in 113 patients were evaluated with colour Doppler ultrasonography. Subjective and semi-quantitative assessment of colour signals as well as spectral Doppler analysis were performed and compared. Comparison of colour Doppler features with angiographic and histopathological findings were also carried out.

Results:

Subjective evaluation revealed that colour signals were more commonly found in malignant (89%) than benign (56%) lesions. Malignant lesions demonstrated a more elaborate vascular network (51%) compared to 12.5% in benign lesions. Spectral Doppler analysis revealed slightly higher specificity values for the pulsatility and resistivity indices, respectively, but lower sensitivity and accuracy values compared to qualitative assessment. Colour Doppler patterns corresponded well with angiographic images, however, the correlation between colour Doppler parameters and microvessel density was not significant.

Conclusion:

Despite the increased examination time required, spectral analysis does not appear to contribute significantly to the differentiation between malignant and benign breast tumours. Features such as the density, pattern and predominant site of colour signals may be more useful for the evaluation of breast lesions on colour Doppler imaging.     

Color flow Doppler characterization of focal hepatic lesions.

OBJECTIVE. The purpose of this study was to determine the sensitivity and specificity of color flow Doppler sonography for the specific diagnosis of focal hepatic lesions. SUBJECTS AND METHODS. Color flow Doppler images of 118 focal hepatic lesions in 108 patients were analyzed prospectively. In most patients, liver disease was suspected or known to be present before the Doppler images were obtained. Experienced sonologists obtained and interpreted all sonograms. The lesions were classified, according to their color flow pattern, into two main categories: lesions with internal vascularity and lesions with no internal vascularity. The color flow Doppler pattern of each lesion was correlated with the diagnosis of the lesion on a lesion-by-lesion basis. One hundred two lesions were proved by biopsy and 16 lesions were confirmed by evaluation with other imaging techniques. Lesions included 29 hepatocellular carcinomas, 64 metastases, one cholangiocarcinoma, and 24 benign lesions. The sensitivity and specificity of vascularity as shown by color Doppler imaging in the diagnosis of hepatocellular carcinoma were determined. RESULTS. The majority of hepatocellular carcinoma lesions (76%) had internal vascularity. Most of the metastases (67%) and benign lesions (75%) had no internal vascularity. When the presence of internal vascularity was used as the discriminating criterion, the sensitivity of color flow Doppler findings for the diagnosis of hepatocellular carcinoma was 0.76. The specificity of internal vascularity for the diagnosis of hepatocellular carcinoma vs other focal lesions was 0.69; for hepatocellular carcinoma vs metastases it was 0.67. CONCLUSION. Although most hepatocellular carcinomas have internal vascularity on color flow Doppler images, a significant number of metastases also have internal vascularity. This overlap limits the usefulness of color flow Doppler imaging for distinguishing hepatocellular carcinoma from metastatic tumors.     

彩色多普勒超声对鉴别良恶性肾肿瘤的意义

目的探讨彩色多普勒超声（CDUS）对鉴别肾脏良、恶性肿瘤的意义。方法32例由手术病理证实的肾肿瘤患者（23例肾细胞癌，6例肾盂移行细胞癌，以及3例肾错构瘤）均经CDUS检查，首先分析其二维声像图特征，其次测量其肾动脉峰值血流速度及阻力指数，并将良、恶性患者的测量均值进行比较。结果肾脏良、恶性肿瘤具有不同的声像图特征，恶性肿瘤患者肾动脉峰值流速高于良性肿瘤患者，RI低于良性肿瘤患者。在32例中，CDUS定位诊断准确率为100％，2例恶性肿瘤被误诊为良性肿瘤，2例良性肿瘤被误诊为恶性肿瘤，CDUS的诊断敏感性为93．5％，特异性33．3％，准确性87．5％。结论CDUS，尤其是彩色多普勒血流显像（CDFI）技术对肾动脉血流参数的检测及对肿瘤内血流分布的评价，在鉴别肾脏良、恶性肿瘤中起重要作用。