高频声像图与彩色多普勒显像对乳腺肿瘤的诊断价值

目的评价高频超声及CDFI对乳腺肿瘤的诊断价值。方法回顾性分析67例经手术病理证实乳腺肿瘤的高频超声图像及彩色多普勒血流表现。结果高频超声能清晰显示乳腺肿块大小、形态、内部结构等,CDFI血流分级有差异,但对小乳癌血流信号检出不敏感。结论高频超声及彩色多普勒对乳腺肿瘤有较高的诊断价值,但仍有局限性。     

高频彩超在乳腺肿瘤鉴别诊断中的诊断价值

目的探讨高频彩超在乳腺肿瘤鉴别诊断中的价值。方法对140例乳腺肿瘤患者术前进行乳腺超声检查,结合术后病理结果对照分析乳腺肿瘤超声二维声像图、彩色多普勒(CDFI)和能量多普勒超声(PDUS)的诊断符合率。结果乳腺良性肿瘤诊断符合率为84.1%,恶性肿瘤诊断符合率为87.3%,彩色多普勒显示,恶性肿瘤的血流信号较良性的丰富,血流分级较良性高,差异有统计学意义(P<0.001)。能量多普勒显示,良恶性肿瘤病灶内的血管形态比较,差异有统计学意义(P<0.001)。结论高频彩超对乳腺肿瘤的检出率高,应用二维声像图特点与彩色多普勒和能量多普勒超声综合判断,可以明显提高对乳腺良恶性肿瘤的诊断和鉴别诊断水平。     

彩色多普勒超声及超声引导下穿刺活检术在110例乳腺肿瘤患者中的临床应用

摘 要：［目的］探讨彩色多普勒超声及超声引导下穿刺活检术在乳腺肿瘤患者中的临床应用价值。 ［方法］收集经影像学诊断的110例乳腺肿瘤患者的临床资料进行回顾性分析。按照术后病理诊断结果分为乳腺癌组（56例）及良性肿瘤组（54例）。对两组患者彩色多普勒超声结果及高频超声引导下穿刺活检结果与术后病理结果进行比较。［结果］ 乳腺良性肿瘤组与乳腺癌组患者二维声像图比较差异具有统计学意义（P<0.05）;乳腺癌组血流信号以2~4级为主,良性肿瘤组以0~1级为主,乳腺癌组血流速度及血流阻力指数均远远大于良性肿瘤患者,差异具有统计学意义（P<0.05）;超声引导穿刺结果诊断乳腺肿瘤准确率为99.09%（109/110）;所有患者均未出现严重穿刺后并发症。 ［结论］彩色多普勒超声可直观评价肿瘤部位形态及血流信号,超声引导下乳腺肿瘤穿刺活检术与术后病理结果一致性较高,提示该方法对于判断乳腺肿瘤良恶性具有较高的诊断意义。     

彩色多普勒超声鉴别乳腺良恶性肿瘤的临床应用

目的：探讨彩色多普勒超声鉴别乳腺良恶性肿瘤的诊断价值。方法：对84例乳腺肿瘤患者，进行二维超声确定肿瘤的部位、形态、大小、边界等一般情况。然后用彩色多普勒超声观察血流分级，用频谱多普勒测量病灶内血流的搏动指数（PI）、阻力指数（砌）和峰值流速等并记录。结果：彩色多普勒超声鉴别乳腺良性与恶性肿瘤在血流分级及多普勒峰值PI、RI有显著性的差异（P〈0．05。结论：彩色多普勒超声有助于乳腺肿瘤良恶性的鉴别诊断。     

乳腺叶状肿瘤良、恶性的二维及彩色超声表现

目的研究乳腺叶状肿瘤良、恶性的二维声像图及彩色多普勒血流（CDFI）特点。方法回顾分析19例经手术病理证实的乳腺叶状肿瘤的二维及彩色多普勒超声所见。结果①叶状肿瘤良性8例、恶性4例、交界性7例。②良性肿瘤二维超声表现为：乳腺肿物较大，呈类圆形或分叶状。形态规则，边界清晰，见包膜回声及侧方声影，内部多为欠均匀的中低回声；恶性肿瘤二维超声表现为：乳腺肿块形态欠规则，边界不清，无包膜或包膜不完整，内部回声不均匀，后方伴声衰减。③多普勒超声表现，良、恶性肿物内及周边彩色多普勒血流信号较丰富，恶性组动脉血流速度和RI高于良性组。结论乳腺叶状肿瘤具有一些特征性的超声声像图表现。肿块局部边界不清、后方声衰减、血流丰富、流速及阻力指数增高提示恶性程度可能性较高。二维超声及CDFI结合病史有利于乳腺叶状肿瘤的良、恶性诊断和鉴别诊断。     

造影剂增强超声在乳腺肿瘤诊断中的应用

造影剂增强超声扫描能显示乳腺肿瘤内细小低速的血流,提高超声对肿瘤血管显示的准确性,从而提高超声对乳腺肿瘤良恶性的判别能力和对乳腺癌术后复发及腋窝淋巴结转移的诊断准确性.     

三维彩色血管能量成像诊断乳腺肿瘤的应用价值

[目的]探讨三维彩色多普勒能量图（3D-CPA）在乳腺良恶性肿瘤鉴别诊断中作用.[方法]对87例102个乳腺肿块进行3D-CPA检查,其中乳腺癌35个,良性肿瘤67个,并对肿瘤血管三维图像进行半定量分析,比较乳腺良性肿瘤组及恶性肿瘤组的血流分级和血管形态差异.[结果]乳腺良恶性肿瘤的血流分级和血管形态不同.乳腺良性肿块以Ⅰ级血流为主,而乳腺癌则以Ⅲ级血流为主（P＜0.01）.乳腺癌以不规则型和穿入型血流乳腺癌组为主,而良性肿瘤则大部分显示为环绕型和抱球型（P＜0.01）.以穿入型和不规则型诊断乳腺癌,其敏感性为96.29%,特异性为84.61%.[结论]3D-CPA可作为乳腺良恶性肿瘤的鉴别诊断新的补充手段.     

彩色多普勒超声对乳腺恶性肿瘤的诊断价值

目的 探讨乳腺癌高频彩超声像图表现及肿瘤内部、肿瘤边缘与周围腺体组织之间彩色多普勒血流状况对乳腺癌的超声诊断价值.方法 对50例经病理证实的乳腺恶性肿瘤的高频彩超声像图进行回顾性分析,比较不同肿块大小的乳腺恶性肿瘤的内部及肿块边缘与周围腺体组织0.5cm范围内的血流参数.结果 乳腺恶性肿瘤多表现为形态不规则,边界欠清,边缘呈锯齿状,内部以低回声为主且分布不均匀,多数病灶内有微小钙化点,多数后方回声衰减,肿块纵横径比＞1,肿块内部及肿块边缘与周围腺体组织之间彩色多普勒血流分级多表现为丰富血流,RI≥0.7,并且这些参数与肿块大小有密切关系.结论 乳腺肿瘤内部及肿瘤与周围腺体组织0.5cm范围内彩色多普勒血流状况对诊断乳腺癌具有较高的正确率,并且肿块越大,血流越丰富. 其结合二维声像图表现,可显著提高乳腺癌诊断的准确率,具有较高的临床应用价值.     

彩色多普勒超声与实时灰阶超声造影对乳腺肿瘤的诊断价值比较

目的 探讨实时灰阶超声造影与彩色多普勒超声对乳腺肿瘤的诊断价值。方法 对术前72名乳腺肿瘤患者进行彩色多普勒超声及实时灰阶超声造影检查,与病理结果进行对照分析乳腺良恶性肿瘤彩色多普勒超声及超声造影特征,比较两种方法的敏感性、特异性及诊断正确率。结果 (1)乳腺良恶性肿瘤彩色多普勒超声及超声造影特征不同,乳腺良性肿瘤多表现为0~Ⅰ级血流,RI＜0.7,而恶性以Ⅱ~Ⅲ级血流、RI≥0.7为主;乳腺良性肿瘤以等增强、均匀增强为主,恶性肿瘤以高增强、不均匀增强为主;(2)实时灰阶超声造影对乳腺肿瘤血供的敏感性(100%)明显高于彩色多普勒超声(79.2%);(3)彩色多普勒超声诊断乳腺肿瘤的敏感性、特异性、准确性分别为71.4%、80.0%、75.0%,Kappa值为0.50。超声造影诊断乳腺肿瘤的敏感性、特异性、准确性分别为76.2%、70.0%、73.6%,Kappa值为0.46。结论 实时灰阶超声造影对乳腺肿瘤血供的敏感性高,但对良恶性的鉴别意义并不优于彩色多普勒超声。     

三维超声成像对乳腺癌外科手术的指导价值

 目的 探讨三维超声成像对乳腺癌外科手术的指导意义。方法 对68例经病理证实的乳腺癌患者，手术前用二维及三维超声观察乳腺肿瘤情况。结果 三维超声成像不仅能提高乳腺癌的超声诊断符合率[符合率94.1 %，高于二维（88.2 %）]，还可以清晰显示乳腺癌肿块形态结构及其与周边临近组织的立体关系及浸润层次等，如肿瘤侵犯皮肤、胸肌、胸壁等情况（显示率分别为75.0 %，63.6 %，60.0 %），且对乳腺癌肿内血流分布及走行情况显示更清晰、敏感（显示率达95.6 %）。结论 三维超声成像能更充分地表现肿瘤的形态结构、毗邻关系及血流分布情况, 对乳腺癌外科手术有着重要的指导意义。     

单纯型和混合型乳腺黏液腺癌的超声特征分析

目的 分析单纯型乳腺黏液腺癌（pure mucinous breast carcinoma,PMBC）和混合型乳腺黏液腺癌（mixed mucinous breast carcinoma,MMBC）的二维超声和彩色多普勒血流显像特征。方法 回顾性分析2013年1月至2020年12月于我院就诊且经手术病理证实的49例乳腺黏液腺癌（mucinous breast carcinoma,MBC）患者的二维超声、彩色多普勒血流显像表现,比较PMBC和MMBC患者在形态、边缘、内部回声、后方回声、钙化、血流分级和BI-RADS分类等方面的差异。结果 49例MBC病灶中,BI-RADS 3类1例,BI-RADS 4a类4例,BI-RADS 4b类15例,BI-RADS 4c类11例,BI-RADS 5类18例。PMBC组肿块呈混合回声的显示率高于MMBC组（P=0.025）;MMBC组肿块后方回声衰减及边缘毛刺、模糊的显示率高于PMBC组（P=0.008,0.023）;MMBC组血流3级肿块和BI-RADS 5类肿块占比均高于PMBC组;BI-RADS 4b类肿块占比低于PMBC组。结论 PMBC较...     

彩色多普勒血流显像及乳腺内筋膜韧带声像变化对鉴别诊断乳腺小肿块的价值

背景与目的:彩色多普勒血流显像(colorDopplerflowimaging,CDFI)已广泛应用于乳腺肿块的超声诊断,但CDFI结合乳腺内筋膜韧带(浅、深筋膜和Cooper韧带)的声像变化在鉴别诊断乳腺小肿块(直径≤2cm)中应用的文献报道甚少。本研究探讨CDFI结合乳腺筋膜和Cooper韧带的声像改变在鉴别诊断小乳癌的应用价值。方法:对乳腺肿块直径≤2cm的110例患者(经术后病理确诊为良性52例,恶性58例)进行CDFI检查,分析乳腺病灶内部和周边的血流分布及多普勒频谱。根据血流丰富程度分成四个等级,并结合乳腺内筋膜韧带(浅、深筋膜和Cooper韧带)受浸润情况的观察,将诊断结果与病理结果进行对照。结果:超声对乳腺良、恶性小肿块诊断的符合率分别为:90.4%、84.5%。假阳性率为9.6%;假阴性率为15.5%。良恶性肿块的血流分级和收缩期流速峰值(Vmax)、阻力指数(RI)及浅、深筋膜和Cooper韧带的声像变化均有显著性差异。结论:CDFI结合乳腺内筋膜及韧带的声像变化,对乳腺小肿块的诊断和鉴别诊断具有一定的临床应用价值。     

Role of Superb Microvascular Imaging in Differentiating Between Malignant and Benign Solid Breast Masses

IntroductionThe purpose of this study was to evaluate the diagnostic performance of superb microvascular imaging (SMI) in breast lesions.Materials and MethodsEighty-five solid breast lesions were studied with color Doppler flow imaging (CDFI), power Doppler imaging (PDI), monochromatic SMI (mSMI), and contrast-enhanced ultrasonography (CEUS). The penetrating vessels (PVs) and microvascular morphologic and distribution features of the breast tumors were evaluated for each modality.ResultsThe diagnostic accuracies of CDFI, PDI, mSMI, and CEUS were calculated and compared. Surgical pathologic analysis showed 47 benign and 38 malignant lesions. Compared with CDFI and PDI, mSMI and CEUS detected more PVs in breast lesions. The microvascular architecture showed significant differences between benign and malignant lesions. Benign lesions mainly displayed avascular, line-like, and branch-like patterns, and malignant lesions tended to display root hair-like and crab claw-like patterns. mSMI and CEUS identified more root hair-like and crab claw-like patterns in malignant lesions than CDFI and PDI. The sensitivity, negative predictive value, and accuracy of mSMI findings in diagnosing malignancy based on PVs and vascular patterns were both higher than those of CDFI and PDI.ConclusionsmSMI is equal to CEUS and superior to CDFI and PDI in identifying microvascular and discriminating malignant and benign breast masses.     

多模态超声检查对腹壁下动脉穿支皮瓣自体移植乳房再造术前血管评估研究

目的:探讨多模态超声对腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣血管检查有效性,并分析穿支血管的影响因素。方法:纳入2013年2月至2018年10月43例于天津医科大学肿瘤医院使用DIEP皮瓣进行乳房再造术的女性乳腺癌患者,对穿支血管行术前常规及彩色多普勒超声检查,并在超声造影增强状态下行三维重建,直观显示穿支血管的走行分布情况,同时体表标注投影位置。结果:43例患者腹壁下动脉穿支主要分布在脐周5 cm范围内,每侧2～5支,其中28例呈不对称分布。DIEP穿支血管管径与患者腹壁脂肪层厚度呈正相关(r=0.436,P<0.05);血管收缩期峰值血流速度与穿支血管管径呈正相关(r=0.448,P<0.05)。43例患者行超声造影检查后彩色血流信号均能显著增强,其中39例经三维重建后能清晰显示穿支血管与腹壁下动脉主干的关系,4例穿支血管显示欠连续。结论:多模态超声检查在乳腺癌患者DIEP乳房再造术前评估穿支血管具有重要的应用价值,腹壁脂肪层厚度对优势血管的选择有一定影响。     

超微血管成像背景下超声造影在甲状腺乳头状癌患者颈侧区淋巴结中的鉴别诊断价值

目的 探讨超微血管成像(SMI)技术背景下超声造影(CEUS)对甲状腺乳头状癌(PTC)患者颈侧区淋巴结良恶性的鉴别诊断价值.方法 选取在郑州大学第一附属医院行PTC手术及颈部淋巴结清扫术的63例患者,共计98枚淋巴结,术前均行彩色多普勒(CDFI)、超微血管成像(SMI)、SMI+超声造影(CEUS),观察淋巴结的血...     

彩色多普勒超声在颈动脉体瘤诊断治疗中的应用价值--附12例报告

目的探讨彩色多普勒超声（ＣＤＦＩ）对颈动脉体瘤的诊断及术式选择的应用价值。方法通过ＣＤＦＩ对颈部肿物和颈部大血管进行常规及血流检查。结果颈动脉体瘤为颈动脉分叉部低回声不均质光团,内部血流极为丰富。行颈动脉压迫试验,健侧颈动脉血流流速、流量有不同程度增加。本组１２例中,仅１例误诊,确诊率９１．７％。结论ＣＤＦＩ对于颈动脉体瘤的诊断和术式选择能起很大的指导作用。     

Power Doppler breast ultrasound: association of vascularization and ER/c-erbB-2 co-expression in invasive breast carcinoma

Background

Angiogenesis is a fundamental component of oncogenesis. In this study we provided morphologic evidence of vascularization by using power Doppler ultrasound to correlate the clinicopathologic features of tumorigenesis, ER/c-erbB-2 expression, and tumor grade in invasive breast carcinoma.

Methods

Three indices (VI, vascularization index; FI, flow index; VFI, vascularization flow index) were used to analyze 3D power Doppler ultrasound images from 168 patients with malignant breast carcinoma and to correlate their clinicopathologic features.

Results

VI (the mean tumor vascularity) was correlated with ER negativity (p < 0.0029) and VFI (the overall perfusion) was correlated with ER positivity (p < 0.0029). HER2 positivity was statistically significantly correlated with tumor vasculature (VI, VFI) and tumor size/volume. FI (the mean blood flow volume) was significantly correlated with tumor size/volume, but VI was not. The univariate or multivariate logistic regression analysis also showed the reverse correlations between ER expression and tumor vascularity, and positive correlations between HER2 expression and tumor vascularity as well as tumor volume.

Conclusions

This morphologic evidence of vascularization is correlated with tumor angiogenesis and ER/c-erbB-2 co-expression, which could clarify the biology of breast cancer.     

彩色多普勒及超声能量图对乳腺癌化疗疗效的评价

目的探讨彩色多普勒（CDFI）及超声能量图（PDI）在乳腺癌新辅助化疗前后诊断中的价值。方法采用彩色多普勒及超声能量图对120例乳腺癌患者新辅助化疗前后原发灶及淋巴结的大小,二维超声图像,血流分布,血流动力学参数等各项指标的变化进行观测分析。结果 120例患者原发灶化疗前平均体积为（17.66±9.87）cm3,化疗后为（8.66±5.68）cm3;平均Vmax及RI在化疗前后分别为（33.34±13.63）cm/s、（0.84±0.11）和（20.12±8.27）cm/s、（0.68±0.08）,化疗前后差异均有统计学意义,P〈0.05。结论彩色多普勒及超声能量图可为乳腺癌新辅助化疗提供简便、安全的疗效观察手段。     

彩色多普勒血流显像技术对乳腺肿瘤的鉴别诊断价值

目的：探讨彩色多普勒血流（CDFI）显像技术对乳腺肿瘤的鉴别诊断价值。方法：应用Philips iU22超声诊断仪高频探头对114例136枚乳腺肿瘤进行二维超声、CDFI检查并记录血流参数,比较良恶组之间的差异性。结果：乳腺良恶性肿瘤声像图特征的敏感性、特异性、阳性预测值在组间有显著性差异（P〈0.05）。肿块血流检出率、血流分级在良恶性组间差异有统计学意义（P〈0.05）。PSV、PI、RI等血流动力学参数恶性组均高于良性组,组间存在显著性差异（P〈0.01）。结论：二维超声、CDFI血流分级、血流动力学参数（PSV、RI、PI）综合分析和评价,鉴别乳腺肿瘤良恶性具有实用价值及临床意义。     

Color-coded and spectral Doppler flow in breast carcinomas – Relationship with the tumor microvasculature

The phenomenon of tumor angiogenesis is an important aspect of understanding tumor biology. Studies in breast carcinoma have shown microvessel density (MVD) assessed by immunohistochemistry to be of prognostic importance in primary breast cancer. On the other hand, recently developed highly sensitive color-coded Doppler techniques offer a noninvasive method to examine neovascularisation in breast tumors. The purpose of this study was to determine the relationship between Doppler flow parameters and microvessel count assessed by immunohistochemistry. Fifty-three patients with primary breast cancer were examined preoperatively with color-coded Doppler ultrasound. The obtained Doppler frequency spectra were analyzed for peak systolic flow velocity (Vmax). Following surgery, paraffin-embedded microsections were immunohistochemically stained for factor VIII-related antigen. Tumor angiogenesis was assessed by microvessel count under light microscopy. Undifferentiated tumors correlated with high MVD (p=0.009) whereas other clinicopathological parameters were not associated with MVD. Color Doppler signals were detected in 50 out of 53 breast tumors. Evaluation of tumor flow velocity with various clinicopathological parameters showed a significant correlation with tumor size (p=0.0001) and lymph node metastasis (p=0.02). However, there was no significant correlation between MVD and intratumoral blood flow velocity assessed by color-coded Doppler. Our findings showed that Doppler flow measurement did not correlate with the extent of tumor angiogenesis of breast cancer. The present data give circumstantial evidence that microvessel count assessed by immunohistochemistry reflects the microvascular network, whereas tumor vasculature documented by Doppler ultrasound supplies information on the macrovasculature.