彩色多普勒超声对乳腺良恶性肿块的鉴别诊断价值

目的应用彩色多普勒血流显像（CDFI）观察乳腺肿块的血流特点，评价血流参数（PSV、R0对乳腺良、恶性肿块的鉴别诊断价值。方法运用CDFI检测73例的77个乳腺肿块，并与术后病理对照。对其中超声检测出血流的60个乳腺肿块观察血流特点并进行血流参数测定，比较乳腺良、恶性肿块的差异，同时对RI诊断的敏感性、特异性、阳性预测值、阴性预测值加以分析。结果乳腺恶性肿块的CDFI血流信号较良性肿块明显丰富。恶性肿块的PSV、RI值明显高于良性肿块CP〈O．05），以RI≥0．70诊断乳腺癌敏感性和特异性较高，分别为82．6％和80．95％。结论彩色多普勒血流显像及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。     

高频超声检测乳腺癌与乳腺纤维腺瘤诊断价值的探讨

目的:探讨高频超声和彩色多普勒(CDFI)对乳腺良、恶性肿瘤的形态及血流动力学特点,对鉴别良、恶性肿瘤的诊断价值。方法:应用高频超声结合CDFI技术对146例乳腺肿瘤的声像图特征及血流动力学与病理结果对照分析。结果:146例乳腺肿瘤中,乳腺纤维腺瘤90例,符合率94.4%,浸润性导管癌56例,符合率91.1%。结论:乳腺癌的特征性表现为形态不规则,毛刺状或蟹爪状,致密小钙化灶和后方回声衰减,CDFI:RI>0.75。乳腺纤维腺瘤的特征性表现为边界清晰,形态规则,有包膜和侧边声影,CDFI:RI<0.75。但是部分良、恶性肿瘤有交叉表现。     

彩色多普勒超声血流参数测定在乳腺良、恶性肿块鉴别诊断中的价值

目的:评价彩色多普勒超声血流参数(RI、PI、Vmax)在乳腺良、恶性肿块鉴别诊断中的价值.材料和方法:运用高频彩色多普勒超声诊断仪对408个乳腺肿块进行血流检测,对其中超声检出血流的340个乳腺肿块进行多普勒血流参数测定,比较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:乳腺恶性肿块的RI、PI、Vmax值明显高于良性肿块(P<0.001),以RI≥0.72或PI≥1.3或Vmax≥13cm/s诊断乳腺癌,其敏感性和特异性最高,分别为85.5%和82.9%、80%和83.6%、70.1%和82.7%,其中以RI≥0.72的恶性似然比最高为5.0.彩色多普勒超声与灰阶超声征象相结合可使乳腺恶性肿块的超声诊断敏感性和特异性分别达97.6%和93.9%.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,与肿块的灰阶声像图征象相结合可明显提高乳腺肿块的超声诊断准确率.     

男性乳腺疾病的超声诊断

目的探讨男性乳腺常见疾病的声像图表现,以提高其诊断水平。方法 82例经超声检查并经临床证实的男性乳腺疾病,包括乳腺发育症65例,乳腺炎7例,乳腺癌5例,乳腺纤维腺瘤2例,乳腺脂肪瘤3例,对所有患者的声像图表现进行了回顾性分析。结果声像图显示男性乳腺疾病随病种而有不同表现,乳腺发育症呈弥漫型与结节型低回声区;乳腺癌呈边界不清和内部回声不均匀的病灶,常伴灶内微小钙化;急性乳腺炎表现为乳头周围局限性低回声区,边界清楚,回声均匀,而慢性乳腺炎表现为乳房内不均质低回声区;乳腺纤维腺瘤表现为椭圆形实质低回声光团,边缘光整;乳腺脂肪瘤表现为边界清楚的扁椭圆形稍高或低回声光团。本组2例慢性乳腺炎误诊为乳腺癌。诊断敏感性、特异性、准确性、阳性预测值及阴性预测值分别为100%,97.4%,96.3%,71.4%,97.4%。结论超声检测能直观显示男性乳腺病变的部位、大小、形态、内部回声及血流显像特征,有助于鉴别良性与恶性病变。     

3.0T磁共振动态增强及波谱成像对乳腺癌定性诊断的价值简

目的：探讨3.0T磁共振动态增强扫描（DCE-MRI）与氢质子波谱（1H-MRS）成像在乳腺癌定性诊断中的临床应用价值。方法收集我院经手术后病理或穿刺活检病理证实的乳腺肿瘤患者78例,共计82个肿瘤作为研究组,其中乳腺癌54个,良性肿瘤28个。全部病例均于术前行磁共振动态增强后1H-MRS检查,回顾性分析本组病例的DCE-MRI及1H-MRS表现,并将MRI诊断结果与病理结果进行对比分析。统计学处理采用χ2检验等。结果 DCE-MRI检查单独诊断乳腺癌的敏感性为87％,特异性为71％,准确性为82％,阳性预测值为86%,阴性预测值为74%。1H-MRS检查单独诊断乳腺癌的敏感性为91％,特异性为86％,准确性为89％,阳性预测值为92%,阴性预测值为83%。DCE-MRI联合1H-MRS诊断乳腺癌的敏感性为98％,特异性为82％,准确性为93％。结论磁共振波谱与动态增强扫描单独诊断乳腺癌的敏感性及准确率较低,二者联合应用可明显提高其敏感性和诊断准确率,对乳腺癌的术前定性诊断有重要应用价值。     

彩色多普勒与二维超声结合在诊断早期乳腺癌中的价值

目的　探讨彩色多普勒血流显像（CDFI）与二维超声结合诊断早期乳腺癌的价值。方法　对45例乳腺肿块（≤2cm）进行CDFI与二维超声检查。结果　乳腺癌21例,其中20例CDFI显示有丰富血流,阻力指数0.70±0.06,明显高于乳腺良性肿块。24例良性肿块中,仅有7例检出血流信号,RI为0.60±0.06(Ρ＜0.01)。结论　CDFI与二维超声结合可明显提高早期乳腺癌诊断的敏感性、特异性和诊断准确率。     

乳腺叶状肿瘤与纤维腺瘤高频超声特征的对比分析

目的:探讨高频超声对乳腺叶状肿瘤与纤维腺瘤的诊断价值。方法:对术前行高频彩色多普勒超声检查、并经手术病理证实的48例乳腺叶状肿瘤和128例纤维腺瘤的超声声像图和临床资料进行回顾性对比分析。结果:高频超声声像图显示2组在肿瘤形状、内部回声、有无钙化及无回声区、后方回声、血流信号分级方面差异均有统计学意义(均P0.05)。结论:高频超声声像图示肿块呈欠规则或不规则形,内部回声不均匀,见钙化及无回声区,后方回声增强,彩色血流分级呈Ⅱ或Ⅲ级,均视为乳腺叶状肿瘤与纤维腺瘤的鉴别要点。     

小乳腺癌的高频超声诊断与鉴别

小乳腺癌 (简称小乳癌 ,其最大纵横径≤ 2cm) ,超声诊断及鉴别较为困难。本研究回顾性分析了小乳癌的高频二维声像图表现及彩色多普勒血流情况 ,并与乳腺小纤维腺瘤和小瘤样增生进行鉴别 ,旨在探讨小乳癌的高频超声特点 ,以提高其诊断小乳癌的准确率。1　材料和方法本组 74例患者均经手术病理及细胞学穿刺证实 ,其中小乳癌 2 2例 ,年龄 3 1～ 70岁 ;乳腺小纤维腺瘤 2 8例 ,年龄 17～ 43岁 ;乳腺小瘤样增生 2 4例 ,年龄 2 7～ 60岁。使用Medsion～60 0 0C超声仪 ,探头频率 7.5～ 10 .0MHz ,应用表浅器官软件包。患者取仰卧位或侧卧位 ,充分…     

彩色超声在健康体检中筛查乳腺癌的临床价值研究

目的:探讨高频彩色超声在健康体检中筛查乳腺癌的临床价值。方法:采用高频线阵探头对5597例健康体检女性进行常规乳腺检查,记录可疑乳腺癌病例的年龄、性别、肿块的声像图特点,进一步应用CDFI技术分析其血流特征,对照手术病理证实的病例建立随访制度,定期复查。结果:5597例健康体检女性中,发现可疑乳腺癌9例,经手术病理证实6例。癌平均直径1.4cm。结论:高频彩色超声结合CDFI技术在健康体检中对乳腺癌的早期发现、诊断具有重要的临床价值。     

高频彩色多普勒超声在乳腺肿瘤诊断中的应用价值

目的探讨高频彩色多普勒超声对鉴别乳腺良恶性肿块的应用价值。方法对86例经手术病理确诊的乳腺疾病患者（56例良性,30例恶性）进行术前彩超检查,对比性分析了两组间高频声像图、彩色多普勒血流成像（CDFI）、病灶内血流Adler分级、阻力指数（RI）、峰值流速（PSV）的差异。结果乳腺良恶性肿块声像图鉴别以肿块边界及形态特征最重要,彩色多普勒显示乳腺癌内的血流较良性肿块明显丰富（P〈0．05）,乳腺癌的血管分布异常、频谱多普勒示肿块内动脉血流PSV、RI也是显著高于良性肿块且有显著性差异（P〈0．05）。结论综合分析和评价血流Adler分级及频谱多普勒各项血流动力学参数（PSV,RI）指标,有助于对乳腺良恶性肿块的鉴别。     

高频超声与X线钼靶对早期乳腺癌的诊断价值

目的 分析比较高频超声、X线钼靶单独及两者联合应用对早期乳腺癌的诊断价值.方法 体检发现乳腺包块、怀疑乳腺肿瘤的258例患者,行高频超声、X线钼靶的单独检查和联合检查,并行手术治疗.对照分析手术病理与影像学表现.结果 258例患者,手术病理证实早期乳腺恶性肿瘤135例,良性乳腺肿瘤123例.对于诊断早期乳腺癌,联合检查的敏感性优于单独的高频超声检查或X线钼靶检查(P<0.05),准确性优于X线钼靶检查(P<0.05),特异性、阳性预测值、阴性预测值、假阳性、假阴性等指标3组间均无显著差异(P均>0.05).对于早期乳腺癌患者,高频超声和X线钼靶相比,检出的钙化灶较少(18.3% vs 36.5%,P<0.01),能够发现更多的乳腺癌腋窝淋巴结转移(69.0% vs 33.3%,P<0.01).结论 高频超声与X线钼靶的单独和联合检查对于早期乳腺恶性肿瘤均为可靠的影像学诊断方法,联合应用诊断早期乳腺癌具有较高的敏感性和准确性.     

Suspected appendicitis in children: US and CT--a prospective randomized study

PURPOSE: To evaluate the accuracy of ultrasonography (US) and of abdominal computed tomography (CT) performed in addition to US in the diagnosis of childhood appendicitis. MATERIALS AND METHODS: Six hundred children with suspected appendicitis were included in a prospective randomized study. After clinical examination, the patients were randomly assigned to undergo US only (283 patients) or US with abdominal CT (317 patients). Radiologic findings were correlated with surgical, histopathologic, and clinical follow-up findings. RESULTS: Two hundred forty-four (40.7%) of all patients had appendicitis. In the US only group, US had a sensitivity of 86%, specificity of 95%, positive predictive value of 91%, negative predictive value of 92%, and diagnostic accuracy of 92%. The combination of US and CT performed in the other group yielded a sensitivity of 99%, specificity of 89%, positive predictive value of 87%, negative predictive value of 99%, and diagnostic accuracy of 93%. Analysis of data on US performed in all 600 patients and on CT performed in 317 patients revealed, respectively, sensitivities of 80% and 97%, specificities of 94% and 93%, positive predictive values of 91% and 92%, negative predictive values of 88% and 98%, and diagnostic accuracies of 89% and 95%. The overall negative appendectomy rate was 3.7%; and the perforation rate, 21%. CONCLUSION: US is valuable in the diagnosis of appendicitis in children. In inconclusive cases, performing additional abdominal CT can improve diagnostic accuracy and thereby decrease the negative appendectomy rate without an increase in the perforation rate.     

Significance of the pseudocapsule on MRI of renal neoplasms and its potential application for local staging: a retrospective study

OBJECTIVE: The purpose of our study was to evaluate the role of MRI in showing a pseudocapsule for local staging of renal tumors, and its potential application to select patients for partial surgery. MATERIALS AND METHODS: Eighty tumors (73 renal cell carcinomas [RCCs] and seven oncocytomas) were preoperatively evaluated by MRI. MRI findings were assessed with a special focus on perinephric fat and pseudocapsule. Correlations were performed with pathologic staging after surgery. RESULTS: At pathology, a pseudocapsule was recognized in 79 cases. Twenty-three RCC were staged pT3a (21 clear cell; two papillary). MR images exhibited a pseudocapsule in 90% of cases as a hypointense rim surrounding the tumor on T2-weighted images. MRI findings concerning isolated analysis of the pseudocapsule for differentiating stage T1/T2 from T3a were sensitivity: 86%, 50%; specificity: 95%, 92%; positive predictive value: 95%, 33%; negative predictive value: 88%, 92%; and accuracy: 93%, 89%, for clear cell and papillary types, respectively. For stage T3a, with both abnormalities of the pseudocapsule and perirenal fat, results were, for overall RCC sensitivity: 84%; specificity: 95%; positive predictive value: 91%; negative predictive value: 91%; and accuracy: 91%. CONCLUSION: The identification of the pseudocapsule offers an additional value for local staging by MRI. The presence of an intact pseudocapsule is a sign of lack of perinephric fat invasion. It is more likely to predict that the tumor can be removed by partial surgery.     

彩色多普勒密度量化值在诊断乳腺肿块中的价值

目的:通过与半定量分析方法的比较,评价计算机辅助定量分析彩色多普勒信号密度在乳腺癌诊断中的应用价值.材料和方法:50例乳腺肿块患者(恶性37例,良性13例),分别用半定量和计算机辅助定量分析方法检测,比较这两种方法对良、恶性乳腺肿块鉴别诊断的灵敏度、特异度和准确性.结果:良、恶性乳腺肿块CDFI等级间的差异无显著性.而良、恶性乳腺肿块CDFI密度量化值间的差异存在显著性,P＜0.01.以CDFI密度量化值大于3.62(良性乳腺肿块的CDFI密度量化平均值)作为乳腺恶性肿块的诊断标准:准确性76.0%,特异度83.8%,灵敏度53.8%,均高于CDFI等级法.结论:信号密度量化分析方法由于在对彩色血流信号的识别上,并没受到主观因素的影响,因此较半定量分析方法能更客观和可靠地反映肿块内的血供情况.     

Scintimammography in conjunction with ultrasonography for local breast cancer recurrence in post-mastectomy breast

The aim of this study was to compare the usefulness of (99)Tc(m)-methoxy-isobutyl-isonitrile (MIBI) scintimammography and ultrasonography, alone and in combination, for the detection of chest wall recurrence in the post-mastectomy breast. A total of 41 consecutive post-mastectomy patients (mean age 46.6 years; median age 45 years) with clinical suspicion of breast cancer recurrence were evaluated. For scintimammography all patients received a 740-900 MBq iv injection of (99)Tc(m)-MIBI; planar images were taken 5-10 min post-injection followed by supine single photon emission CT. Breast ultrasonography was performed in each patient using a 7.5 MHz transducer. Both MIBI uptake and ultrasound findings were documented using standard protocols. All patients had fine needle aspiration cytology biopsy (FNAC), core biopsy or excision biopsy for final tissue diagnosis. Of the 41 patients, 24 had true positive signs of local breast cancer recurrence upon ultrasonography, 10 were diagnosed as true negatives, a sensitivity of 86%, specificity 77%, positive predictive value (PPV) 89%, negative predictive value (NPV) 71% and accuracy 83% (p = 0.001). By comparison, scintimammography findings were found to be true positive in 25 patients and true negative in 12 patients - sensitivity 89%, specificity 92%, PPV 96%, NPV 80% and accuracy 90% (p = 0.001). Using a combination of these two modalities, the combined sensitivity was 100%, specificity 77%, PPV 90%, NPV 100% and accuracy 93%. The high NPV of the two studies in combination implies a potential use of this approach to exclude recurrent disease in patients with a low initial index of suspicion and/or when histology is indeterminate.     

FDG PET and other imaging modalities in the primary diagnosis of suspicious breast lesions

Mammography is the primary imaging modality for screening of breast cancer and evaluation of breast lesions (T staging). Ultrasonography is an adjunctive tool for mammographically suspicious lesions, in patients with mastopathy and as guidance for reliable histological diagnosis with percutaneous biopsy. Dynamic enhanced magnetic resonance mammography (MRM) has a high sensitivity for the detection of breast cancer, but also a high false positive diagnosis rate. In the literature, MRM is reported to have a sensitivity of 86-96%, a specificity of 64-91%, an accuracy of 79-93%, a positive predictive value (PPV) of 77-92% and a negative predictive value (NPV) of 75-94%. In unclarified cases, metabolic imaging using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) can be performed. In the literature, FDG PET is reported to have a sensitivity of 64-96%, a specificity of 73-100%, an accuracy of 70-97%, a PPV of 81-100% and an NPV of 52-89%. Furthermore, PET or PET/CT using FDG has an important role in the assessment of N and M staging of breast cancer, the prediction of tumour response in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy, and the differentiation of scar and cancer recurrence. Other functional radionuclide-based diagnostic tools, such as scintimammography with sestamibi, peptide scintigraphy or immunoscintigraphy, have a lower accuracy than FDG PET and, therefore, are appropriate only for exceptional indications.     

高场磁共振1H-MRS在乳腺肿瘤定性诊断中的临床应用价值

目的 探讨高场磁共振1 H-MRS在乳腺肿瘤定性诊断中的临床应用价值及影响因素.方法 收集我院经手术病理或穿刺活检病理证实的乳腺肿瘤患者160例,共计172个肿瘤作为研究组,其中乳腺癌93个,良性肿瘤79个.全部病例均于术前行磁共振动态增强后1 H-MRS检查,回顾性分析本组病例的1 H-MRS表现及MRI诊断,并将MRI诊断结果与病理结果进行对比分析.结果 93个乳腺癌病灶中78个出现胆碱(Choline,Cho)峰.79个良性肿瘤中6个出现Cho峰.以3.23ppm处出现Cho峰(SNR≥2)为乳腺癌的诊断标准,其诊断的敏感性为83.9％,特异性为92.4％,准确率为87.8％,阳性预测值为92.9％,阴性预测值为83.0％.结论 高场磁共振1 H-MRS对乳腺癌的诊断敏感性和特异性较高,在乳腺肿瘤的定性诊断中有重要应用价值.     

Usefulness of scintimammography as an adjunct to mammography and ultrasound in the diagnosis of breast diseases

This study was undertaken to evaluate the diagnostic efficacy of 99mtechnetium methoxyisobutylisonitrile scintimammography (SM) and combined use of mammography and ultrasound in the detection of the breast lesions in the symptomatic breast. Histopathological findings were the gold standard. Eighty patients with symptomatic breasts underwent mammography and/or ultrasound breast followed by SM. In 25 patients there were 27 lesions that were malignant and 55 patients had 65 lesions that were benign. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of SM were found to be 92, 72, 58, 96 and 78%, respectively, as compared with the combined use of mammography and ultrasound, which showed these parameters to be 89, 94, 86, 95 and 92%, respectively. In this study, SM showed slightly better sensitivity than combined mammography and ultrasound, whereas the specificity was clearly shown as higher in the latter.