乳腺肿瘤超声造影与微血管密度的相关性探讨

[目的]探讨超声造影微血管显像与微血管密度（MVD）的相关性及其在乳腺肿瘤中的诊断价值。[方法]选取乳腺肿块患者70例,术前一周行超声造影检查,利用时间—强度曲线评估肿块性质;术后病理标本行CD34免疫组化标记,观察肿块微血管分布,分析超声造影与MVD相关性。[结果]良恶性肿瘤灌注类型明显不同。良恶性肿瘤时间强度—曲线形态特征不同,两者各定量值均有显著差异（P〈0.05）。免疫组化显示良恶性肿瘤排列特征不同,MVD有显著性差异（P=0.007）。良恶性肿瘤峰值强度与MVD均有明显相关性,且恶性肿瘤曲线下面积与MVD具有一定相关性。[结论]乳腺超声造影在一定程度上可以反映肿块微血管分布特征,有助于乳腺良恶性肿瘤的鉴别。     

乳腺浸润性导管癌的超声造影增强参数与微血管密度相关性研究

目的探讨乳腺浸润性导管癌(invasive ductal carcinoma,IDC)超声造影增强参数与病理微血管密度(microvessel density,MVD)的相关性。方法对52例经手术或穿刺活检病理证实的IDC患者行超声造影,记录各项造影参数;对术后病理标本HE染色进行肿瘤病理分级,应用CD34行免疫组化检测MVD;分析超声造影参数与MVD的相关性。结果 52例IDC中,高分化组25例,低分化组27例。高分化组、低分化组的MVD分别为(2.87±0.97)%和(4.32±1.07)%,不同分化程度组间MVD差异有统计学意义(P<0.001)。低分化组峰值强度及曲线下面积均高于高分化组(P<0.05),且峰值强度、曲线下面积均与MVD显著相关(P<0.05),曲线下面积与MVD最相关(r=0.89,P<0.001)。结论超声造影增强参数与病理MVD有相关性,其有助于评估IDC的分化程度。     

乳腺肿块的超声造影特征与病理对照分析

目的 乳腺超声成像是乳腺疾病诊断不可或缺的主要技术,造影技术又克服了传统超声的局限性,极大提高了检测肿块低速血流的敏感性.本研究观察乳腺良恶性肿块的超声图像及超声造影表现,探讨其超声图像及超声造影的特征.方法 对2013 01-01-2015-06-30在广西壮族自治区人民医院就诊及手术治疗的451例乳腺肿块患者的超声图像特征、血流情况进行观察及实时超声造影,选用SonoVue超声造影剂,对肿块的高频超声图像、造影增强形态、强度和造影时间强度曲线特征进行观察,并与病理进行对照分析.结果 经病理确诊451例乳腺肿块中,恶性肿块240例,良性肿块211例,超声造影有其特征性表现.(1)恶性肿块表现为进入丰富,分布尚均及不均.其造影强度分别为高增强188例(78.3％),中等增强43例(17.9％),极少至低增强9例(3.8％).(2)进入肿块的增强范围常超过二维超声图像,周围可见多条粗大的血管进入肿块,恶性肿块范围增大、放射状增强、穿支血管均较良性明显增加,良性肿块可见环状增强,并为特征性改变,共59例(28.0％).(3)本组恶性肿块超声造影敏感度92.45％,特异度95.91％,阳性预测值96.66％,阴性预测值90.82％.本组恶性肿块二维超声检查敏感度82.63％,特异度65.02％,阳性预测值60.40％,阴性预测值85.29％.结论 通过系统地对乳腺恶性肿决超声图像及超声造影表现进行观察,进一步发现了不同乳腺肿块,尤其是恶性肿块的超声造影特征表现,认为超声造影可提高对乳腺肿块低速血流显示的敏感度,并有其特征性表现,有助于乳腺良恶性病变的鉴别诊断及提高诊断准确率.     

彩超鉴别诊断乳腺良恶性肿块的价值评估

目的:探讨彩色多普勒超声对乳腺良恶性肿块的鉴别诊断价值.方法:应用二维超声观察肿块的形态、边界、内部回声、有无后方衰减及侧方声影,并应用彩色多普勒血流显像(CDFI)观察肿块内部血流分布情况,并测量血流阻力指数(RI).结果:67例乳腺癌患者中64例超声诊断与病理结果相符,另有3例误诊为良性肿块,诊断符合率为95.5%;29例乳腺良性肿块患者中28例超声诊断与病理结果相符,另有1例误诊为恶性肿块,诊断符合率为96.6%.结论:彩色多普勒超声对乳腺良恶性肿块的检查与病理符合率高,有很好的鉴别诊断价值.     

实时超声造影对乳腺肿瘤BI-RADS分类的诊断价值分析

目的分析实时超声造影对乳腺肿瘤乳腺影像报告与数据系统(BI-RADS)分类的诊断价值。方法以120例乳腺实性肿块患者为研究对象。在常规超声的基础上行造影检查。分析超声造影检查的良、恶性肿瘤的增强程度、增强范围变化、增强边缘、灌注方式、造影剂分布和肿瘤血管图像特征情况,比较常规超声和超声造影的BI-RADS分类情况,并以病理检查为金标准评价比较两种检查方法的诊断能力。结果超声造影检查对于良性和恶性肿瘤的增强程度、增强范围变化、增强边缘、灌注方式、造影剂分布和肿瘤血管情况差异均具有统计学意义(P<0.05);常规超声和超声造影检查的BI-RADS分类情况差异不具有统计学意义(P>0.05);超声造影检查的准确度和对恶性肿瘤的灵敏度高于常规超声(P<0.05),两种检查方法对恶性肿瘤的特异度差异无统计学意义(P>0.05),但超声造影检查对恶性肿瘤的特异度略高于常规超声检查。结论造影检查可在常规超声基础上提高对乳腺肿瘤BI-RADS分类准确性,提高了对良恶性肿瘤的鉴别诊断准确度、特异度和灵敏度,为临床进一步诊治提供依据,但仍需扩大样本量进一步从超声检查操作和图像分析能力的规范性方面展开研究。     

超声造影检查在乳腺BI-RADS 4类的乳腺肿块良恶性鉴别诊断中的价值

目的:探讨超声造影检查在常规超声诊断为乳腺BI-RADS 4类的乳腺肿块良恶性鉴别诊断中的价值。方法:对2016年7月至2017年10月在西安交通大学第一附属医院门诊就诊并经常规超声诊断为乳腺BI-RADS 4类的76例患者共76个乳腺肿块进行超声造影检查,以穿刺活检或手术切除病理结果为金标准建立诊断试验分析。结果:最终病理证实良性病变53例（良性组）,恶性病变23例（恶性组）。超声造影特点如形态不规则、边界不清晰、有穿入或扭曲血管、对比剂不均匀性增强、内部有充盈缺损及造影后面积较二维增大在恶性组的比例显著高于良性组,差异有统计学意义（P<0.05）。超声造影诊断乳腺BI-RADS 4类病灶良恶性鉴别诊断的敏感度、特异度及准确性分别为96%、85%和88%。结论:良恶性乳腺肿块的超声造影特征明显不同,超声造影可以有效鉴别BI-RADS 4类乳腺病灶的良恶性,有望提高穿刺活检的恶性检出率。     

乳腺良恶性肿瘤微血管构筑的异质性及其血流动力学的功能变化

目的 探讨乳腺良恶性肿瘤及其不同灌注区域在血管构筑、血流动力学功能、超微结构及其微血管分布方面的差异性.方法 应用实时灰阶超声造影微血管成像(MVI)技术,检测30例乳腺恶性肿瘤(33个病灶)和30例乳腺纤维腺瘤(34个病灶)的微血管造影特征.应用时间-强度曲线(TIC)定量分析技术,检测瘤灶边缘及中心部区域灌注参数及平均灌注参数峰值强度(PI)、曲线下面积(AUC)、达峰时间(TTP)和廓清时间(WOT).应用透射电镜观察瘤内新生血管超微结构改变,应用免疫组化技术检测CD34的表达.结果 乳腺良恶性肿瘤造影后,病灶呈不均匀增强、充盈缺损、紊乱的血管网、血管扩张、血管迂曲征象的差异有统计学意义(P<0.05).恶性组病灶中,TIC多数(29/33,87.9%)呈速升缓降型;良性组病灶中,TIC多数(27/34,79.4%)呈缓升速降型.恶性组平均AUC和WOT大于良性组(P<0.05).两组平均PI和TTP比较,差异无统计学意义(P0.05).恶性组病灶边缘各灌注参数与中心区域相比,差异有统计学意义(P<0.05);良性组病灶边缘各灌注参数与中心区域相比,差异无统计学意义(P>0.05).恶性组新生血管内皮细胞超微结构不同于正常血管内皮细胞,具有分裂旺盛的瘤性特征,痛灶边缘以扩张、迂曲的大血管为多,癌灶中心常见狭窄、闭塞的幼稚新生血管及固缩、变形的内皮细胞和周细胞.恶性组的微血管密度(34.84±8.34)显著高于良性组(18.65±4.69,P<0.05),微血管丰富区位于痛巢边缘.结论 实时超声造影灌注模式、TIC形态、各平均灌注参数及区域灌注参数的差异,为乳腺良恶性肿瘤的鉴别诊断提供了重要依据.肿瘤间质中新生微血管密度、形态、分布、结构及功能的差异性,是影像学评价肿瘤血管生成的基础.     

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。     

超声造影对乳腺 BI-RADS 4类结节鉴别诊断价值

目的:研究超声造影对乳腺 BI-RADS 4类结节良恶性的鉴别诊断价值。方法:回顾性分析本院60例乳腺 BI-RADS 4类结节常规超声及超声造影检查资料,观察乳腺超声造影增强模式,分析良恶性结节之间超声造影增强特征的差异,并与穿刺活检或术后病理结果对照。结果:乳腺良恶性结节超声造影增强过程中其增强强度、增强时间、增强完整性方面有显著性差异（P<0.05）,但在超声造影增强过程中增强顺序、增强均匀性方面尚未发现有显著差异（P>0.05）。常规超声 BI-RADS对乳腺良恶性结节诊断效能的的灵敏度、特异度、阳性预测值、阴性预测值分别为81.8%（18/22)、73.7%(28/38)、64%(18/28)和87.5%（28/32）,超声造影判断乳腺 US BI-RADS 4类结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值分别为90.9%(20/22)、86.8%(33/38)、88.0%(22/25)和94.3%（33/35）。超声造影对乳腺良恶性结节的诊断价值与病理结果的Kappa 值为0.75,具有较好的一致性。结论:乳腺超声造影不同增强特征对乳腺 BI-RADS 4类结节良恶性判断有较高的准确性,在指导临床治疗策略方面具有明确的应用价值。     

妇科恶性肿瘤超声造影表现与微血管密度相关性研究进展

 微血管密度（MVD）是评价肿瘤血管生成的金标准。超声造影近年发展迅速,可通过测定各种灌注参数,间接反映妇科恶性肿瘤新生微血管形成程度,并评估肿瘤的生物学行为以判断预后。对妇科恶性肿瘤超声造影、MVD检测,以及二者之间相关性研究的进展进行了综述。     

Breast Lesions： Correlation of Dynamic Contrast Enhancement Patterns on MR images with Tumor Angiogenesis

Objective To determine whether dynamic contrast -enhanced MRI features of the early -phase enhancement rate, enhancement amplitude, and signal-intensity (SI) time course are associated with the microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of malignant and benign breast lesions. Methods Sixty patients with breast lesions, detected with physical examination or conventional mammography, were examined pre —operatively with dynamic contrast-enhanced MRI from December 1998 to June 2000. Of these 60 patients, histopathological correlation was available in 38. These 38 patients(aged 29–73 years) formed the basis of this study. SI changes during dynamic scanning were assessed quantitatively. Early-phase enhancement rate and enhancement amplitude were calculated. Time-SI curves of the lesions were obtained and classified according to their shapes as type I (which was steady enhancement to the end of the dynamic data acquisition at 7.5min.), type II (plateau of SI after avid initial contrast enhancement), or type III (washout of SI after avid initial contrast enhancement). The mean MVD and VEGF expression of the lesions were measured with immunohistochemical staining methods in all the pathologic specimens by a pathologist without knowledge of the results of the MR examination. Care was taken to ensure identical location in the plane of the MR image and pathologic specimens. The relationships among dynamic contrast-enhanced MRI features, MVD, and VEGF expression of benign and malignant breast lesions were analyzed. Results Histology revealed 21 malignancies and 17 benign lesions. The mean MVD and VEGF expression for the 21 malignant lesions were significantly higher than the mean MVD and VEGF expression for the 17 benign lesions (P<0.01). High VEGF expression of benign and malignant breast lesions showed a significant association with increased MVD (P< 0.01 ). Among all 38 lesions, greater (>60%) MR early-phase enhancement rate and time-SI curve type II or III showed a significant association with MVD and VEGF expression. All the differences mentioned above showed statistical significance (P<0.01) except the difference between VEGF expression and the distribution of curve types which had no statistical significance (P=0.069). No significant relationships were observed between the enhancement amplitude and MVD (P>0.05) and VEGF expression (P> 0.05). Regarding the distribution of MVD, the study showed that the greater MVD was most frequently observed at the marginal region of the breast cancers, although the distribution of MVD was heterogeneous in each lesion. Conclusions MVD and VEGF affect the contrast medium enhancement of breast lesions. The early -phase enhancement rate and time — SI curve types of benign and malignant breast lesions are closely related to MVD and VEGF. As a noninvasive method, contrast-enhanced MRI has a potential role in estimating the degree of angiogenesis of breast neoplasms.     

乳腺良恶性病变组织中微血管密度和维汉族差异的研究

目的　探讨不同乳腺病变组织中微血管密度 (microvesseldensity ,MVD)的区别及维汉差异。方法　采用免疫组化SP法 ,检测了汉族患者的乳腺纤维腺瘤、小叶增生和维吾尔族及汉族的乳腺浸润性导管癌 (invasiveductalcarcinoma ,IDC)三种病变的MVD值。结果　乳腺IDC中MVD显著高于良性病变 (P <0 0 5 ) ;两种良性病变间MVD值相比差异无显著性 (P >0 0 5 ) ;在乳腺IDC中 ,汉族的MVD与维族的MVD相比差异无显著性 (P >0 0 5 )。结论　微血管增加在乳腺IDC的发生发展中起到促进作用 ,但与维汉之间以及与淋巴结转移无关     

脑星形细胞肿瘤微血管密度和NET-1 蛋白的表达及其相关性

 目的 探讨脑星形细胞肿瘤组织中微血管密度（MVD）和NET-1蛋白表达的意义。方法 应用免疫组化方法，检测65例脑星形细胞肿瘤组织和5例正常脑组织中，NET-1蛋白的表达以及血管内皮细胞表面抗原CD34单抗标记测定MVD，分析NET-1蛋白表达和MVD与脑星形细胞肿瘤分级关系。结果 MVD与脑星形细胞肿瘤分级相关，NET-1阳性组MVD显著高于NET-1阴性组，NET-1表达强度与MVD呈高度正相关（r1=0．6682，P〈0．05）。结论 MVD可以是判断星形细胞瘤恶性程度指标之一，NET-1可能通过促进星形细胞肿瘤组织微血管形成发挥作用。     

乳腺肿瘤癌变过程中血管生成与VEGF表达相关性研究

Objective  

The aim of the study was to detect the expression of vascular endothelial growth factor (VEGF) and microvessel density (MVD) in breast benign tissues and malignant tumors to clarify the relationship between VEGF expression, angiogenesis and breast carcinoma occurrence.     

Expression and clinical significance of vascular endothelial growth factor in benign and malignant tissues of breast

Objective:To detect the expression of vascular endothelial growth factor(VEGF)and microvessel density(MVD)count in breast benign affection,breast atypical hyperplasia and breast carcinoma in situ,and to clarify the relationship between VEGF expression,MVD and the clinicopathological features of these diseases. Methods:The expression of VEGF and MVD count in 115 cases breast benign diseases(including 40 breast fibroid tumor,40 breast cystic hyperplasia and 35 intraductal papilloma,19 breast atypical hyperplasias and 32 breast carcinomas in situ were examined by immunohistochemistry staining(SP-method). Results:The positive rate of VEGF in breast benign diseases,breast atypical hyperplasia and breast carcinoma in situ were 21.74%(25/115)、31.58.%(6/19)and 53.13%(17/32)respectively.It was the lowest in breast benign affection group,and was the highest breast carcinoma in situ group.The expression of VEGF increased gradually in the three groups(P＜0.05).The MVD count of the three groups were 14.41±2.59,18.89±4.47 and 21.13±4.12 respectively,It was the lowest in breast benign affection group,and was the highest breast carcinoma in situ group.The MVD count of the three groups increased gradually(P＜0.05).In VEGF positive group,MVD count was 19.41±4.78;In VEGF negative group,MVD count was 14.91±3.15.The MVD count was higher in VEGF positive group than that in VEGF negative group(P＜0.05). Conclusion:The results of this study suggested that VEGF could promote microvessel growth in breast tumors.The occurrence and progression of breast cancer might be related with the expression of VEGF.     

不同乳腺病变组织中TSP-1、CD44V5、HER4表达对微血管密度的影响

目的　探讨不同乳腺病变组织中微血管密度(MVD )的差异及其与TSP 1,CD44V 5 ,HER 4表达情况的关系。方法　采用免疫组化SP法,检测乳腺纤维腺瘤、小叶增生和乳腺浸润性导管癌(IDC )组织中TSP 1,CD 44V 5 ,HER 4的表达情况及MVD。结果　在IDC组织中的MVD明显高于其它两种组织(P <0 .0 5 ) ;在3种组织中MVD与TSP 1,CD 44V 5的表达均无关(P >0 .0 5 ) ,但在IDC中,MVD值与HER4表达有关(P <0 .0 5 ) ,HER 4阳性的IDC组织MVD较高。结论　IDC组织的MVD高于良性病变;HER4的表达可促进IDC组织中MVD的增加。     

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.     

多层螺旋CT灌注成像诊断周围型肺癌及其微血管密度对照研究

Objective： To investigate the clinical diagnostic value of peripheral lung cancer using multi-slice CT （MSCT） perfusion imaging and the relationship with microvessel density （MVD）. Methods： 38 patients with pulmonary masses proved by pathology including 25 cases of peripheral lung cancer and 13 cases of benign masses were studied prospectively with GE Lightspeed Qx/I plus 16-slice helical CT perfusion imaging, and 25 patients with lung cancer were comparative studied with its MVD calculated using LSAB. With the CT perfusion 2-body tumor software, the parameters of CT perfusion including blood value （BV）, blood flow （BF）, mean transit time （MTT） and permeability surface （PS） were analyzed. Results： The four parameter values in lung cancer were all higher than that in pulmonary benign masses, and there were significant differences among BV, MTT and PS （P〈0.05）, especially in BV （P〈0.01）. The MVD value of lung cancer was higher than that of pulmonary benign masses （P〈0.05）, and the MVD of adenocarcinoma was higher than that of squamous cell carcinoma （P〈0.05）. In 25 cases with lung cancer, there was positive correlation only between BV and MVD value （r=0.852, P〈0.01）. Conclusion： It is helpful to diagnose the peripheral lung cancer with MSCT perfusion imaging and to differentiate from pulmonary benign masses, its bases are MVD pathologically.