高频超声及弹性成像在浅表软组织肿物良恶性鉴别中的应用研究

目的 探讨二维高频超声、彩色多普勒超声和超声弹性成像在浅表软组织肿物良恶性鉴别中的价值.方法 对83例浅表软组织肿物患者(共计108个病灶)进行超声检查,全部资料均经术后病理证实(良性肿物56个,恶性肿物52个),对其中69个肿物做了超声弹性成像评分.常规超声检查了解肿物的位置、大小、形态、边界、内部回声、与周围组织的关系;用彩色多普勒超声重点观察肿物周围及内部血流分布;然后通过弹性成像评分判定肿物质地软硬.分析图像,总结上述结果在鉴别良恶性病变中的应用价值.结果 良、恶性浅表软组织肿物所达组织层次、大小、血流分布、弹性成像评分的差异均有统计学意义(P<0.05).以血流分布多作为判断恶性的标准,其敏感性为69.2 %,特异性为80.40o,准确性为75.000.以超声弹性成像评分≧4分作为判断恶性的标准,其敏感性为72.7,特异性为80.6 0o,准确性为76.8%a结论二维高频、彩色多普勒超声及弹性成像的联合应用有助于对浅表软组织肿物的良恶性鉴别.     

甲状腺良恶性结节的彩色多普勒超声半定量研究

目的 应用受试者工作特征曲线(ROC曲线)对甲状腺结节进行综合评价,并选取最佳诊断界点.方法 应用二维及彩色多普勒超声技术观察81例甲状腺肿块的超声表现,并与手术及病理对照:针对实性肿物的大小、形态、边界、声晕、内部回声、钙化、液化、纵横比及血流情况等超声指标进行相关性分析;选取其中7项相关指标再进行半定量分级评分.根据各指标分级情况,将各分数相加,绘制判定甲状腺结节良恶性的ROC曲线,同时确定最佳Youden指数的诊断界点.结果 与良恶性结节相关性最好的是结节形态,其次是结节钙化情况.结节大小、液化及周边血流与良恶性无明显相关.根据相关指标,所得ROC曲线下面积(Az)为0.942(P < 0.05),最佳Youden指数为0.738,其工作界点为13.结论 通过ROC超声多指标评分可提色多普勒超声在判定甲状腺结节良恶性的优势与效能,对甲状腺结节的良恶性作出较为准确的诊断.     

超声弹性成像与常规超声对乳腺病灶鉴别诊断价值的对比研究

目的比较常规超声（包括灰阶超声、彩色多普勒血流显像、频谱多普勒超声）及超声弹性成像对良、恶性乳腺肿块的鉴别诊断价值。方法对手术病理证实的475个乳腺病灶的常规超声、超声弹性成像图像进行回顾性分析,用ROC曲线评价其诊断价值。结果超声弹性成像及常规超声诊断乳腺良恶性病灶的ROC曲线下面积（Az）分别为：0.959和0.899,差异有统计学意义（Z=2.7,P〈0.01）。结论在乳腺良恶性病灶的鉴别诊断方面,超声弹性成像的综合诊断价值优于常规超声。     

高应超声及彩色多普勒血流显像在诊断浅表软组织肿物中的应用

目的：探讨高频超声及彩色多普勒血流显像（CDFI）在诊断浅表软组织肿物中的应用。方法：对84例经手术、病理证实的浅表软组织肿物的二维声像图及彩色多普勒血流显像进行分析。结果：82例为良性,2例为恶性。82例良性肿物中,12例可探及血流信号,均为血管瘤和炎性肿块。囊性肿物的超声诊断符合率为100％。结论：高频超声及彩色多普勒血流显像对浅表软组织肿物的诊断及鉴别诊断具有一定的临床价值。     

乳腺微小实性病灶的弹性应变率比值分析

目的：探讨弹性应变率比值（Strain ratio,SR）在乳腺微小实性病灶（≤10 mm）良恶性鉴别诊断中的价值.方法：对165例共184个乳腺微小病灶进行术前超声实时组织弹性成像（Ultrasonography real-time tissue elastography,URTE）检查,采用SR法分析计算病灶与周围对照组织的SR及其平均值.以病理诊断为金标准,构建受试者工作特征曲线（Receiver operating characteristic,ROC）,获得SR的最佳诊断临界值并分析其对乳腺微小实性病灶良恶性鉴别诊断的价值.结果：184个乳腺病灶中,良性114个,恶性70个.良、恶性病灶SR平均值分别为1.81±0.334,2.92±0.753.根据本组良恶性病灶SR绘制的ROC曲线,曲线下面积（Area under the ROC curve,AUC）为0.891,面积标准误为0.023.面积的95％可信区间为0.846～0.935,不包括0.5,P=0.000,差异具有显著统计学意义.通过ROC曲线分析确定良恶性病灶SR的最佳诊断临界值为2.165.其对应的诊断敏感性（Se）81.4％,特异性（Sp）77.2％,约登指数（YI）为0.586,Se与Sp之和最大（1.586）,误诊率与漏诊率之和最小（0.414）.结论：SR能提供乳腺微小实性病灶硬度信息,有助于病灶的良恶性鉴别诊断.     

彩色多普勒超声对浅表软组织肿块良恶性的鉴别诊断

目的探讨彩色多普勒超声对浅表软组织肿块良恶性的鉴别诊断价值。方法回顾分析经手术和病理证实的96例浅表软组织肿块的声像图资料,观察并分析浅表软组织良恶性肿块的声像图特点及鉴别要点。结果96例浅表软组织肿块中,良性病变79例,其肿块长轴多与皮肤平行,圆度系数平均值为2．57;术前超声诊断与术后病理结果比较,诊断符合率为93．7％（74／79）。恶性肿块17例,恶性肿块圆度系数平均值为1．52,超声诊断符合率为70．6％（12／17）。良恶性肿块圆度系数比较差异有统计学意义（P〈0．05）;肿块的边界、内部回声等其他二维征象,对良恶性肿块的鉴别无显著意义。彩色多普勒超声检查显示：96例浅表软组织肿块中62例探及血流信号,其中良性肿块收缩期峰值流速（PSV）≤20cm／s,阻力指数（RI）〈0．70,与术后病理诊断的符合率分别为91．4％、85．7％,二者作为鉴别良、恶性肿块的临界值,其敏感性、特异性分别为82．9％、87．5％。结论彩色多普勒超声对浅表软组织肿块具有较高的诊断价值,圆度系数、PSV和RI参数可作为鉴别诊断浅表软组织肿块良恶性的依据。     

超声弹性成像对乳腺小实性病灶的鉴别诊断价值

目的 探讨超声弹性成像在乳腺小实性病灶(最大径≤10mm)鉴别诊断中的价值.方法 回顾性分析经手术病理证实的274个乳腺小实性病灶的常规超声及超声弹性成像图像.常规超声采用BI-RADS-US标准判断病灶的良恶性.超声弹性成像采用改良5分评分法判断病灶的良恶性.以手术病理结果为诊断金标准,构建受试者工作特征曲线,比较两种方法对乳腺肿物的诊断率.结果 超声弹性成像及常规超声BI-RADS分级诊断乳腺良恶性病灶的曲线下面积分别为0.891和0.742,差异有统计学意义(Z=4.053,P＜0.001).结论 超声弹性成像有助于乳腺小实性病灶的鉴别诊断.     

超声弹性成像图的面积比对乳腺癌诊断价值的初步研究

目的 探讨超声弹性成像图的面积比对乳腺肿物良恶性判断的价值.方法 对102例女性患者共125个乳腺肿物进行超声弹性成像(UE)检查,获得相应的弹性图,测量肿物的面积比(弹性图像中病灶面积/二维图像中病灶面积).以病理结果作为金标准,构建ROC曲线,判断诊断价值,并进一步与评分法相比较.结果 超声弹性成像图的面积比在乳腺肿物良恶性组之间的差异具有显著性意义(P=0.000 1).面积比判断乳腺肿物良恶性的最佳临界点为1.26,ROC曲线下面积为0.943,其判断乳腺恶性病变的敏感性、特异性、准确性分别为0.864、0.981、0.960.弹性成像评分法判断乳腺恶性病变的敏感性、特异性、准确性分别为0.909、0.990、0.992,其ROC曲线下面积为0.931.两者对乳腺癌诊断价值的差异没有统计学意义(P＞0.05).结论 超声弹性成像图的面积比可用于判断乳腺肿物的良恶性,可以作为评分法提供一定的帮助.     

高频超声对浅表软组织肿物的诊断价值

目的：探讨高频超声对浅表肿物的诊断价值。方法：用高频超声和彩超检查82例浅表肿物，记录病变部位、形态、大小、边缘及彩超表现，并与手术及病理对照。结果：良性肿瘤73例，恶性肿瘤9例。结论：高频超声对浅表肿物敏感性高；对囊性肿物准确率高；结合二维超声、临床表现、彩超血流情况有助于判断肿物良恶性。     

超声对囊实性乳腺癌的诊断价值

目的探讨囊实性乳腺癌的超声特征及超声在乳腺囊实肿物定性诊断方面的价值。方法收集有病理诊断的囊实性乳腺癌病例共11例,回顾性分析其二维图像及彩色多普勒超声特征,于获得病理结果前参照美国放射学会BI-RADS标准对超声图像进行良恶性评判分级,共分为1～5级。结果 11例囊实性肿物最大径平均(4.52±3.24)cm,肿物的纵横比均1;超声表现以囊性为主的4例,实性为主其内伴有液性无回声者7例。可检出血流信号并取到搏动样血流频谱的5例,其中血流阻力指数(RI)大于0.9者有4例;伴有腋下淋巴结转移的2例。超声对乳腺囊实性肿物的良恶性性质的判断:评为4级即术前提示可疑恶性者4例,评为5级即术前提示恶性的有7例,经手术和穿刺病理证实无假阴性。结论超声对囊实性乳腺癌的诊断有较大的优势,相对于囊性为主的囊实性肿物,对实性为主的囊实性肿物更容易做出良恶性判断。     

Does three-dimensional power Doppler ultrasound help in discrimination between benign and malignant ovarian masses?

OBJECTIVES: To determine if tumor vascularity as assessed by three-dimensional (3D) power Doppler ultrasound can be used to discriminate between benign and malignant ovarian tumors, if adding 3D power Doppler ultrasound to gray-scale imaging improves differentiation between benignity and malignancy, and if 3D power Doppler ultrasound adds more to gray-scale ultrasound than does two-dimensional (2D) power Doppler ultrasound. METHODS: One hundred and six women scheduled for surgery because of an ovarian mass were examined with transvaginal gray-scale ultrasound and 2D and 3D power Doppler ultrasound. The color content of the tumor scan was rated subjectively by the ultrasound examiner on a visual analog scale. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated in the whole tumor and in a 5-cm(3) sample taken from the most vascularized area of the tumor. Logistic regression analysis was used to build models to predict malignancy. RESULTS: There were 79 benign tumors, six borderline tumors and 21 invasive malignancies. A logistic regression model including only gray-scale ultrasound variables (the size of the largest solid component, wall irregularity, and lesion size) was built to predict malignancy. It had an area under the receiver-operating characteristics (ROC) curve of 0.98, sensitivity of 100%, false positive rate of 10%, and positive likelihood ratio (LR) of 10 when using the mathematically best cut-off value for risk of malignancy (0.12). The diagnostic performance of the 3D flow index with the best diagnostic performance, i.e. VI in a 5-cm(3) sample, was superior to that of the color content of the tumor scan (area under ROC curve 0.92 vs. 0.80, sensitivity 93% vs. 78%, false positive rate 16% vs. 27% using the mathematically best cut-off value). Adding the color content of the tumor scan or FI in a 5-cm(3) sample to the logistic regression model including the three gray-scale variables described above improved diagnostic performance only marginally, an additional two tumors being correctly classified. CONCLUSIONS: Even though 2D and 3D power Doppler ultrasound can be used to discriminate between benign and malignant ovarian tumors, their use adds little to a correct diagnosis of malignancy in an ordinary population of ovarian tumors. Objective quantitation of the color content of the tumor scan using 3D power Doppler ultrasound does not seem to add more to gray-scale imaging than does subjective quantitation by the ultrasound examiner using 2D power Doppler ultrasound.     

Image-directed color Doppler ultrasonography in the evaluation of superficial solid tumors

Image-directed color Doppler ultrasonography (ICDUS) studies of 86 patients with superficial solid masses yielded significantly lower resistive index (RI) values in acute inflammatory lesions, but no significant difference between the maximum systolic flow velocities (S) of the patient groups with malignant, benign, and acute inflammatory lesions. When analyzed separately, the malignant soft-tissue tumor subgroup was shown to have significantly higher mean RI compared to that of the malignant node subgroup. We conclude that RI may be useful in the differentiation of acute inflammatory masses from other pathological entities. Malignant soft-tissue tumors, especially sarcomas, may have different Doppler features from those of carcinomatous tumors. © 1995 John Wiley & Sons, Inc.     

Prospective cross-validation of Doppler ultrasound examination and gray-scale ultrasound imaging for discrimination of benign and malignant pelvic masses.

OBJECTIVE: To cross-validate, prospectively, the diagnostic performance of established ultrasound methods for discrimination of benign and malignant pelvic masses. METHODS: A total of 173 consecutive women with a pelvic mass judged clinically to be of adnexal origin underwent preoperative ultrasound examination including color and spectral Doppler techniques. A total of 149 tumors were benign, and 24 were malignant. The sensitivity and false-positive rate with regard to malignancy were calculated for the following methods, using cut-off values recommended in previous publications: Lerner score; ultrasound morphology, i.e. tumors without solid components being classified as benign and tumors with solid components as malignant; tumor color score; pulsatility index; resistance index; time-averaged maximum velocity; peak systolic velocity; the combined use of ultrasound morphology and tumor color score and the combined use of ultrasound morphology and peak systolic velocity. Sensitivity and false-positive rate were also calculated for subjective evaluation of the gray-scale ultrasound image and for subjective evaluation of the gray-scale ultrasound image supplemented with subjective evaluation of color Doppler ultrasound examination. The confidence with which the diagnosis was made, based on subjective evaluation, was rated on a visual analog scale. RESULTS: Subjective evaluation of the gray-scale ultrasound image was by far the best method for distinguishing benign from malignant tumors (sensitivity 88%, false-positive rate 4%), followed in descending order by subjective evaluation of the gray-scale ultrasound image supplemented with color Doppler examination, the Lerner score and the time-averaged maximum velocity. Adding Doppler examination to subjective evaluation of the gray-scale image did not increase the number of correct diagnoses, but it increased the confidence with which a correct diagnosis was made in 14% of tumors. In 11 tumors (6% of the series as a whole), the addition of Doppler examination changed the diagnosis based on subjective evaluation of the gray-scale ultrasound image from an incorrect (n = 1) or uncertain (n = 10) diagnosis to a correct and confident diagnosis. CONCLUSION: In experienced hands, subjective evaluation of the gray-scale ultrasound image is the best ultrasound method for discriminating between benign and malignant adnexal masses. The main advantage of adding Doppler examination to subjective evaluation of the gray-scale image is an increase in the confidence with which a correct diagnosis is made.     

经静脉声学造影剂增强乳腺肿块彩色血流信号的初步研究

本文探讨经静脉声学造影剂对乳腺肿块彩色血流信号的增强作用及鉴别良恶性病变的应用价值。１０例患者中７例为乳腺癌，３例为良性肿块，经静脉注射声学造影剂后，病灶区彩色血流信号显著增强：６例乳腺癌和１例良性肿块病灶内见有片状彩色血流区，血管数增多２～６条；１例直径＜１．０ｃｍ的乳腺癌见有１条彩色血流束；２例良性肿块中１例无彩色信号而另１例仅有１条血管。结果提示：经静脉声学造影剂能显著增强乳腺肿块彩色多普勒血流信号，更准确地反映肿块血供状况；有助于准确鉴别乳腺良、恶性病变。     

超声定位光散射成像技术在乳腺肿块定性诊断中的价值

目的探讨运用超声定位光散射乳腺成像(US-guided optical imaging system,OPTIMUS)系统对乳腺肿块的定性诊断价值。方法回顾分析经病理检查证实且同时应用OPTIMUS系统和彩色多普勒超声诊断的36例乳腺肿块,评价两种方法的诊断结果与病理诊断的一致性。并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积(area under the curve,AUC),判断OPTIMUS系统及彩色多普勒超声两种检查手段的准确性。结果 36例乳腺肿块术后病理诊断良性16个,恶性20个。彩色多普勒超声诊断乳腺肿块中良性17个,恶性19个;OPTIMUS系统诊断乳腺肿块中良性14个,恶性22个。OPTIMUS系统、彩色多普勒超声诊断与病理诊断结果的一致性检验Kappa值分别为0.772、0.497,其两者之间一致性检验Kappa值为0.606。OPTIMUS系统、彩色多普勒超声诊断的AUC分别为0.923(95%CI:0.834～1.013)、0.802(95%CI:0.654～0.949)。结论 OPTIMUS对乳腺肿块的定性判断较彩色多普勒超声诊断准确性及敏感性高,两者结合可进一步提高诊断准确性。     

彩色多普勒超声在浅表组织肿块良恶性鉴别诊断中的应用价值

目的：探讨彩色多普勒超声对浅表组织肿块良恶性的鉴别诊断价值。方法采用回顾性研究的方法,对我院收治的经彩色多普勒超声证实的100例浅表组织肿块进行声像图分析,并与手术和术后病理结果比较,比较浅表组织肿块良性和恶性的声像图特点和血流信号。结果100例浅表组织肿块中共有80例为良性病变：肿块长轴与皮肤平行,平均圆度系数为2．58,与术后病理诊断符合率为93．8％;有20例为恶性肿块：平均圆度系数为1．51,诊断符合率为70．0％。良性与恶性肿块的圆度系数以及后方回声衰减经统计学检验表明二者差异有显著性（P ＜0．05）,而良性与恶性肿块的内部回声、边界等二维征象方面差异无统计学意义（P ＞0．05）。彩色多普勒超声结果表明：100例软组织肿块中66例有血流信号,良性肿块收缩期峰值流速不高于20 cm/s,阻力系数低于0．70,与术后病理结果的诊断符合率分别为91．7％和86．1％,可作为良性和恶性肿块鉴别的临界值（P ＜0．05）,其特异性和敏感度分别为87.7％和83．0％。结论彩色多普勒超声在浅表组织肿块良恶性鉴别中具有较高的应用价值,其诊断符合率高,成像清晰,而肿块的圆度系数、后方回声衰减、收缩期峰值流速和阻力系数均可作为良恶性肿块鉴别依据。     

Characterization of Benign and Malignant Solid Breast Masses: Harmonic Versus Nonharmonic 3D Power Doppler Imaging

The aim of this study was to compare the diagnostic performance of nonharmonic ultrasound (US) and tissue harmonic imaging (THI) using three-dimensional (3D) power Doppler sonographic technique to classify benign and malignant breast tumors by vascularization. From January 2003 to February 2004, we evaluated 200 patients and one of lobular carcinoma in situ was excluded from the malignant category. One hundred and ninety-nine subjects were enrolled. All subjects with one or more breast masses were studied with 3D power Doppler US nonharmonic and harmonic technologies. Sixteen of 199 subjects were excluded because masses exceeded 3 cm limit of our US probe's footprint (n = 5) or no harmonic Doppler information (n = 11). A total of 97 benign and 86 pathologically proven malignant breast tumor images were analyzed. 3D power Doppler US imaging was performed using a Voluson730 US system. Three histogram indices, the vascularization index (VI), flow index (FI) and vascularization-flow index (VFI), on both nonharmonic and harmonic images were calculated for the intratumor and for shells with an outside thickness of 3 mm surrounding the breast lesion. A multilayer perception (MLP) neural network classifier used the vascularity indices to determine whether the breast tumors are benign or malignant. The receiver operating characteristic (ROC) curves are performed to estimate the diagnostic performances for nonharmonic and harmonic methods. ROC curve analysis used overall age, volume, VI, FI and VFI for both intratumor and shells with an outside thickness of 3 mm surrounding the breast lesions in nonharmonic US and THI. The area under the ROC curve (A_Z) was 0.9086 and 0.9009 (p = 0.3770). The sensitivity was 90.7% and 83.7% (p = 0.72), respectively, and the specificity was 92.8% and 92.8% (p = 1.00), respectively. In conclusion, the performance of 3D power Doppler US with respect to the characterization of solid breast masses as benign or malignant was not significantly improved with tissue harmonic imaging. (E-mail: darren_chen@cch.org.tw)     

彩色多普勒超声血流阻力指数联合糖链抗原125对卵巢肿瘤的诊断价值

目的探讨彩色多普勒超声血流阻力指数（resistance index,RI）联合血清糖链抗原125（carbohydrate antigen 125,CA125）检测在卵巢良、恶性肿瘤鉴别诊断中的价值。方法检测60例卵巢肿瘤患者血清CA125水平,并行彩色多普勒超声检查记录RI,与手术组织病理结果进行对照,比较RI及RI联合CA125诊断卵巢肿瘤的效能。结果手术组织病理诊断卵巢良性肿瘤45例,恶性肿瘤15例;RI联合CA125诊断良性、恶性卵巢肿瘤的准确率（93.33%、86.67%）高于RI（66.67%、53.33%）（P〈0.05）。结论彩色多普勒超声RI联合血清CA125检测鉴别诊断良、恶性卵巢肿瘤优于单独应用彩色多普勒超声RI。     

二维及彩色多普勒超声对良性、交界性、恶性卵巢肿瘤的诊断价值

目的　探讨经腹二维及彩色多普勒超声对良性、交界性、恶性卵巢肿瘤的诊断价值。方法　对 118例卵巢肿瘤进行二维及彩色多普勒超声检测 ,并对其良性、交界性、恶性卵巢肿瘤的形态、包膜、内部结构、实性回声面积、周边、腹水及内部血流阻力指数进行对比分析。结果　良性、交界性、恶性卵巢肿瘤的形态、包膜、内部结构及实性回声面积有明显差异 (P <0 .0 1)。 61%的恶性肿瘤出现腹水 ,而良性肿瘤不足 2 % ,交界性卵巢肿瘤 44 %出现腹水。三者周边和内部血流的检出无差异 (P >0 .0 5 ) ,而内部血流的阻力指数有明显差异 (P <0 .0 1)。结论　超声形态学和彩色多普勒检测卵巢肿瘤的血流阻力指数 ,能够提高良性、交界性、恶性卵巢肿瘤的诊断价值