声脉冲辐射力成像技术在乳腺病灶诊断中的初步研究

目的 探讨声脉冲辐射力成像（ARFI） 技术在乳腺病灶良恶性鉴别诊断中的应用价值。方法应用基于ARFI研制的超声弹性成像新技术声触诊组织定量分析（VTQ）, 对146例患者共150个乳腺病灶进行超声弹性量化检测,所有病灶均经手术或穿刺活检病理证实。采用受试者工作特征（ROC）曲线评价VTQ值对乳腺病灶良恶性的鉴别诊断价值,并确定临界值。结果150个乳腺病灶中有55个良性和95个恶性。乳腺病灶良性组与恶性组的VTQ值分别为（2.05±1.58）m/s和（6.94±2.11）m/s,两组差异有统计学意义（P＜0.01）。以VTQ值2.5m／s为临界值诊断乳腺病灶的良恶性,诊断恶性的敏感度为79％,特异度为71％,准确度为75％;以VTQ值28m／s为临界值诊断最小径≥8mm乳腺病灶的敏感度为90％,特异度为82％,准确度为85％。结论 ARFI技术为乳腺病灶的超声诊断提供了一个新的定量指标VTQ值,其对鉴别乳腺病灶,特别是最小径≥8mm病灶的良恶性有较高的诊断价值。     

声辐射脉冲成像技术鉴别肝脏肿瘤良恶性的临床研究

 目的　探讨声辐射脉冲成像（ARFI）技术检测肝脏肿瘤组织硬度、评价肿瘤性质的临床价值。方法　对91例肝肿瘤患者的103个病灶进行ARFI检测,其中良性肿瘤55个,恶性肿瘤48个,所有病灶均进行声触诊组织成像（VTI）及声触诊组织定量（VTQ）检测及分析,比较良恶性肿瘤VTI图像特征及VTQ值差异,分析受试者工作特征曲线（ROC）的最佳临界值。结果　VTI图像上,硬度高于周围肝组织的恶性肿瘤占79.17 %（38／48）,良性肿瘤占56.36 %（31／55）,两者差异有统计学意义（χ2＝0.627,P＜0.01）。良性肿瘤VTQ值为（1.72±0.39）m／s,恶性肿瘤VTQ值为（2.64±0.65）m／s,两者比较差异有统计学意义（t＝8.638,P＜0.01）。以2.10 m／s为VTQ截断值,诊断ROC曲线上最佳临界点,其诊断肝脏恶性肿瘤的敏感度、特异度分别为83.3 %、81.8 %。结论　ARFI弹性成像技术提供的组织硬度信息有助于良恶性肝脏肿瘤的鉴别诊断,有望成为未来新的成像模式。     

ARFI技术在乳腺良恶性结节鉴别诊断中的价值

目的:探讨声脉冲辐射力弹性成像技术（acoustic radiation force impulse,ARFI）对乳腺良恶性结节鉴别诊断的临床应用价值。方法:选取2015年1月至2017年12月在我院诊治，对有明确病理诊断结果的185例乳腺结节患者（199个病灶）的临床诊断资料进行回顾性分析。分别应用VTI、VTQ技术对乳腺结节进行诊断，对比分析诊断结果。结果:VTQ鉴别诊断乳腺良恶性结节正确162个，误诊37个，诊断准确率81%；绘制ROC曲线分析得出AUC为0.86，良、恶性结节最佳截断值为4.6 m/s，此时诊断敏感度82%，特异度84%。 VTI诊断乳腺结节正确149个，误诊50个，诊断准确率75%；进行ROC曲线分析，AUC为0.76，以VTI分级≥IV级作为乳腺良恶性结节的鉴别诊断点，其敏感度78%，特异度74%。结论:声脉冲辐射力弹性成像技术为乳腺良、恶性结节的鉴别诊断提供了一种新的诊断方法，具有很高的临床应用价值。     

声脉冲辐射力弹性成像对甲状腺微小癌的诊断价值

目的探讨声脉冲辐射力(ARFI)弹性成像对甲状腺微小癌(TMC)的诊断价值。方法对徐州医学院附属医院2014年7月至2015年7月期间收治的甲状腺小结节患者47例53个最大径≤1 cm结节应用常规超声及ARFI弹性成像进行检查。以病理诊断为金标准,分别绘制VTI与VTQ诊断TMC的ROC曲线,比较曲线下面积。结果 53个结节包括良性病变25个,恶性病变28个。VTI检查硬度分级≥Ⅳ级结节22个,包括良性病变0个,恶性22个;VTI分级Ⅳ级结节31个,包括良性病变25个,恶性6个。VTI诊断TMC的敏感性、特异性、准确率分别为78.6%、100%、88.8%。VTQ检查横向剪切波速度(SWV)≥2.76m/s结节25个,其中7个良性病变,18个恶性病变;SWV2.76 m/s结节28个,其中18个良性病变,10个恶性病变。VTQ诊断TMC的敏感性、特异性、准确率分别为64.3%,72.0%,67.9%。VTI及VTQ诊断TMC的ROC曲线下面积(AUC)分别为0.898和0.672(Z=2.317,P=0.0351)。结论 ARFI弹性成像鉴别诊断TMC效果良好,其中VTI较VTQ具有更高的诊断价值。     

声脉冲辐射力成像技术对鉴别良恶性胆囊壁增厚的应用价值

目的:探讨声脉冲辐射力成像技术（coustic radiation force impulse，ARFI）鉴别良恶性胆囊壁增厚的应用价值。方法:使用西门子超声的声脉冲辐射力（ARFI）弹性成像的声触诊组织定量成像（virtual tough tissues quantification ，VTQ ）和声触诊组织定性成像（virtual tough tissues imaging，VTI）检测327 例受检者的胆囊壁，比较取样区胆囊壁的横向剪切波速度即声触诊组织量化值（VTQ ）及VTI 图像特征。结果:正常胆囊壁、良性增厚胆囊壁与壁厚型胆囊癌胆囊壁的VTI 图像有明显差异，VTQ 测值有显著差异（P < 0.05），根据ROC 曲线分析最佳诊断界值，当剪切波速度≥ 2.65m/s时，诊断胆囊癌的灵敏度、特异度分别为94.0% 、93.7% 。结论:声脉冲辐射力成像技术可以无创鉴别良恶性胆囊壁增厚，具有临床应用价值。      

声脉冲弹性成像(ARFI)中VTQ、VTIQ及CEUS在甲状腺TI-RADS 4级结节中的鉴别诊断价值

目的:比较声脉冲弹性成像(acoustic radiation force impulse, ARFI)中声触诊定量技术(virtual touch quantification, VTQ)、声触诊组织成像定量技术(virtual touch tissue imaging quantification, VTIQ)与超声造影(contrast enhanced ultrasound, CEUS)对甲状腺影像报告和数据系统(TI-RADS)4级结节良恶性的鉴别诊断价值。方法:选取2018年08月至2020年01月在本院接受超声检查的甲状腺结节患者97例(109个结节),根据术后病理结果分为良性组(57例,61个结节)、恶性组(40例,48个结节)。比较两组VTQ、VTIQ检查的剪切波速度(SWV)值及CEUS结果;采用受试者工作特征曲线(ROC)比较VTQ、VTIQ、CEUS对甲状腺TI-RADS 4级结节良恶性的鉴别诊断价值。结果:恶性组VTQ检查的SWV值为[(3.19±0.48) m/s],高于良性组[(2.62±0.46) m/s],且恶性组VTIQ检查的SWV值[(3.81±0...     

扩散加权成像中表观弥散系数和相对表观弥散系数对乳腺恶性肿瘤的诊断价值

目的 探讨扩散加权成像(DWI)中表观弥散系数(ADC)和相对表观弥散系数(rADC)对乳腺恶性肿瘤的诊断价值.方法 对53例进行乳腺疾病初诊的女性患者的66个病灶,应用单次激发自旋回波-平面回波序列(SE-EPI)进行扫描,在相同的感兴趣区(ROI)下,分别于扩散敏感系数(b)为500和800 s/mm~2.时,测量病灶及同侧远隔部位正常乳腺腺体的ADC值,并计算rADC值.根据受试者工作特性曲线(ROC),确定鉴别乳腺良、恶性病变的最佳ADC和rADC阈值,评价不同b值下,各阈值鉴别诊断乳腺良、恶性病变的敏感度、特异度和准确率.结果 当b值为500 s/mm~2时.良、恶性病灶对应的ADC值分别为(1.71±0.31)×10~(-3)mm~2/s和(1.31±0.38)×10~(-3) mm~2/s,诊断乳腺恶性肿瘤的最佳ADC阈值为1.435×10~(-3)mm~2/s,其诊断的敏感度为82.1%,特异度为81.5%;最佳rADC阈值为0.62,其诊断的敏感度为76.9%,特异度为100%.当b值为800 s/mm.时,良、恶性病灶的ADC值分别为(1.55士0.29)×10~(-3)mm~2/s和(1.14±0.29)×10~(-3)mm~2/s,诊断乳腺恶性肿瘤的最佳ADC阈值为1.295×10~(-3)mm~2/s,其诊断的敏感度为79.5%,特异度为81.5%;最佳rADC阈值为0.71时,诊断的敏感度为89.7%,特异度为88.9%.当b值为800 s/mm~2、rADC的诊断阈值为0.71时,ROC曲线下面积最大.结论 DWI扫描时间短,无需对比剂.ADC和rADC作为诊断指标,其敏感度、特异度均较高,尤其是rADC,对乳腺恶性肿瘤的诊断具有较高的临床应用价值.     

声脉冲辐射力技术结合BIRADS分类在乳腺实性肿块鉴别诊断中的应用价值

目的:探讨声脉冲辐射力技术（ARFI）结合超声BIRADS分类在乳腺实性肿块良恶性鉴别中的应用价值。方法:对来我院检查诊断为乳腺实性肿块的82位患者,进行ARFI弹性成像和BIRADS分级,以病理结果为金标准,分别对ARFI结合BIRADS诊断肿块良恶性和单一运用ARFI及BIRADS诊断乳腺肿块良恶性的准确性进行统计学分析。结果:ARFI联合BIRADS分类诊断乳腺实性肿块良恶性的特异性、灵敏度、阳性预测值、阴性预测值、准确性各为96%、98.8%、96%、98.8%、98.1%,Kappa值为0.948,单用ARFI诊断乳腺实性肿块良恶性的特异性、灵敏度、阳性预测值、阴性预测值、准确性各为88%、96.3%、88%、96.3%、94.3%,Kappa值为0.843。单用BIRADS分类法诊断乳腺实性肿块良恶性的特异性、灵敏度、阳性预测值、阴性预测值、准确性各为84%、95.1%、84%、95.1%、92.5%,Kappa值为0.791。ARFI联合BIRADS分类诊断效能与较单独运用ARFI及BIRADS相比,差异有统计学意义（P＜0.05）。结论:AFRI联合BIRADS分类诊断肿块良恶性能提高诊断的准确性,值得推广。     

声辐射力脉冲成像与超声造影诊断良恶性肾脏肿瘤研究

目的探讨声辐射力脉冲成像与超声造影诊断良恶性肾脏肿瘤的临床意义。方法以2015年6月至2017年8月甘肃庆阳市合水县中医院及庆阳市人民医院收治的68例肾脏肿瘤患者为研究对象,采用声辐射力脉冲成像与超声造影检查,以术后病理检查结果为金标准,比较声辐射力脉冲成像与超声造影对良恶性肾脏肿瘤的诊断意义。结果术后病理检查结果显示,恶性肿瘤患者51例(肾透明细胞癌41例,肾乳头状癌5例,嫌色细胞癌3例,未分类肾细胞癌2例),良性肿瘤患者17例(血管平滑肌脂肪瘤14例,嗜酸细胞腺瘤3例)。声辐射力脉冲成像结果提示,47例恶性病灶,21例良性病灶。超声造影结果显示,43例典型造影特征为恶性病灶,25例呈现向心性增强模式为良性病灶。声辐射力脉冲成像与超声造影对肾脏肿瘤定性诊断的敏感度、准确度及特异性相比,差异无统计学意义(P0.05),两者联合诊断可提高对良恶性肾脏肿瘤诊断敏感度和准确度。结论声辐射力脉冲成像技术与超声造影对肾脏肿瘤定性诊断具有重要意义,联合诊断可提高敏感性和准确性。     

超声造影和声辐射力脉冲技术在肾良恶性肿瘤鉴别诊断中的价值比较

目的 探讨超声造影和声辐射力脉冲技术在鉴别诊断肾实质良恶性病灶中的应用价值。方法对67例疑似肾肿瘤患者进行超声造影（CEUS）和声辐射力脉冲（ARFI）技术检查,所有检查结果均经手术后病理证实或随访观察证实,采用双盲法分析两种超声技术对肾脏良恶性肿瘤的诊断价值。结果 CEUS诊断肾良、恶性肿瘤的敏感度、特异性、准确率分别为89.80%、88.89%、89.55%;ARFI技术诊断的敏感度、特异性、准确率分别为81.63%、83.33%、82.09%;两者的诊断效能（敏感度、特异性、准确率）差异无统计学意义（均P>0.05）。结论 CEUS与ARFI技术在诊断肾脏肿瘤的良恶性方面,具有相似的敏感度和准确率,两者对肾脏肿瘤的诊断可起到互补作用,为临床正确诊治疾病提供参考。     

声辐射力脉冲超声弹性成像对乳腺实质性病灶的诊断(英文)

Objective:The aim of our study was to make the qualitative and quantitative analysis to breast lesions using acoustic radiation force impulses (ARFI), and assess the diagnostic value of ARFI for differentiation between benign and malignant solid breast masses, meanwhile evaluate the influences of ARFI with breast imaging reporting and data system (BI-RADS) of suspicious masses. Methods:Seventy-five women with 86 breast lesions underwent conventional breast ultrasound examination. Then B-mode BI-RADS features and assessments were recorded and standard breast US supplemented by ARFI elastographic examination were repeated. The data were recorded and analyzed as following:area ratio of breast lesion, the shear-wave velocity, the ratio of the shear-wave velocity between lesions and surrounding normal tissues, and according to the elastographic data reconsidered the BI-RADS category, all the results have been correlated with pathological results and make statistical evaluations of ARFI for differentiation between benign and malignant solid breast masses. Meantime our study has correlated the adjusted BI-RADS category of suspicious breast lesions with the pathological results and made assessment. Results:Thirty-eight patients were malignant breast carcinoma (31 invasive ductal carcinoma, 5 intraductal carcinoma in situ, 2 medullary carcinoma, 2 invasive lobular carcinoma), 48 patients were benign breast lesions (23 fibroadenoma, 12 benign nodular hyperplasia, 5 phyllodes tumor, 6 adenosis, 2 intraductal papilloma). Underwent conventional breast ultrasound exam, 42 cases were BI-RADS category 3, 23 cases were BI-RADS category 4. When adding elastographic data, 46 cases were BI-RADS category 3 and 20 cases were BI-RADS category 4. Compared with pathological results showed for both the specificity of BIRADS features and the area under ROC curve has risen. Virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ) data showed the area ratio (AR) between elastographic lesions area and B-mode lesions area, SWV (maximal shear-wave velocity of lesions), R-SWV (shear-wave velocity ratio between lesions and surrounding normal tissues) in benign breast lesions were lower than those in malignant lesions which has statistical significance and the cut-off point were 1.1, 4.65 m/s, 5.18 respectively. Conclusion:The ARFI elastography can provide the reliable qualitative and quantitative analysis about hardness of breast lesions, supply the new BI-RADS category features to suspicious breast masses and serve as an effective diagnostic tool for differentiation between benign and malignant solid masses.     

声脉冲辐射力成像技术评价乳腺癌新辅助化疗疗效的价值研究

目的 探讨声脉冲辐射力成像技术(ARFI)在乳腺癌新辅助化疗疗效评价中的应用价值.方法 选取42例原发性浸润性乳腺癌患者(共42个病灶),所有患者均于新辅助化疗后行外科手术治疗.应用ARFI技术测量新辅助化疗前后病灶最大弹性值变化率.以Millen-Payne(MP)分级系统作为病理反应的评价依据,Ⅰ~Ⅲ级为组织学非显著反应,Ⅳ~Ⅴ级为组织学显著反应.以手术病理诊断为金标准,应用受试者工作特征曲线(ROC)评价ARFI的诊断价值.结果 42例乳腺癌组织中,69.05%(29/42)为组织学显著反应,30.95%(13/42)为组织学非显著反应.通过ROC曲线确定的评价新辅助化疗有效和无效的VTQ值变化率诊断界值为29%(曲线下面积为0.925,95%CI:0.863~0.987),敏感度为91.1%,特异度为83.3%,准确度为87.7%.新辅助化疗后,组织学显著反应组乳腺癌患者的VTQ值(弹性值)明显低于化疗前,差异有统计学意义(P﹤0.01).结论 ARFI技术可通过定量测量新辅助化疗前后乳腺癌硬度变化,为乳腺癌新辅助化疗的疗效评估提供新方向.     

Diagnostic Value of Elastography Using Acoustic Radiation Force Impulse Imaging and Strain Ratio for Breast Tumors

Purpose

The aim of this study was to determine whether the combination of B-mode ultrasonography (BUS), acoustic radiation force impulse (ARFI) elastography, and strain ratio (SR) provides better diagnostic performance of breast lesion differentiation than BUS alone.

Methods

ARFI elastography and SR evaluations were performed on patients with 157 breast lesions diagnosed by BUS from June to September 2013. BUS images were classified according to the Breast Imaging-Reporting and Data System. ARFI elastography was performed using Virtual Touch™ tissue imaging (VTI) and Virtual Touch™ tissue quantification (VTQ). In VTI mode, we evaluated the color-mapped patterns of the breast lesion and surrounding tissue. The lesions were classified into five categories by elasticity score. In VTQ mode, each lesion was assessed using shear wave velocity (SWV) measurements. SR was calculated from the lesion and comparable lateral fatty tissue. We compared the diagnostic performance of BUS alone and the combination of BUS, ARFI elastography, and SR evaluations.

Results

Among the 157 lesions, 40 were malignant and 117 were benign. The mean elasticity score (3.7±1.0 vs. 1.6±0.8, p<0.01), SWV (4.23±1.09 m/sec vs. 2.22±0.88 m/sec, p<0.01), and SR (5.69±1.63 vs. 2.69±1.40, p<0.01) were significantly higher for malignant lesions than benign lesions. The results for BUS combined with ARFI elastography and SR values were 97.5% sensitivity, 92.3% specificity, 93.6% accuracy, a 79.6% positive predictive value (PPV), and a 99.1% negative predictive value. The combination of the 3 radiologic examinations yielded superior specificity, accuracy, and PPV compared to BUS alone (p<0.01 for each).

Conclusion

ARFI elastography and SR evaluations showed significantly different mean values for benign and malignant lesions. Moreover, these two modalities complemented BUS and improved the diagnostic performance of breast lesion detection. Therefore, ARFI elastography and SR evaluations can be used as complementary modalities to make more accurate breast lesion diagnoses.