彩色多普勒超声及超声造影在乳腺癌新辅助化疗疗效评估中的价值

目的探讨彩色多普勒超声及超声造影对乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)疗效评估中的应用价值。方法选取2014年1月—2015年6月收治的行NAC乳腺癌患者60例,分别于NAC前和NAC后应用彩色多普勒超声记录病灶大小、血流分级、血流阻力指数等指标;对其中26例行超声造影检查患者记录造影相关参数,包括造影剂到达肿瘤的时间、达峰时间及峰值强度。根据NAC前、后各项指标变化情况评估NAC疗效。结果NAC后病灶最大径、形态、边界、周边晕带、内部回声变化、血流分级及血流阻力指数均较NAC前差异有统计学意义（P<0.05）。NAC后造影相关参数到达肿瘤的时间、达峰时间及峰值强度均较NAC前有明显变化,差异有统计学意义（P<0.05）。结论超声造影可以通过检测乳腺癌NAC前、后各项指标变化情况,准确评估NAC疗效。     

彩色多普勒超声对乳腺癌的诊断及误诊分析

目的:分析乳腺癌的二维超声及彩色多普勒血流特点,并对超声误诊的小乳腺癌加以分析,以提高乳腺癌的诊断准确率。方法:采用AgilentSONOS5500型彩色多普勒超声诊断仪,对63例乳腺癌(包括超声误诊的6例小乳癌)患者进行彩色多普勒显像检查,获取肿块的二维影像、彩色多普勒血流分级、最大流速(Vmax)、阻力指数(RI)等多参数指标,并与术后病理对照,分析超声误诊原因。结果:63例乳癌中形态不规则56例(56/63),占88.9%,回声不均57例(57/63),占90.4%,病灶内簇状微小钙化点45例(45/63),占71.4%,后方回声衰减53例(53/63),占84.1%。血流动力学分析:彩色多普勒血流分级为2-3级48例(48/63),占76.1%,Vmax≥20cm/s42例(42/63),占66.6%,RI≥0.746例(46/63),占73.0%,超声误诊的6例小乳癌中误诊为纤维腺瘤3例,乳腺增生结节2例,乳腺脓肿1例,且均为直径少于2cm的小乳癌。结论:综合分析乳腺癌的二维及彩色血流特点,可提高乳腺癌的诊断率,而对<2cm的小乳癌,包块境界较清晰,回声较均且包块内血流不显示者误诊率较高。     

彩色多普勒血流特征在乳腺癌和纤维腺瘤诊断中的应用价值

目的:探讨彩色多普勒血流分布特征在乳腺癌和纤维腺瘤诊断中的应用价值。方法:应用彩色多普勒血流显像观测50例乳腺癌与62例乳腺纤维瘤的血流走行、分布特点,按肿块大小分为Ⅰ组(直径2.0cm)和Ⅱ组(直径≤2.0cm)。结果:乳腺纤维瘤组的血流总检出率为32.3%(20/62),低于乳腺癌98%(49/50),两组差异有显著性(P0.05);直径≤2.0 cm的,乳腺癌组血流检出率为85.7%(30/35),乳腺纤维瘤组仅为7.3%(4/41),两组差异有显著性(P0.05);直径2.0cm的,乳腺癌、乳腺纤维瘤的血流检出率分别为100%(15/15)、80.1%(17/21),两组无显著差异(P0.05)。乳腺癌组血流分级0~Ⅰ级为16%(8/50),低于乳腺纤维瘤组90.3%(56/62),乳腺癌组血流分级Ⅱ~Ⅲ级为84%(42/50),高于乳腺纤维瘤组9.7%(6/62),两组差异有显著性(P0.05)。乳腺纤维瘤组的周边血流检出率为70%(14/20),高于内部血流检出率30%(6/20)(P0.05)。乳腺纤维瘤组彩色多普勒血流未见穿入型血管。乳腺癌组的周边血流检出率为61.2%(30/49),高于内部血流流检出率28.6%(14/49),与乳腺纤维瘤组无显著差异(P0.05);10.1%(5/49)的乳腺癌可探及穿入型血管,与乳腺纤维瘤相有显著差异(P0.05)。结论:彩色多普勒血流显像可明确地显示乳腺癌和纤维瘤血管的分布及形态特征,能够提高乳腺癌诊断的准确性。     

高频及彩色多普勒超声对早期乳腺癌诊断价值分析

目的评价高频超声及彩色多普勒血流成像对早期乳腺癌的诊断价值。方法 45例经手术病理证实为无淋巴结转移的早期乳腺癌患者,术前均经高频超声与彩色多普勒血流成像检查。对所有患者的超声表现进行了回顾性分析。结果本组45例中,锯齿状或蟹虫样病变见于41例,内部低回声45例,后方衰减28例,肿块内微钙化23例,丰富的彩色血流信号10例。术前超声正确诊断38例,包括浸润性导管癌30例,单纯癌5例,黏液腺癌1例,乳头状癌1例,以及浸润性小叶癌1例,而其余7例术前误诊为良性病变,包括纤维腺瘤2例和增生结节5例。与病理对照,术前超声诊断准确率为84.4%。结论早期乳腺癌有一定的超声表现特征,因此,高频超声及彩色多普勒血流成像对尽早发现乳腺癌具有重要应用价值。     

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。     

乳腺癌的彩色多普勒及高频超声表现(附82例分析)

目的 探讨乳腺癌的高频超声图像特征及彩色多普勒血流表现。方法回顾性分析82例经手术、病理证实为乳腺癌的高频超声表现及彩色多普勒血流特征：结果乳腺癌的高频超声图像像，如肿块的形态、边界、内部回声、钙化、衰减及彩色多普勒血流，有一定的特征。结论高频超声与彩色多普勒技术联合应用诊断乳腺癌，其诊断符合率会有一定的提高。     

彩色多普勒超声诊断特殊类型乳腺癌的应用价值

目的：探讨彩色多普勒超声诊断特殊类型乳腺癌的应用价值。方法：回顾性分析7例经手术、病理证实为特殊类型乳腺癌各型的声像图及彩色多普勒血流表现。结果：炎性乳腺癌病变广泛，图像表现多样化，呈多发性或巨大肿块，内部为混合性或实性改变。双侧乳腺癌、哺乳期乳腺癌及男性乳腺癌图像有典型的恶性肿瘤特征，乳腺派杰氏病早期腺体内无局限性病灶。结论：彩色多普勒超声对炎性乳癌、双侧乳腺癌、哺乳期乳腺癌及男性乳腺癌的诊断有重要价值。乳腺派杰氏病早期确诊主要依赖于病理检查。     

彩色多普勒超声鉴别乳腺良恶性肿瘤的临床价值

目的：研究乳腺良恶性肿瘤的声像图彩色多普勒血流的表现,探讨彩色多普勒超声在鉴别乳腺良恶性肿瘤中的实用价值。方法：对68例经病理确诊患者的声像图资料,结合病理进行综合分析。结果：乳腺良恶性肿瘤在测量值的纵横比、形态、边界、包膜、内部回声、后方衰减、回声的类型、钙化、腋窝淋巴结、血流的分级、血流形态等均存在显著差异。结论：根据乳腺良恶性肿瘤的彩超特点及病理进行综合分析,具有较高的诊断价值。     

乳腺癌患者新辅助化疗的MRI研究

乳腺癌新辅助化疗(亦称初始化疗或术前化疗)最初是指对局部晚期乳腺癌患者手术治疗之前所进行的辅助化疗,目前己将该治疗扩展至肿瘤较大的可手术的乳腺癌患者,以使肿瘤降期,进而达到保乳手术治疗的目的。随着新辅助化疗在乳腺癌患者中不断推广应用,临床实践中迫切需要一种能准确评价化疗后肿瘤变化的检查方法,本文对RI(magnetic resonance imaging)在乳腺癌新辅助化疗中的研究进行综述。     

彩色多普勒超声在乳腺癌TNM分期中的应用

目的探讨彩色多普勒超声检查对乳腺癌TNM分期的评价能力。方法108例乳腺癌患者于术前1周内均经临床乳房触诊分期和彩色多普勒超声分期,并与术后1周内病理分期(用作金标准)相比较。结果术前彩色多普勒超声检查对TNM分期的准确率与术后病理分期无明显差异(P>0.05),而显著高于术前临床乳房触诊分期(p<0.01)。该两种方法的TNM分期准确率分别为92%和76%。临床触诊对腋淋巴结的误诊率与漏诊率分别为15%和17%,而彩超仅为5%和4.6%。结论彩色多普勒超声对乳腺癌术前TNM分期具有明显优势,且能减少术前单靠临床触诊所导致的盲目性。     

乳腺癌新辅助化疗疗效评价的相关研究

术前新辅助化疗已成为局部进展期乳腺癌患者的标准化治疗方法,随着新辅助化疗在临床治疗中的广泛应用,疗效评价显得尤为重要。如何能无创、及时、准确、有效地评价化疗疗效已成为临床研究的重点。目前临床上通常采用临床触诊、影像学测量及病理学检查等方法,同时对乳腺癌生物学因子的研究也在迅速展开。现将各种评价方法的应用现状作一综述。     

彩色多普勒血流显像和脉冲多普勒技术对乳腺肿块的诊断作用

目的 探讨彩色多普勒血流显像和脉冲多普勒超声在乳腺肿块诊断中的应用价值。方法 对90例乳腺肿块行彩色多普勒血流显像和脉冲多普勒血流研究，测量其血流参数。结果 乳腺恶性肿块内收缩期峰值血流速度（Vp)、阻力指数（RI）、搏动指数（PI）均高于良性肿块，两组间有显性差异（P＜0.01)。结论 在乳腺肿块诊断中，彩色多普勒血流显像和脉冲多普勒技术是一种简便、有效的辅助检查方法。     

Prognostic value of pre-treatment DCE-MRI parameters in predicting disease free and overall survival for breast cancer patients undergoing neoadjuvant chemotherapy

The purpose of this study was to investigate whether dynamic contrast enhanced MRI (DCE-MRI) data, both pharmacokinetic and empirical, can predict, prior to neoadjuvant chemotherapy, which patients are likely to have a shorter disease free survival (DFS) and overall survival (OS) interval following surgery. Traditional prognostic parameters were also included in the survival analysis. Consequently, a comparison of the prognostic value could be made between all the parameters studied.MR examinations were conducted on a 1.5 T system in 68 patients prior to the initiation of neoadjuvant chemotherapy. DCE-MRI consisted of a fast spoiled gradient echo sequence acquired over 35 phases with a mean temporal resolution of 11.3 s. Both pharmacokinetic and empirical parameters were derived from the DCE-MRI data. Kaplan-Meier survival plots were generated for each parameter and group comparisons were made utilising logrank tests.The results from the 54 patients entered into the univariate survival analysis demonstrated that traditional prognostic parameters (tumour grade, hormonal status and size), empirical parameters (maximum enhancement index, enhancement index at 30 s, area under the curve and initial slope) and adjuvant therapies demonstrated significant differences in survival intervals. Further multivariate Cox regression survival analysis revealed that empirical enhancement parameters contributed the greatest prediction of both DFS and OS in the resulting models.In conclusion, this study has demonstrated that in patients who exhibit high levels of perfusion and vessel permeability pre-treatment, evidenced by elevated empirical DCE-MRI parameters, a significantly lower disease free survival and overall survival can be expected.     

二维及彩色多普勒超声在甲状腺癌诊断中的应用及价值

目的:探讨彩色多普勒对甲状腺癌的诊断价值。方法:通过临床病理证实的28例甲状腺癌患者术前彩色多普勒检查结果进行分析。结果:甲状腺癌的彩色多普勒表现为甲状腺低回声包块,边界不清,血流增加,17例患者肿瘤内有微钙化。结论:彩色多普勒超声对甲状腺癌的诊断有很大的应用价值。     

Role of power Doppler techniques and ultrasound contrast enhancement in the differential diagnosis of focal breast lesions

The purpose of this article is to demonstrate the diagnostic impact of ultrasound in differentiating focal breast lesions with special regard on power Doppler and US contrast agents. The sonographic evaluation of breast lesions has become a standard procedure during the past 15 years. Especially the improvement of B-mode resolution and the use of high-frequency probes increased the diagnostic value of US. Assuming that the neoangiogenetic vascular architecture of solid breast lesions can be depicted reliably by color Doppler, many authors tried to differentiate between benignity and malignancy using Doppler criteria such as flow and morphologic aspects. Additionally, adjuvant techniques, such as harmonic imaging and new US contrast agents, are meant to be success-promising tools. Whereas the sensitivity and specificity of color Doppler have varied in different studies, prognostic prediction and treatment monitoring seem to be the future areas of application. To evaluate sufficiently flow signals of very small vessels with low flow velocity, the use of contrast-enhancing agents may be necessary. Nevertheless, an indispensable condition for successful Doppler-based assessment of the entity of breast lesions is the standardization of techniques, evaluation, analysis and weighting of the parameters. Electronic Publication     

乳腺导管内乳头状瘤的彩色多普勒超声评价

目的探讨乳腺导管乳头状瘤的彩色多普勒超声表现分型及其临床意义。方法回顾性分析74例经手术和病理证实的乳腺导管内乳头状瘤患者的彩色多普勒超声表现。根据手术结果将术前超声有无局灶性病灶及局灶性病灶的超声表现进行分型,分析其临床意义。结果手术证实74例有87个病灶,其中9例彩超检查无阳性发现,33例为囊实性混合性回声灶,21例为单纯导管扩张,11例表现为实性结节;21个病灶内检出彩色血流信号。结论提高对典型和不典型乳腺导管内乳头状瘤超声表现的认识,掌握检查技巧,有利于提高显示率,更好地服务临床。     

二维及彩色多普勒超声诊断乳腺包块的临床价值

目的：探讨二维及彩色多普勒超声诊断乳腺包块的临床价值。方法应用高频探头对85例各种原因引起的乳腺包块进行检查,所有病例均经手术及病理证实,并与超声诊断对照分析。结果85例乳腺包块经病理证实良性者32例,二维＋多普勒超声准确诊断30例,诊断符合率为93．8％;恶性者53例,二维＋多普勒超声准确诊断50例,诊断符合率为94．3％,且无论良性或恶性,二维＋多普勒超声诊断符合率均较单纯二维声像图诊断率高。结论二维声像图结合彩色多普勒检查可大大提高诊断的正确率,对乳腺疾病的早期发现及良恶性鉴别具有重要意义。     

Role of Duplex Power Doppler Ultrasound in Differentiation between Malignant and Benign Thyroid Nodules

Objective

To evaluate the usage of duplex power Doppler ultrasound (PDUS) for the differentiation of benign and malignant thyroid nodules.

Materials and Methods

We prospectively examined 77 thyroid nodules in 60 patients undergoing ultrasound-guided fine needle aspiration biopsy (FNAB). Each nodule was described according to size, inner structure, borders, parenchymal echogenicity, peripheral halo formation, and the presence of calcification (B-mode ultrasound findings). Vascularity as determined by PDUS imaging was defined as non-vascular, peripheral, central, or of mixed type. For each nodule, the pulsatility index (PI) and resistive index (RI) values were obtained. Results of FNAB and surgical pathological examination (if available) were used as a proof of final diagnosis to categorize all nodules as benign or malignant. A receiver operating characteristic (ROC) curve analysis was performed to establish cut-off, sensitivity, and specificity values associated with RI-PI values.

Results

A significant relationship was observed between malignancy and irregular margins, microcalcifications, and hypoechogenicity on ultrasound examination (p < 0.05). The pattern of vascularity as determined by PDUS analysis was not a statistically significant criterion to suggest benign or malignant disease in this study (p > 0.05). The central, peripheral, and mean RI-PI values were higher in malignant nodules when compared to the other cytologies (p < 0.05).

Conclusion

Vascularity is not a useful parameter for distinguishing malignant from benign thyroid nodules. However, RI and PI values are useful in distinguishing malignant from benign thyroid nodules.     

MRI评估及预测乳腺癌新辅助化疗疗效研究进展

准确评估及预测乳腺癌新辅助化疗后的病理反应有助于了解病情变化。MRI可以反映肿瘤形态、乳腺背景实质强化、肿瘤血流灌注及水分子扩散运动变化等重要信息,对评估和预测乳腺癌新辅助化疗疗效具有重要作用。基于MRI的影像组学可以从医学图像中获取定量和高通量的特征,反映肿瘤的异质性,从而实现对乳腺癌新辅助化疗疗效的精准评估及预测。就MRI评估及预测乳腺癌新辅助化疗疗效的研究进展予以综述。     

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。