能量多普勒超声造影在乳腺肿瘤诊断中的应用研究

目的　研究乳腺肿块能量多普勒超声造影前后血流信号变化和特征。方法　 51例乳腺肿块患者 (2 8例良性 ,2 3例恶性 ) ,选用Levovist作为超声造影剂 ,观察造影前后肿块内的血流形态 ,计算机辅助定量测定肿块彩色像素密度及造影后能量多普勒血流信号到达峰值时间。结果　造影后恶性组血流信号增强效果比良性组明显 ,不规则型、穿入型、分支型血流形态在恶性组中分别为 69.6 %、73 .9%、82 .6 % ,在良性组中分别为 2 1 .4 %、32 .1 %、2 8.6 % ,良性组与恶性组比较 ,差异有显著性意义 (P <0 .0 5)。恶性组彩色像素密度增加比良性组明显 ,开始增强时间、到达峰值时间比良性组短 (P <0 .0 5)。结论　Levovist能有效增强乳腺肿块的能量多普勒血流信号 ,有助于进一步观察肿瘤血管形态 ,对乳腺肿瘤的鉴别诊断有帮助     

乳腺肿块能量多普勒血流指数与微血管密度关系的研究

目的探讨乳腺肿块能量多普勒血管指数(VI)与病理微血管密度的相关性。方法超声检测乳腺肿块患者55例(良性24例,恶性31例),用DFY-Ⅱ型超声图像定量分析诊断仪对肿块能量多普勒血流信号进行定量分析,测定VI;抗CD34免疫组织化学染色测定包块微血管密度(MVD),对VI和MVD的相关性进行分析。结果恶性组VI和MVD较良性组高,两者差异有显著性意义(P<0.01),VI与MVD间具有良好相关性(r=0.9,P<0.01)。结论DFY-Ⅱ型超声图像定量分析诊断仪所测VI可较好反应乳腺肿块血流情况,有助于乳腺疾病的鉴别诊断。     

乳腺肿瘤超声彩色像素密度及造影增强强度与微血管密度相关性对比分析

目的对比分析乳腺肿瘤超声彩色像素密度、超声造影增强强度与病理切片微血管密度相关性。方法对56例乳腺肿瘤患者,进行超声检查,获得超声多普勒彩色像素密度、超声造影增强强度,术后病理标本CD34免疫组化染色,检测微血管密度。结果乳腺肿瘤恶性组的超声造影增强强度EI、彩色多普勒彩色像素密度CPD及微血管密度MVD高于良性组(P0.01),EI、CPD与MVD均呈正相关,其偏相关系数分别为分别r_(CPD)=0.576、P=0.005,r_(el)=0.886、P=0.000。结论与超声多普勒彩色像素密度相比,超声造影增强强度与微血管密度有更高的相关性,能更客观评估乳腺肿瘤血管生成。     

乳腺肿块的彩色多普勒血流定量与病理基础研究

本文在彩色多普勒血流显像（ＣＤＦＩ）的基础上，用血管数目、平均彩色像素密度（ＭＣＰＤ）作为指标分别对乳腺良性肿块、腋窝淋巴结未转移性乳癌和腋窝淋巴结转移性乳癌的血流丰富程度进行半定量和定量分析，结合病理研究，确定上述三组乳腺肿块的微血管形态、面密度。结果显示：上述三组的血管数目和ＭＣＰＤ值依次升高（ｐ＜０．０１），这与三组的病理微血管面密度分析结果具有相同的趋势，表明ＣＤＦＩ在诊断乳腺良、恶性肿块和判断预后中具有重要临床价值，相关的病理研究可为ＣＤＦＩ诊断乳腺肿块和评估乳癌预后提供病理基础     

彩色多普勒超声在乳腺小肿块良恶性鉴别诊断中的应用价值

目的 探讨乳腺小肿块（直径〈2cm）的超声表现特征及彩色多普勒超声对其良恶性的鉴别诊断价值。方法 64例乳腺小肿块经手术病理证实,其中恶性肿块27例,良性肿块37例。分析乳腺小肿块患者的彩色多普勒超声表现特征,应用彩色多普勒血流显像（CDFI）观察其血流分布特征,频谱多普勒检测血流参数阻力指数（RI）的大小。结果 乳腺小肿块良性组和恶性组的形态、边界包膜、纵横比及内部有无微小钙化比较,差异有统计学意义（P〈0．05）。恶性肿块血流分级≥Ⅱ级,RI〉0．7,血流频谱表现为峰值前移,舒张末期无血流信号或可见反向血流;良性肿块血流分级多为0-I级,RI〈0．7,血流频谱表现为以静脉血流频谱为主。9例恶性肿块伴有同侧腋窝淋巴结肿大,2例良性肿块为反应增生肿大。结论 彩色多普勒超声对乳腺小肿块良恶性的鉴别诊断具有重要价值,结合声像图特征和CDFI表现能有效诊断。     

增强超声诊断小乳腺癌及评价血管生成活性的价值

目的研究声诺维(SonoVue)造影增强能量多普勒对小乳腺癌鉴别诊断的意义及评价小乳腺癌血管生成活性的价值.方法增强能量多普勒研究39例乳腺小病灶(恶性21例,良性18例),图像定量计算病灶内彩色像素密度.与术后免疫组化所测微血管密度(MVD)对照,分析两者的相关性.结果增强前彩色像素密度恶性组与良性组间无显著性差异,且彩色像素密度与MVD无相关性.增强后能量多普勒恶性组彩色像素密度高于良性组,与MVD呈正相关(r=0.67,P＜0.05).结论声诺维有助于小乳腺癌的鉴别诊断,增强能量多普勒可有效评价小乳腺癌血管生成活性.     

多普勒超声在鉴别良恶性腋下淋巴结中的意义探讨

目的 评价彩色多普勒超声(CDFI)和多普勒超声流速曲线在鉴别良恶性腋下淋巴结中的应用价值.方法 研究对象为乳癌患者的16枚转移性和27枚非转移性的腋下淋巴结,均经病理证实;另有病理证实的乳腺良性病变患者的腋下淋巴结19枚和正常者的22枚腋下淋巴结作为对照组.分别测量或评价腋下淋巴结的CDFI密度、CDFI分布、淋巴结内血流峰值流速、阻力指数作为鉴别良恶性腋下淋巴结的参数.结果 恶性腋下淋巴结CDFI密度等级(2,范围0-3)与良性腋下淋巴结CDFI密度等级(1,范围0-4)有明显差异;恶性淋巴结CDFI密度量化值明显大于(9.82±4.94)良性淋巴结(5.55±5.53);恶性淋巴结CDFI分布等级(2,范围0-3)与良性淋巴结CDFI分布等级(1,范围0-3)有明显差异.多普勒流速曲线分析显示:最大流速、阻力指数在良恶性腋下淋巴结间无显著性差异.结论 CDFI在鉴别良恶性腋下淋巴结中具有较高的应用价值.多普勒超声流速曲线不能作为鉴别良恶性腋下淋巴结的指标.     

膀胱癌能量多普勒血流分级与病理微血管密度的相关性研究

目的探讨能量多普勒超声技术测定膀胱癌内血流分级与病理微血管密度的相关性。 方法采用能量多普勒技术观察36例膀胱癌血流信号，进行血流分级，术后对肿瘤进行抗CD34因子免疫组化染色测量肿瘤微血管密度，HE染色确定肿瘤浸润深度，根据有无膀胱肌层浸润分肌层浸润组和无肌层浸润组，另取10例膀胱全切患者正常膀胱组织作为对照。 结果能量多普勒技术测定的肿瘤内彩色血流信号与病理微血管密度有较好的相关性（r=0．391，P=0．020）。随着膀胱癌内血流增多，微血管密度（microvessel density，MVD）计数呈上升趋势，随肿瘤浸润深度增加，MVD计数呈上升趋势，肌层浸润组MVD计数明显高于无肌层浸润组和正常对照组，P〈0．05。 结论能量多普勒超声所检测的膀胱癌内血流信号与病理微血管密度测值相关性较好，彩色能量多普勒超声（powe，Dopplerimaging，PDI）显示的血流信号在组织学和生物学上与血管生成和病理分期有关。     

彩色多普勒超声在乳腺良恶性病变诊断中的应用

目的探讨彩色多普勒超声在诊断乳腺良恶性病变中的应用,提高彩色多普勒超声对乳腺肿块的诊断准确率。方法运用彩色多普勒超声对124例乳腺肿块进行超声检查,将所得的二维及彩色多普勒声像图特征与手术病理结果对照分析。同时根据超声检测结果将124例患者分为良性组及恶性组,分析比较两组二维超声像图特征、血流信号检出率。结果 90例病理诊断为良性肿块的超声检出准确率为95.6%;34例病理诊断为恶性肿块的超声检出准确率为94.1%;乳腺良恶性肿块彩超声像图鉴别特征:肿块边界、包膜、形态、内部回声、后方衰减及腋窝淋巴结特征组间差异明显,两组在各级血流信号显示例数间差异显著。结论彩色多普勒超声对乳腺肿块的检出率高,对乳腺良恶性病变的诊断具有较高的应用价值。     

乳腺肿块的彩色多普勒超声诊断与鉴别诊断

目的探讨彩色多普勒血流显像鉴别乳腺肿块的诊断价值。方法对80个乳腺肿块患者（良性肿块组42个,恶性肿块组38个,均经术后病理证实）进行超声检查,对比分析良、恶性肿块的二维超声特点、彩色血流情况及血流动力学参数的特征。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PT、RI值明显高于良性肿块,两组对比有统计学意义（P〈0．05）。结论彩色多普勒超声作为无创的检查方法,可清晰显示肿块的二维声像图特点和血流动力学特征,对乳腺肿块的鉴别具有重要临床应用价值。     

Correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis.

OBJECTIVE: To record the correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis. METHODS: Women with palpable breast masses scheduled for excision biopsy were scanned with two- and three-dimensional color power Doppler sonography before and after the administration of a sonographic contrast agent. Vessel counts were performed on two- and three-dimensional sonographic images before and after contrast agent administration. All tumors were surgically removed and underwent immunohistochemical analysis for microvessel density assessment. The sonographic measure of tumor vascularity was correlated with microvessel density. RESULTS: Pathologic examination showed 43 breast cancers and 14 benign breast masses. Higher microvessel density was noted in malignant than benign breast masses (P < .0005). Color power Doppler sonographic measurement of tumor vessel number showed a significant positive correlation with tumor size (P < .05) and progesterone receptor negativity (P < .05). A significant positive correlation was observed between microvessel density and the number of intratumoral blood vessels assessed by both two- and three-dimensional color power Doppler sonography (P < .05). Regression models showed three-dimensional color power Doppler sonography to have a significantly higher correlation with microvessel density when compared with two-dimensional color power Doppler sonography at baseline (P < .005). The administration of a sonographic contrast agent did not improve correlation with microvessel density. CONCLUSIONS: A significant correlation was shown between color power Doppler sonographic measurement of tumor vascularity and microvessel density by immunohistochemical analysis. Further improvement in Doppler sonographic techniques to map capillary vessel flow should be explored to improve the current association with pathologic findings.     

Quantitative vascularity of breast masses by Doppler imaging: regional variations and diagnostic implications.

Seventy‐four biopsy proven breast masses were imaged by color and power Doppler imaging to evaluate vascular pattern of malignant and benign breast masses. The images were analyzed for vascularity. The measurements were made over the entire mass as well as regionally at its core, at its periphery, and in the tissue surrounding it. The surgical specimens were analyzed for microvessel density. The diagnostic performance of Doppler sonographic vascularity indices was evaluated by receiver operating characteristic analysis. The malignant masses were 14 to 54% more vascular than the benign masses. Both types of masses were more vascular by ultrasonography than the tissue surrounding them. Whereas benign masses were 2.2 times more vascular than the surrounding tissue, the malignant masses were 5.0 times more vascular. In a subset of patients the regional vascularity at the core, periphery, and surrounding tissue by Doppler imaging exhibited a strong correlation (R2 > 0.9) with the corresponding histologic microvessel density measurements. Although the malignant masses exhibited a strong gradient in vascularity, core > periphery > surrounding tissue, the benign masses had relatively uniform distribution of vascularity. The area under the receiver operating characteristic curve (A(Z)) for the Doppler indices ranged from 0.56 +/‐ 0.07 to 0.65 +/‐ 0.07. A nonlinear analysis including age‐specific values of Doppler indices improved the diagnostic performance to A(Z) = 0.85 +/‐ 0.06. In conclusion, quantitative Doppler imaging when used in combination with a nonlinear rule‐based approach has the potential for differentiating between malignant and benign masses.     

Power Doppler sonography of breast masses: correlation of Doppler spectral parameters with tumor angiogenesis and histologic growth pattern.

The purpose of this study was to examine the relationship between spectral analysis on power Doppler sonography and microvessel density. Power Doppler sonography was performed in 71 patients with breast masses (36 invasive carcinomas and 35 benign lesions). Microvessel density was measured in surgical specimens from all breast carcinomas using anti-factor VIII-related antibody. Invasive carcinomas were divided into two groups according to their growth pattern (solid type, scirrhous type). The pulsatility index and resistive index were high in malignant tumors compared with those in benign lesions (P < 0.001). The maximum velocity had weak statistical significance (P < 0.05). Although the correlation of maximum velocity with microvessel density was strong in solid tumors (P < 0.001), the maximum intensity in scirrhous tumors had no correlation with microvessel density. In conclusion, solid tumors showed a tendency toward correlation of maximum velocity with microvessel density. High maximum velocity with high microvessel density suggests breast carcinoma and could be predictive of a poor prognosis in invasive breast carcinoma.     

能量多普勒检测乳腺肿瘤血管的准确性及误差原因分析

目的探讨能量多普勒超声检测乳腺肿瘤血管的准确性及误差原因分析。方法对73例灰阶超声诊断为乳腺肿瘤的患者行能量多普勒检查,采用图像分析软件测定肿瘤区域内的彩色像素密度,与病理血管密度对照。采用多元回归方法分析患者年龄、肿瘤的大小、距乳头距离以及后方回声衰减等对相关性研究的影响。结果①乳腺肿瘤彩色像素密度与病理小血管密度的相关系数为0.55(P<0.01)。②后方回声衰减是影响相关性的最主要因素(P=0.007),年龄次之(P=0.011),肿瘤大小和距乳头距离无显著影响(P值均大于0.05)。③校正后的彩色像素密度与病理小血管密度相关系数为0.75(P<0.01)。结论能量多普勒检测乳腺肿瘤血管的准确性主要受肿瘤后方回声衰减的影响,如以浅表部的彩色像素密度代表整个肿瘤的彩色像素密度,可以提高其准确性。     

Fibroadenomas: computer-assisted quantitative evaluation of contrast-enhanced power Doppler features and correlation with histopathology

We aimed to evaluate whether the histopathologic variability of fibroadenomas accounts for their varied appearance in contrast enhanced power Doppler (PD). Forty patients with fibroadenomas (aged 19 to 61 years) underwent power Doppler ultrasound (US) prior to and following IV bolus injection of a microbubble contrast agent. A 3-min computer-assisted assessment of the color pixel density (CPD) was used for objective evaluation of the increase in color Doppler signals. Enhancement characteristics were correlated to histopathologic features of microvessel density and epithelial hyperplasia, patient's age, tumor size, use of exogenous hormones and menopausal status. Epithelial hyperplasia was diagnosed in 19 patients. Compared to baseline values, patients with epithelial hyperplasia showed a significant increase in mean CPD following contrast media administration (p < 0.01). There was a significant correlation to patient's age (p < 0.0001) and tumor size (p < 0.0001), but not to the use of exogenous hormones and menopausal status. Microvessel counts did not show a significant correlation to CPD at baseline (p = 0.07) or with CPD on contrast enhanced PD (p = 0.13), or with patient age (p = 0.43) or tumor size (p = 0.34). Intratumoral epithelial hyperplasia, primarily occurring in young patients, may contribute to the differential diagnostic overlap in some fibroadenomas and thus limit the ability of PD to distinguish between benign and malignant masses on the basis of enhancement characteristics.     

Analysis of three-dimensional Doppler ultrasonographic quantitative measures for the discrimination of prostate cancer.

OBJECTIVE: The purpose of this study was to determine whether several quantitative ultrasonographic measures have potential to discriminate prostate cancer from normal prostate and to determine the best combination of these measures. The true spatial distributions of cancer within the prostates studied were obtained histologically after radical prostatectomy. The relationship between Doppler ultrasonography and microvessel count was also investigated. METHODS: Three-dimensional Doppler ultrasonographic data were acquired from 39 patients before radical prostatectomy. The removed prostate was sectioned, and whole-mount hematoxylineosin-stained slides were used to identify all regions of cancer within each prostate. These histologic and ultrasonographic data were spatially registered. Doppler ultrasonographic measures were calculated within uniformly sized three-dimensional regions that were either entirely cancerous or noncancerous, and receiver operating characteristic analysis was performed on the results. Microvessel counts were made within each contiguous cancerous region and correlated with ultrasonographic measures. RESULTS: Color pixel density was the best simple measure for discriminating prostate cancer (accuracy, 80%). The mean power mode value (normalized mean power in color pixels) was inversely related to cancer with an accuracy of 1--normalized mean power in color pixels = 65% (low mean power is more cancerous). When color pixel density was combined with the normalized mean power in color pixels, its accuracy improved slightly to 84%. The peak microvessel count had a negative correlation with color pixel density as well as with cancer stage. CONCLUSION: Doppler ultrasonography does provide discriminatory information for prostate cancer, with color pixel density being the most promising measure.     

Color Doppler flow as an indicator of nodal metastasis in solid breast masses.

Tumor metastases are dependent on angiogenesis. This prospective study evaluates the role of color Doppler sonographic signals in (1) detecting blood flow in solid breast masses, (2) differentiating between benign and malignant breast tumors, and (3) identifying women at risk for axillary lymph node metastasis. Ultrasonographically proved solid breast masses from 95 women were evaluated with color Doppler imaging for the presence of blood flow. A characteristic curvilinear or branching signal pattern, labeled the "rim sign," was noted to be either present or absent at the periphery of the mass in all cases. The color Doppler sonographic signals in 86 patients with pathologic results were correlated with the occurrence of malignancy and axillary lymph node metastasis. Fifty-three of the 86 patients (62%) had benign breast disease and 33 patients (38%) had malignant tumors. Sixteen (30%) of the benign tumors and 20 (61%) of the malignant cancers demonstrated a positive rim sign. A positive rim sign has a 61% sensitivity and a 70% specificity for the prediction of breast malignancy. In the malignant masses, nodal involvement occurred in 50% of patients with a positive rim sign and 10% of patients with a negative rim sign. A negative rim sign has a negative predictive value of 90% for nodal metastasis. Color Doppler imaging can detect blood flow in both malignant and benign solid breast masses. A positive rim sign is a poor prognostic factor whereas a negative rim sign is a good prognostic indicator for axillary nodal metastases.     

Correlation of Quantified Contrast‐Enhanced Sonography With In Vivo Tumor Response

Objective.. The purpose of our study was to establish in vivo criteria for monitoring tumor treatment response using 3‐dimensional (3D) volumetric gray scale, power Doppler, and contrast‐enhanced sonography. Methods.. Twelve mice were implanted with Lewis lung carcinoma cells on their hind limbs and categorized to 4 groups: control, chemotherapy, radiation therapy, and chemoradiation. A high‐frequency ultrasound system with a 40‐MHz probe was used to image the tumors. Follow‐up contrast‐enhanced sonography was performed on days 7 and 14 of treatment with two 50‐μL boluses of a perflutren microbubble contrast agent injected into the tail vein. The following contrast‐enhanced sonographic criteria were quantified: time to peak, peak intensity, α (microvessel cross‐sectional area), and β (microbubble velocity). Three‐dimensional power Doppler images were also obtained after the acquisition of contrast data. On day 15, the tumors were excised for immunohistochemical analysis with CD31 fluorescent staining. Results.. The tumor size and 3D power Doppler vascular index showed no statistically significant correlation with microvascular density in all examined groups. Among all of the analyzed contrast‐enhanced sonographic parameters, relative α showed the strongest correlation with the histologic microvessel density (Pearson r = 0.93; P < .01) and an independent association with the histologic data in a multiple regression model (beta = .93; R² = 0.86; P < .01). Conclusions.. Of the various examined sonographic parameters, α has the strongest correlation with histologic microvessel density and may be the parameter of choice for the noninvasive monitoring of tumor angiogenic response in vivo.     

Echo contrast-enhanced power Doppler ultrasonography for assessment of angiogenesis in renal cell carcinoma.

OBJECTIVE: Tumoral growth is an angiogenesis-dependent event. Although there are studies about the importance of histopathologic angiogenesis in various malignancies, the assessment of the angiogenesis by radiologic techniques is not well established. The aim of this study was to investigate the efficacy of echo contrast-enhanced power Doppler ultrasonography (PDUS) in determining the angiogenic status of renal cell carcinoma (RCC). METHODS: Power Doppler ultrasonography was performed before and after intravenous administration of an echo contrast agent in 42 patients with renal masses. Twenty-one of these renal masses were diagnosed as RCC histopathologically, and these 21 patients were reevaluated retrospectively. The color pixel ratios of selected images were calculated as the ratio of the number of pixels showing power Doppler signals to the total number of pixels within the lesion. The results were compared with the histopathologic microvessel density (MVD). RESULTS: A significant correlation was found between color pixel ratio and MVD values in both PDUS techniques. The use of the echo contrast agent improved this correlation and P values (Spearman rho from 0.436 to 0.551; P from .048 to .01). CONCLUSIONS: Color pixel ratio values reflect the MVD in RCC. Therefore, these results suggest that preoperative quantification of angiogenesis can be possible with the help of PDUS in RCC.