Combined sonoelastographic scoring and strain ratio in evaluation of breast masses

Aim of the work

To detect the diagnostic performance of the combined use of sonoelastographic scoring and strain ratio in differentiation of benign and malignant breast masses with the histopathology is the standard reference.

Patients and methods

One hundred and seventy-two women with 190 breast masses were enrolled in this prospective study. Conventional US (B-mode and color Doppler US) and sonoelastography (elasticity score “ES” and calculation of strain ratio “SR”) were performed. B-mode images were classified according to the Breast Imaging Recording and Data System. The hardness was determined with 5-point scoring method and SRs of the lesions were calculated. Receiver operating characteristic (ROC) curves were performed and the cutoff point for differentiation of benign and malignant masses was detected.

Results

There was a significant difference (P = 0.02) in the mean SRs between benign and malignant breast masses. The area under the curve (AUC) for combination of ES and SR (0.964) was higher than for ES alone (0.852) and B-mode US (0.823). A cutoff value of 3.6 for the SR allowed the best differentiation of benign and malignant breast lesions.

Conclusion

The combined use of elasticity score and strain ratio of sonoelastography increased the diagnostic performance in distinguishing benign from malignant breast masses.     

Diagnostic performance of sonoelastographic Tsukuba score and strain ratio in evaluation of breast masses

The aim of this prospective study was to evaluate the diagnostic performance of the use of strain index ratio by sonoelastography to differentiate between benign and malignant breast lesions.

弹性应变率在甲状腺良恶性结节鉴别诊断中的应用进展

甲状腺结节是临床常见的甲状腺疾病,常规二维甲状腺超声检查约50%的受检者可以发现甲状腺结节,其中约9.2%～14.8%细针穿刺结果为恶性,而临床确诊的甲状腺结节中约5%为恶性。研究表明,常规超声在评价甲状腺结节时有一定的主观性,病变特性在观察者之间无显著的一致性[4],其对结节的良恶性鉴别诊断率则更低,约29.0%～59.2%[5],且甲状腺微小结节更容易漏诊。超声弹性成像是近年来医学超声领域的一种新的具体而客观的技术方法,其能够提供组织弹性这一基本力学属性,是对常规超声进行甲状腺结节良恶性进行鉴别的一种很好的补充,可提高鉴别诊断甲状腺良恶性结节的敏感性、特异度和准确性[6]。超声弹性成像主要有弹性评分法和弹性应变率比值法,弹性评分法已广泛应用于临床,弹性应变率比值作为超声弹性成像量化参数,其相关应用报道目前尚不多见,本文就弹性应变率在鉴别甲状腺结节良恶性中的应用进行综述。     

The value of strain ratio in differential diagnosis of thyroid solid nodules

Objective

To assess the clinical value of strain ratio in differentiating thyroid solid nodules and explore its distribution characters based on pathological results.

Materials and methods

The study was approved by the ethic committee and the informed consents were signed. Ninety nine solid thyroid nodules (67 benign and 32 malignant) from 71 female (mean age 46.3 ± 9.8 years) and 28 male (mean age 54.9 ± 11.7 years) patients were evaluated. Five radiologists evaluated the nodules based on a four-degree elastography score system. Strain ratio was calculated on-line. Diagnostic performances of the two evaluations were compared using Receiver Operating Characteristic (ROC) curves. Values of different pathological nodules were compared by one-way ANOVA.

Results

Areas under the ROC curve (AUC) of the five readers were 0.82, 0.81, 0.79, 0.73 and 0.83, respectively. The AUC of strain ratio evaluation was higher (0.88 vs. 0.79, p < 0.001) than that of the ES score evaluation. Best cut-off points of the two evaluations were 3.5 (82% sensitivity, 72% specificity) and 4.225 (81% sensitivity, 83% specificity), respectively. Both the ES score and strain ratio were higher for malignant nodules than that for benign ones (p < 0.001).

Conclusions

Strain ratio was a useful index in differential diagnosis of thyroid solid nodules. It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence. The best cut-off point for benign and malignant nodules was 4.2.     

Additional value of qualitative strain ultrasound elastography and strain ratio in predicting thyroid malignancy

Objective

To detect if strain ultrasound elastography and strain ratio have additional value to the conventional grey scale ultrasound in predicting thyroid malignancy.

超声弹性成像两种比值法在诊断乳腺良恶性肿瘤中的价值

目的：探讨局部应变率比值（LSR）与整体应变率比值（ESR）对乳腺良恶性肿瘤的诊断价值。方法134例患者经手术病理证实189个病灶（良性139个,恶性50个）进行实时弹性成像定量检查,绘制病灶整体与局部弹性应变率比值的ROC曲线,比较两种模式的价值。结果ESR的ROC曲线下面积（area under the curve,AUC）为0．866,最佳临界点为3．14,敏感度、特异度、分别为86．2％（43/50）、81．29％（113/139）。LSR的AUC为0．932,最佳临界点为31．14,敏感度、特异度分别为96．02％（48/50）、90．02％（125/139）,两者的差异有统计学意义（P＜0.01）。结论LSR比ESR对乳腺良恶性肿瘤具有更高的诊断价值。     

甲状腺实性结节动静脉比例鉴别结节良恶性的价值研究

目的利用彩色多普勒血流显像技术观测甲状腺实性结节内血流的动静脉比例,探讨动静脉比例在甲状腺结节良恶性鉴别的价值。方法对66例患者的81个甲状腺实性结节进行彩色多普勒检查。计算并对比良恶性结节的动静脉比例有无差异,对比不同观察者测量的动静脉比例的差异,评价动静脉比例对甲状腺实性结节良恶性鉴别的价值。结果甲状腺恶性结节动静脉比例以动脉型为主,良性结节以静脉型或混合型为主。两种结节的动静脉比例差异有统计学意义（P〈O．05）。不同观察者测量的良性结节及恶性结节中混合型的动静脉比例数值具有统计学差异（P〈0．05）,但是不影响对结节良恶性的判断。以结节内动脉型动静脉血流比例作为诊断标准,预测甲状腺恶性结节的灵敏度为76．00％、特异度为89．83％、阳性预测值为88．89％、阴性预测值为94．64％。结论彩色多普勒血流显像技术检测甲状腺结节的动静脉血流比例对结节良恶性的鉴别诊断具有一定价值。     

三种超声方法鉴别乳腺良恶性肿块的对比分析

目的：探讨三种不同超声方法对乳腺良恶性肿块的诊断价值。方法：对30个乳腺肿块患者行二维超声常规检查和多普勒检查,并进行超声征象评分和多普勒分析,用设定的三种方法进行良恶性判断,并与病理和手术结果相对照。结果：三种方法进行乳腺肿块的良恶性判断,符合率明显不同（46．7％,60％,83．7％）,其中以二维超声征象评分结合彩色多普勒超声的定量分析,符合率最高。结论：综合二维超声征象评分和彩色血流的定量分析,大大提高了乳腺肿块良恶性判断的准确率,减少了诊断中的主观性。     

Logistic回归模型评估超声弹性成像对乳腺良恶性结节的诊断价值

目的:采用logistic回归分析建立乳腺结节超声特征参数为变量的诊断模型,评价超声弹性成像对乳腺良恶性结节的鉴别诊断价值.方法:以术后病理结果为金标准,回顾性分析132例患者共185枚乳腺结节的超声声像图特点,甄别出有价值的超声参数,建立logistic回归模型,评价其诊断效能及预测能力.结果:二分类logistic...     

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。     

超声弹性成像评分对鉴别乳腺肿瘤良恶性的价值

_目的：分析弹性成像评分与免疫组织化学因子雌激素受体（ER）、孕激素受体（PR）的关系,探讨弹性成像评分对鉴别乳腺肿瘤良恶性的价值。方法：选取乳腺肿瘤患者100例,运用彩色超声弹性成像技术对患者的病灶进行探查,采用免疫组织化学技术对患者新鲜活检组织标本进行处理,记录其 ER 和 PR 值,并进行统计学分析。结果：乳腺肿瘤弹性成像评分与 ER（rs＝0．835,P＝0．000）及 PR（rs＝0．816,P＝0．000）的表达程度均呈正相关。超声弹性成像评分诊断乳腺肿瘤良恶性的总体符合率达到73％,与免疫组织化学方法近似（ER：71％,PR：61％）,差异不具有统计学意义（P＞0．05）。结论：乳腺弹性成像评分与病灶 ER 及 PR 蛋白表达呈正相关,对鉴别乳腺肿瘤良恶性具有重要价值。     

体素内不相干运动联合扩散峰度成像模型对乳腺良恶性病灶的鉴别诊断价值

目的:探讨体素内不相干运动(IVIM)技术联合扩散峰度成像(DKI)对乳腺良恶性病变的鉴别诊断价值.方法:137例女性患者(共153个病灶)行双侧乳腺多b值DWI检查(b=0～2000 s/mm2);分别使用IVIM、DKI模型获得病灶的真性扩散系数(D)、灌注相关扩散系数(D*)、灌注分数(f)以及平均扩散峰度系数(MK)、平均扩散系数(MD)和ADC值.分析这些参数在乳腺良恶性病变中的变化规律,采用受试者工作特性曲线(ROC)评估各参数的诊断效能.结果:良恶性病灶的D、f、MK、ADC和MD值的中位数差异有统计学意义(P值分别为0.000、0.020、0.000、0.000和0.000),良恶性病灶D*值的差异无统计学意义(P=0.480).D值与和MK、ADC和MD值在鉴别乳腺良恶性病变中的可靠性相当,两两比较差异无统计学意义(P值均大于0.1).当MK值及D、ADC和MD值的阈值分别取0.8073及0.9536×10-3、1.1436×10-3和1.5657×10 3mm2/s时,鉴别良恶性病灶的敏感度和特异度依次分别为(95.7％,84.2％)及(95.7％,81.6％)、(96.5％,84.2％)和(93.9％,84.2％).ROC曲线分析得出D值的诊断效能最大(AUC=0.91).联合D值和MK值的AUC这0.92.结论:采用1VIM和DKI模型获得的相关参数有助于乳腺良恶性病灶的鉴别,以IVIM模型中的真性扩散系数的诊断敏感性和特异性较高,联合真性扩散系数和扩散峰度系数的诊断效能最高.     

Use of FDG-PET in differentiating benign from malignant compression fractures

Objective The objective was to evaluate the use of fluorodeoxyglucose positron emission tomography (FDG-PET) in differentiating benign from malignant compression fractures. Patients and methods In a retrospective analysis, we identified 33 patients with 43 compression fractures who underwent FDG-PET. On FDG-PET the uptake pattern was recorded qualitatively and semiquantitatively and fractures were categorized as benign or malignant. Standardized uptake values (SUV) were obtained. MRI, CT, and biopsy results as well as clinical follow-up for 1–3 years served as standards of reference. The Student’s t test was used to determine whether there was a statistically significant difference between the SUV for benign and malignant compression fractures. Results There were 14 malignant and 29 benign compression fractures, including 5 acute benign fractures. On FDG-PET, 5 benign fractures were falsely classified as malignant (false-positive). Three of these patients underwent prior treatment with bone marrow-stimulating agents. There were two false-negative results. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET in differentiating benign from malignant compression fractures were 86%, 83%, 84%, 71%, and 92% respectively. The difference between SUV values of benign and malignant fractures was statistically significant (1.9 ± 0.97 for benign and 3.9 ± 1.52 for malignant fractures, p < 0.001). SUV of benign acute and chronic fractures were not statistically significant. Conclusion Fluorodeoxyglucose positron emission tomography is useful in differentiating benign from malignant compression fractures. Therapy with bone marrow-stimulating agents can mimic malignant involvement.     

The clinical value of ultrasound elastography in predicting malignant thyroid nodules

Objective

This study aims to evaluate the clinical value of ultrasound elastography (USE) in providing information on the nature of the thyroid nodules. This was performed using the elastography score and strain ratio in differentiating thyroid benign and malignant nodules and the histopathological examination was used as the diagnostic standard of reference.

Methods

We examined 84 thyroid nodules in 62 patients with ultrasound elastography. Elastography score was assigned based on a four-point scale according to the classification proposed by Itoh et al. with a score of 1 (low stiffness over the entire nodule) to a score of 4 (high stiffness over the entire nodule). Thyroid strain ratio (normal tissue to lesion strain ratio) was calculated. Histopathological results were the standard reference. The area under the curve (AUC) and the best cut-off point were both obtained using receiver-operating characteristic (ROC) curve analysis. The sensitivity, specificity, and accuracy of both techniques were calculated.

Results

Fifty-four of the 84 nodules had scores of 1 and 2, and 50 of these nodules were diagnosed histopathologically as benign. Thirty of the 84 nodules had a score of 3 and 4, and 21 of these nodules were diagnosed histopathologically as malignant. The scores of 1 and 2 with Itoh criteria were significantly seen in benign nodules, whereas, scores of 3 and 4 were significantly seen in malignant nodules (p < 0.05) with sensitivity 84%, specificity 84.7%, PPV 70%, NPV 92.6% and accuracy 84.5%. The mean SR for the benign nodules and malignant ones was significantly different (2.92 ± 0.96 vs. 4.53 ± 0.82, p < 0.001). With ROC analysis, the best cut-off strain ratio point was 3.5 for differentiating benign and malignant nodules with area under the curve (AUC) = 0.87 (0.8–0.95). The sensitivity of the strain ratio was 88%, while the specificity was 86.4%, PPV = 73.3%, NPV = 94.4% and accuracy = 86.9%.

Conclusions

Both the elastographic score and strain ratio are higher in malignant nodules than those in benign ones. Ultrasound elastography can provide quantitative information on thyroid nodule helping in differentiating benign and malignant ones.     

Morphologic blooming in breast MRI as a characterization of margin for discriminating benign from malignant lesions

RATIONALE AND OBJECTIVES: Develop a fully automated, objective method for evaluating morphology on breast magnetic resonance (MR) images and evaluate effectiveness of the new morphologic method for detecting breast cancers. MATERIALS AND METHODS: We present a new automated method (morphologic blooming) for identifying and classifying breast lesions on MR that measures margin sharpness, a characteristic related to blooming, defined as rapid enhancement, with a border that is initially sharp but becomes unsharp after 7 minutes. Independent training sets (98 biopsy-proven lesions) and testing sets (179 breasts, 127 patients, acquired at five institutions) were used. Morphologic blooming was evaluated as a stand-alone feature and as an adjunct to kinetics using free-response receiver operating characteristic and sensitivity analysis. Dependence of false-positive (FP) rates on acquisition times and pathologies of contralateral breasts were evaluated. RESULTS: Sensitivity of morphologic blooming was 80% with 2.46 FP per noncancerous breast: FPs did not vary significantly by acquisition times. FPs varied significantly by pathologies of contralateral breasts (cancerous contralateral: 4.29 FP/breast; noncancerous contralateral: 0.48 FP/breast; P < .0001). Evaluation of 45 cancers showed suspicious morphologies on 10/15 (67%) cancers with benign-like kinetics and suspicious kinetics on 5/10 (50%) cancers with benign-like morphologies. CONCLUSION: We present a new, fully automated method of identifying and classifying margin sharpness of breast lesions on MR that can be used to direct radiologists' attention to lesions with suspicious morphologies. Morphologic blooming may have important utility for assisting radiologists in identifying cancers with benign-like kinetics and discriminating normal tissues that exhibit cancer-like enhancement curves and for improving the performance of computer-aided detection systems.     

Differentiating benign from malignant solid breast masses: comparison of two-dimensional and three-dimensional US

PURPOSE: To compare prospectively obtained static two-dimensional (2D) and three-dimensional (3D) ultrasonographic (US) images in the diagnostic performance of radiologists with respect to the differentiation of benign from malignant solid breast masses with histopathologic examination as the reference standard. MATERIALS AND METHODS: This study had institutional review board approval, and patient informed consent was obtained. Conventional 2D and 3D US images were obtained from 141 patients (age range, 25-71 years; mean age, 46 years) with 150 solid breast masses (60 cancers and 90 benign lesions) before excisonal or needle biopsy. Four radiologists who had not performed the examinations independently reviewed 2D US images and stored 3D US data and provided a level of suspicion concerning probability of malignancy. The sensitivity, specificity, and negative predictive values of 2D images were compared with those of 3D US images. RESULTS: For all readers, 3D US images were the same as or better than 2D US images in terms of sensitivity (100% vs 100% for reader 1; 100% vs 98% for reader 2; 98% vs 93% for reader 3; 93% vs 92% for reader 4), specificity (58% vs 56% for reader 1; 51% vs 46% for reader 2; 83% vs 72% for reader 3; 86% vs 84% for reader 4), and negative predictive values (100% vs 100% for reader 1; 100% vs 98% for reader 2; 99% vs 94% for reader 3; 95% vs 94% for reader 4). These differences, however, were not statistically significant (P > .05). CONCLUSION: The performance of the radiologists with respect to the characterization of solid breast masses with static 2D US images was similar to that with 3D US data.     

磁共振质子波谱分析鉴别乳腺良恶性病变的应用研究

目的 研究磁共振波普分析在鉴别乳腺良、恶性病变的临床价值.方法 对50例2010年5月～2011年5月期间经我院检查怀疑为乳腺病变患者,并对其进行磁共振质子波谱检查.结果 50例患者中共有58个病灶通过病理得到了证实,其中恶性病灶占60.3％,良性病灶占39.7％;39个病灶在3.22～3.28ppm时出现了胆碱峰,19个病灶未出现胆碱峰,对乳腺良、恶性病变诊断中出现胆碱峰的情况经统计学分析均具有显著差异性(P＜0.01).结论 磁共振波普检查在鉴别乳腺良、恶性病变中有着肯定的应用价值.     

3.0T磁共振成像在甲状腺良恶性病变鉴别诊断中的价值研究

目的 探讨磁共振成像在甲状腺良恶性病变鉴别中的应用价值.方法 研究对象为2010年8月～2011年8月我院收治的甲状腺病变48例患者、54个病灶,经Philips 3.0T磁共振成像,比较分析T1WI、T2 WI、DWI(b值为150、300和500s/mm2)及动态增强中良性病灶及恶性病灶的MRI表现,并与病理对照.结果 T1 WI像良性病变呈等及略高信号,恶性病变为不均匀略高信号;T2 WI像良恶性病变均为略高信号,无统计学差异(P＞0.05);DWI成像(良性病变:b值为150时ADC值为2.489±0.442、b值为300时ADC值为1.974±0.369、b值为500时ADC值为1.649±0.445;恶性病变:b值为150时ADC值为1.733±0.326、b值为300时ADC值为1.399士0.258、b值为500时ADC值为1.214±0.302),具有统计学差异(P＜0.05).T1WI动态增强良性病变呈流出型强化曲线,恶性病变呈延迟性消退型曲线,具有一定特征性.结论 磁共振成像对甲状腺良恶性病变鉴别应用价值高,尤其是ADC值对良恶性病灶的鉴别意义较大.     

Differentiation of benign from malignant solid breast masses: conventional US versus spatial compound imaging

PURPOSE: To compare prospectively the diagnostic performance of radiologists who used conventional ultrasonography (US) with that of radiologists who used spatial compound imaging for the differentiation of benign from malignant solid breast masses. MATERIALS AND METHODS: The study was approved by the institutional review board, and informed consent was obtained. Before excisional or needle biopsy was performed, conventional US and spatial compound images were obtained in 67 patients (age range, 25-67 years; mean age, 45 years) with 75 solid breast masses (21 cancers and 54 benign lesions). Three experienced radiologists who did not perform the examinations independently analyzed US findings and indicated the probability of malignancy. Results were evaluated with kappa statistics and receiver operating characteristic (ROC) analysis. RESULTS: For US findings, the presence of calcifications was the most discordant feature (kappa = 0.372) between conventional US and spatial compound imaging, followed by echotexture (kappa = 0.439), boundary echo (kappa = 0.496), orientation (kappa = 0.518), echogenicity (kappa = 0.523), shape (kappa = 0.526), margin (kappa = 0.569), and posterior acoustic transmission (kappa = 0.669). The area under the ROC curve for conventional US was 0.79 for reader 1, 0.88 for reader 2, and 0.82 for reader 3, and the area under the ROC curve for spatial compound imaging was 0.85 for reader 1, 0.88 for reader 2, and 0.89 for reader 3. The partial area index for conventional US was 0.29 for reader 1, 0.69 for reader 2, and 0.39 for reader 3, and the partial area index for spatial compound imaging was 0.29 for reader 1, 0.65 for reader 2, and 0.39 for reader 3. The difference between the diagnostic performances of the two techniques was not significant (P > .05). CONCLUSION: The performance of the radiologists with respect to the characterization of solid breast masses was not significantly improved with spatial compound imaging.