超声弹性成像在乳腺疾病诊断中的研究进展

超声弹性成像技术(UE)以生物组织的弹性(或硬度)与病灶的生物学特性相关为理论基础[1],利用声辐射力弹性成像原理,可以定性、定量地对于组织的弹性特征进行准确评估,是目前临床中非常重要的诊断手段之一,尤其是在女性乳腺疾病的诊断中的应用程度越来越高。本文将针对UE在乳腺肿瘤临床诊断中的应用进展进行综述。     

超声弹性成像在判断腋窝淋巴结性质中的应用

目的 探讨超声弹性成像技术判断腋窝淋巴结性质的价值.方法 应用弹性成像技术检查40例乳腺癌患者62个腋窝淋巴结,对腋窝淋巴结采用四分法进行评分,与手术病理结果对照.结果 62个淋巴结中良性反应性增生38个,恶性转移性病变24个.弹性图中良性病变以1～2分多见,为84.2％ (32/38),恶性转移性病变以3～4分多见,为87.5％ (21/24),两组比较差异有统计学意义(Z值-5.619,P＜0.05).恶性组评分(3.12±0.61)明显高于良性组(1.68±0.74),两组比较差异有统计学意义(t＝8.318,P＜0.05).以弹性评分≥3分作为判断腋窝淋巴结良恶性病变的标准,其敏感度、特异度、准确率分别为77.8％、91.4％、85％.结论 超声弹性成像可为判断腋窝淋巴结的性质提供有价值的信息.     

超声弹性成像在乳腺癌腋窝淋巴结转移早期诊断中的应用

目的 探讨超声弹性成像在乳腺癌腋窝淋巴结转移早期诊断中的应用价值。方法 选取2019年4月至2020年4月于林州市人民医院就诊的疑似乳腺癌腋窝淋巴结转移患者83例,所有患者均行常规超声及超声弹性成像检查,以穿刺活检结果作为“金标准”,分析比较两种检查方式在乳腺癌腋窝淋巴结转移早期诊断中的应用价值。结果 经穿刺活检结果得知,83例疑似乳腺癌腋窝淋巴结转移患者中36例(43. 37%)为阳性,47例(56. 63%)为阴性。超声弹性成像检查的准确度(92. 77%)、灵敏度(94. 44%)、阴性预测价值(95. 56%)高于常规超声(78. 31%、77. 78%、75. 56%),差异有统计学意义(P 0. 05);超声弹性成像检查的特异度(91. 49%)、阳性预测价值(89. 47%)略高于常规超声(78. 72%、73. 68%),但差异未见统计学意义(P 0. 05);且常规超声与穿刺活检具有理想的一致性(Kappa=0. 613),超声弹性成像检查与穿刺活检具有极好的一致性(Kappa=0. 854)。结论 超声弹性成像检查在乳腺癌腋窝淋巴结转移早期诊断中具有较高准确度、灵敏度及特异度,且与穿刺活检结果具有极好的一致性,可为临床早期判断该疾病提供可靠依据,并为患者实施及时、高效的治疗方案提供重要价值。     

实时超声弹性成像在甲状腺占位性病变中的初步应用

目的探讨实时超声弹性成像在甲状腺疾病诊断中的应用价值。方法分析40例(44个病灶)甲状腺占位性病变的超声弹性图表现,将图像分为0～IV级,并与病理结果作对比。结果良性病变以0～II级多见,而恶性病变以III～IV级多见。以III级以上(含III级)作为判断恶性的标准,则其敏感性为100%,特异性为77.1%,准确性81.8%。结论超声弹性成像对甲状腺结节的诊断提供较大帮助。     

超声弹性成像及精细彩色血流显像技术在颈部淋巴结良恶性鉴别诊断中的应用

目的 探讨超声弹性成像及精细彩色血流显像(fine flow)技术在颈部淋巴结良恶性鉴别诊断中的价值.方法 对87例肿大淋巴结分别进行常规超声、Fine flow及弹性成像,与病理或临床随访结果对照,采用Kappa一致性检验和ROC曲线分析3种超声检查结果的准确性.结果 常规超声的一致性较差(Kappa=0.153,P =0.078),Fine flow的一致性中等(Kappa=0.526,P＜0.01),而弹性成像的一致性较好(Kappa=0.741,P＜0.01).常规超声的ROC曲线下面积为0.568(P=0.241),准确率较差;Fineflow的ROC曲线下面积0.787(P＜0.01);弹性成像ROC曲线下面积为0.899(P＜0.01),准确率较高.结论 超声弹性成像对于颈部淋巴结良恶性的鉴别诊断具有较高的应用价值.     

二维超声联合超声弹性成像技术诊断恶性浅表淋巴结

目的:研究二维超声联合超声弹性成像技术对恶性浅表淋巴结诊断效能的影响。方法:选取2015年12月~2018年9月收治的浅表淋巴结患者156例作为研究对象,以病理检查为金标准,均采取二维超声、超声弹性成像检查,比较二维超声联合超声弹性成像检查及单独检查诊断效能。结果:二维超声检查检出恶性80例,良性76例,其中误诊12例,漏诊26例;超声弹性成像检查检出恶性83例,良性73例,其中误诊11例,漏诊22例;二者联合检查检出恶性99例,良性57例,其中误诊12例,漏诊7例。二维超声联合超声弹性成像检查诊断准确率、敏感性均高于单独二维超声、超声弹性成像检查,差异有统计学意义(P<0.05);二维超声联合超声弹性成像检查诊断特异性与二维超声、超声弹性成像单独检查比较,差异无统计学意义(P>0.05)。结论:二维超声联合超声弹性成像技术应用于浅表淋巴结患者诊断中,可在不影响诊断特异性基础上显著提高诊断准确率、敏感性,有效鉴别良、恶性浅表淋巴结,为临床评估病情、制定合理治疗方案提供参考依据。     

超声弹性成像在浅表淋巴结良恶性鉴别诊断中的价值

目的：探讨实时静态超声弹性成像对判断浅表淋巴结良恶性的诊断价值.方法：2012年1月--2012年12月上海交通大学附属胸科医院诊治98例浅表淋巴结肿大患者,共107个肿大浅表淋巴结.107个肿大的浅表淋巴结均经病理学证实其良恶性.采用灰阶超声进行病灶检查,记录淋巴结的长、短径,并计算其比值.对病灶行超声弹性成像,将感兴趣区域（ROI）内病灶区与周围组织硬度相比较,并对弹性图进行分型.结果：恶性淋巴结弹性分级≥Ⅲ级者占77.33％（58/75）,良性淋巴结弹性分级≤Ⅱ级者占68.75％（22/32）,两者比较差异有统计学意义（P＜0.01）.恶性淋巴结长短径比＜2者占90.67％（68/75）,良性淋巴结长短径比＞2者占53.13％（17/32）,两者比较差异有统计学意义（P＜0.01）.但弹性分级与长短径比两种方法之间比较,差异无统计学意义（P＞0.05）.结论：超声弹性图分级对判断浅表淋巴结良、恶性有诊断价值,但是作为诊断方法,较淋巴结长短径比值并无明显优势.     

实时剪切波弹性成像评价颈部及腋窝淋巴结硬度

目的 探讨应用剪切波弹性成像(SWE)技术测定的颈部及腋窝淋巴结弹性模量值鉴别诊断正常与恶性淋巴结的价值。方法 选取经穿刺活检或手术证实颈部及腋窝恶性淋巴结患者72例以及80名正常人,分别纳入恶性及正常浅表淋巴结各100个,其中颈部淋巴结各60个,腋窝淋巴结各40个,于术前进行实时剪切波弹性成像,获取淋巴结弹性模量值,分析比较颈部及腋窝正常、恶性淋巴结间弹性值的差异;以病理结果为"金标准",分别绘制并分析采用颈部、腋窝淋巴结弹性模量平均值诊断恶性淋巴结的ROC曲线,评价诊断效能。结果 颈部正常淋巴结的弹性模量平均值为(18.94±5.20)kPa,恶性淋巴结为(25.48±5.36)kPa,腋窝正常淋巴结的弹性模量平均值为(11.68±2.27)kPa,恶性淋巴结为(19.71±3.93)kPa,颈部正常、恶性淋巴结的弹性模量平均值均分别高于腋窝正常、恶性淋巴结(P均<0.01),同一部位(颈部、腋窝)的恶性淋巴结弹性平均值均高于正常淋巴结(P均<0.01)。应用颈部淋巴结弹性模量平均值诊断恶性淋巴结,ROC曲线下面积(AUC)为0.81,以19.15 kPa为诊断界值时,敏感度为93.3%,特异度为65.0%。应用腋窝淋巴结弹性模量平均值诊断恶性淋巴结,AUC为0.98,以13.95 kPa 为诊断界值时,敏感度为97.5%,特异度为87.50%。结论 SWE弹性模量平均值可以为颈部及腋窝正常与恶性淋巴结的鉴别诊断提供依据。     

超声弹性成像联合灰阶超声在乳腺癌腋窝淋巴结转移中的诊断价值

目的：探讨超声弹性成像联合灰阶超声在乳腺癌腋窝淋巴结转移（axillary lymph node metastasis,ALNM）中的诊断价值。方法：选取2021年6月—2022年3月桂林市中医医院收治的疑似乳腺癌腋窝淋巴结转移患者65例为研究对象。所有患者均行灰阶超声、超声弹性成像与病理检查（金标准）,讨论超声弹性成像与灰阶超声联合诊断乳腺癌ALNM的价值。结果：病理学提示发生ALNM36例（55.38%）,转移组淋巴结皮质厚度、皮髓质比值及超声弹性成像评分均显著高于非转移组（P <0.01）;淋巴结皮质厚度厚、皮髓质比值大、超声弹性成像评分升高与乳腺癌发生ALNM存在相关性（OR> 1,P <0.05）;超声弹性成像、灰阶超声与联合诊断均具有较高的诊断价值,且以联合诊断最高。结论：超声弹性成像技术及灰阶超声联合预测乳腺癌腋窝淋巴结状态,具有较高的诊断准确率,可为患者治疗方案的选择提供可靠依据。     

Quantitative Shear Wave Elastography in the Evaluation of Metastatic Cervical Lymph Nodes

Our aim was to compare the diagnostic performance of shear wave elastography (SWE) with that of gray-scale ultrasound (US) in differentiating metastatic from benign lymph nodes in patients with head and neck malignancies. Maximum shear elasticity modulus (maxSM) was measured on SWE. The reference standard was pathologic diagnosis after surgery. We examined 67 lymph nodes (34 metastatic, 33 benign) from 15 patients (8 men and 7 women; mean age, 54.2 years). The maxSM value was significantly higher for metastatic than benign lymph nodes (41.06 ± 36.34 kPa vs. 14.22 ± 4.19 kPa, p < 0.0001) at a cutoff level of 19.44 kPa. Accuracy, sensitivity and specificity were 94, 91 and 97%, respectively, for SWE, and 91, 88 and 94%, respectively, for gray-scale US. Multiple regression analysis showed that the maxSM value (r = 0.882) and gray-scale US criteria (r = 0.837) were independent variables. SWE may be a valuable quantitative reproducible method for characterizing cervical lymph nodes.     

Three-Dimensional Elastography for Cervical Lymph Node Volume Measurements: A Study to Investigate Feasibility,Accuracy and Reliability

This study investigated the feasibility of using three-dimensional (3-D) elastography in measuring cervical lymph node volume and compared the accuracy and reliability of 3-D elastography and 3-D grayscale ultrasound in measurement of ill-defined cervical nodes. Eighteen porcine lymph nodes from the neck were embedded in tissue-mimicking phantoms and scanned with the two ultrasound techniques. Ultrasound measurements were compared with the volume determined by water-displacement method to evaluate measurement accuracy. Inter-observer reproducibility and intra-observer repeatability of measurements were evaluated. Four patients with enlarged neck nodes were included to evaluate intra-observer repeatability of ultrasound measurements. Results demonstrated that lymph nodes that appeared ill-defined on grayscale ultrasound showed well-defined boundaries on elastography. 3-D elastography has higher measurement accuracy (84.2%), reproducibility (intraclass correlation coefficient, ICC = 0.909) and repeatability (ICC = 0.964–0.988) than does 3-D grayscale ultrasound (62.2%, 0.777 and 0.863–0.906 respectively). As a conclusion, 3-D elastography is accurate and reliable in volume measurement of ill-defined lymph nodes and has potential for accurate assessment of lymph node volume.     

乳腺疾病实时组织弹性成像与病理对照的初步探讨

目的探讨实时组织弹性成像(RTE)对乳腺肿瘤鉴别诊断的价值。方法应用RTE对170例患者共219个乳腺结节进行检查,采用RTE5分评分法进行评价,RTE4分以上为恶性,3分以下为良性。所有患者均获手术病理证实。RTE检查结果与病理结果进行比较。结果良性119例共166个结节,恶性51例共53个结节,RTE诊断恶性病变敏感性为84.9%,特异性为97.6%,准确性为94.5%。结论RTE有助于乳腺肿瘤良恶性鉴别。     

超声弹性成像诊断颈部淋巴结核的价值

目的：研究颈部淋巴结结核的超声弹性成像表现,评价超声弹性成像在其诊断中的价值。方法：采用弹性5分评分法对44例97个颈部淋巴结结核病灶进行分析。结果：有85.7%（30/35）结节型和83.7%（36/43）干酪坏死型颈部淋巴结结核的超声弹性成像评分和为1～2分,有57.8%（11/19）愈合钙化型的弹性成像评分为3～4分。结论：绝大多数颈部淋巴结结核病灶硬度较小,超声弹性成像评分较低,有助于诊断。     

Real-time qualitative ultrasound elastography of cervical lymph nodes in routine clinical practice: interobserver agreement and correlation with malignancy

To evaluate real-time qualitative ultrasound (US) elastography for cervical lymphadenopathy in routine clinical practice, 74 nodes (37 malignant, 37 benign) in 74 patients undergoing sonography underwent US elastography prior to fine needle aspiration for cytology. Dynamic cine loops of elasticity imaging displayed using a chromatic-scale were qualitatively scored by three independent observers for the proportion of stiff areas from ES1-4 (soft to stiff). There was fair to good interobserver agreement as indicated by weighted kappa (κ) statistic from 0.374 to 0.738. Median ES for benign and malignant nodes were 2 and 3 respectively. ES was higher in malignant nodes (p = 0.0003-0.0049, Mann Whitney U tests) although areas under receiver operating characteristic curves (0.68-0.74) indicated suboptimal discrimination. The optimal discriminatory cut-off, ES > 2, achieved only 62.2% sensitivity, 83.8% specificity and 73% accuracy for malignancy. Improvements in reliability and accuracy of real-time qualitative ultrasound elastography are required for it to be adopted into routine clinical practice.     

Real-Time Qualitative Ultrasound Elastography of Miscellaneous Non-Nodal Neck Masses: Applications and Limitations

To evaluate real-time qualitative ultrasound elastography as an adjunct to conventional sonography for evaluation of non-nodal neck masses identified in routine clinical practice, 52 consecutive masses in 49 patients underwent both techniques. Lesion stiffness was graded visually on chromatic-scale elastograms from ES0-3 (low to high). Diagnosis was based on (cyto)pathology (11), corroborative cross-sectional imaging (18) or characteristic conventional sonography (23). There were 16 lipomas, 15 lymphatic/venous vascular malformations (LVVMs), six neurogenic tumours/neuromas, five thyroglossal duct cysts (TGCs), five (epi)dermoids, three abscesses, one second-arch branchial cleft cyst (BCC), and one soft-tissue metastasis. In general terms, lesion stiffness was high (ES2-3) for neurogenic tumours/neuromas, (epi)dermoids and metastasis, and low (ES0-1) for lipomas, LVVM, TGCs and BCC. Abscesses displayed variable stiffness according to fluid content. Technical limitations and artefacts of elastograms were identified. Data from real-time qualitative ultrasound elastography may be a useful adjunct to sonography for diagnosis of non-nodal neck masses (E-mail: aniltahuja@cuhk.edu.hk)     

Shear wave elasticity imaging of cervical lymph nodes

A pilot study of real-time shear wave ultrasound elastography (SWE) for cervical lymphadenopathy in routine clinical practice was conducted on 55 nodes undergoing conventional ultrasound (US) with US-guided needle aspiration for cytology. Elastic moduli of stiffest regions in nodes were measured on colour-coded elastograms, which were correlated with cytology. Malignant nodes (n = 31, 56.4%) were stiffer (median 25.0 kPa, range 6.9-278.9 kPa) than benign nodes (median 21.4 kPa, range 8.9-30.2 kPa) (p = 0.008, Mann Whitney U test). A cut-off of 30.2 kPa attained highest accuracy of 61.8%, corresponding to 41.9% sensitivity, 100% specificity and 0.77 area under the receiver operating characteristic curve. Qualitatively, elastograms of benign nodes were homogeneously soft; malignant nodes were homogeneously soft or markedly heterogeneous with some including regions lacking elasticity signal. SWE is feasible for neck nodes. It appears unsuitable for cancer screening but may detect a subset of malignant nodes. The cause of spatial heterogeneity of malignant nodes on SWE is yet to be established.     

高频超声及弹性成像对乳腺导管内乳头状瘤的诊断价值

目的探讨高频超声及弹性成像在乳腺导管内乳头状瘤诊断中的应用价值。方法收集行乳腺超声检查并经手术病理证实的乳腺导管内乳头状瘤45例,回顾分析其超声分型及声像图表现。结果手术证实45例53个病灶,26例为囊实结节型,17例为实性结节型,2例为单纯囊肿型。结论高频超声结合弹性成像技术不仅可直观地显示乳腺导管内乳头状瘤的部位、大小、形态、内部回声及血供状态,而且可提供肿块与导管的间隔关系及病灶的硬度信息,可作为乳腺导管内乳头状瘤的重要及常规的影像学检查方法。     

颈部淋巴结淋巴瘤皮质回声及其病理基础的初步探讨

目的 描述颈部淋巴结淋巴瘤皮质回声,分析其与病理的相关性,以期有助于此类疾病的超声筛诊.方法 回顾性分析168例淋巴瘤患者的225个颈部受累淋巴结声像图,将淋巴结皮质回声分为均匀(低或极低回声)和不均匀(低回声背景下见点状、点条状、网格状、絮状稍高回声、无回声区),比较不同病理亚型之间上述声像图是否存在差异,并观察其中部分病例的病理切片.结果 颈部淋巴结淋巴瘤皮质回声多数是不均匀(占67.1％),且不同病理亚型间声像图的差异无统计学意义.结论 颈部淋巴结淋巴瘤病变内部所见的点状、点条状、网格状、絮状稍高回声多为增生的网状或胶原纤维组织,这些声像图特征对超声医师筛诊此类疾病有帮助.