超声引导下乳腺病变的扩散光学层析成像:临床应用的可信度

目的通过超声引导下扩散光学层析成像(US-DOT)对乳腺病灶进行实时成像并就诊断时观察者间一致性情况对US-DOT的可信度进行前瞻性评价,同时探讨常规超声(US)联     

乳腺扩散光学断层成像：一种新的成像方法的初步应用及其与磁共振成像的比较

本研究对新型乳腺扩散光学断层成像（diffuse optical tomography,DOT）系统进行评估。使用DOT和MRI评估17例女性病人的18个乳腺病变（10个侵袭性癌．2个纤维腺瘤和6个良性囊肿;直径13～55mm）。在最初36例入选病人中一部分因技术问题而未行该方法检查。兴趣区（region of interest.ROI）的选择是MRI上显示的病变位置以及对侧健康乳腺的镜像部位。由2位观察者分别独自阅片并从定量和定性2方面评估ROI。使用信度检验（kappastatistics,     

常规超声联合超声弹性成像在诊断甲状腺占位性病变中的应用价值

目的：对于常规超声联合超声弹性成像在诊断患者甲状腺占位性病变的效果进行评价。方法选取我院自2010年5月至2013年7月间在我院接受甲状腺手术诊断的68例患者,115个病灶当中,良性占位性病变69例,恶性占位性病变为46例。根据患者采用常规超声以及超声联合弹性成像技术的不同情况进行诊断指标和评分标准的分析对比。结果常规超声联合超声弹性成像的诊断结果比单纯采用常规超声诊断的准确率大大提升。结论常规超声联合超声弹性成像可以大大提升甲状腺占位性病变的诊断准确率,在临床应用中有着重要价值,值得推广运用。     

超声弹性成像与常规超声联合应用在乳腺病灶良恶性鉴别上的价值

目的：探讨超声弹性成像在鉴别乳腺病变良恶性上的价值。材料和方法：对随机来我院检查的400例患者共433个乳腺病灶分别进行常规超声及弹性超声检查，结果与病理对照。结果：常规超声成像和弹性成像在鉴别乳腺病灶良恶性上价值相当（灵敏度、特异度及正确率分别为84．8％、82．8％及83．6％和83．6％、78．2％及80．4％，P〉0．05），但联合应用2种技术灵敏度提高至93．0％，比常规超声检查显著提高（P≤0．01）。结论：超声弹性成像对乳腺恶性病变较敏感，能帮助诊断常规超声较难鉴别的良恶性病变，两者联合应用可进一步提高超声技术的鉴别诊断能力。     

超声造影引导下乳腺BI-RADS 4级占位性病变穿刺活检应用价值

目的探讨超声造影联合超声引导对乳腺BI-RADS 4级占位性病变穿刺活检的临床应用价值。方法选取自2016年1月至2017年12月在北部战区总医院超声科行超声引导下穿刺活检的60例乳腺BI-RADS 4级占位患者为研究对象。将采取超声造影联合超声引导下穿刺活检的患者设为A组(n=39),只采取超声引导下穿刺活检的患者设为B组(n=21)。比较两组患者的穿刺成功率及定性诊断率。结果本研究60例患者全部穿刺成功,穿刺成功率为100.0%(60/60)。A组39例患者取材均满足病理诊断,定性诊断率为100.0%(39/39),其中,良性28例,恶性11例。B组16例患者取材满足病理诊断,定性诊断率为76.2%(16/21),其中,良性10例,恶性6例;其余5例未定性诊断患者中因取材组织液化及坏死较多,无法明确诊断,后经超声造影引导下穿刺活检,结果显示,良性3例,恶性2例。A组定性诊断率显著高于B组,差异有统计学意义(P<0.05)。结论超声造影引导下行乳腺BI-RADS 4级占位性病变穿刺活检,可清楚地显示肿瘤的活性区域及非活性区域,能更准确地定位取材,定性诊断率优于常规超声引导下穿刺活检。     

扩散加权成像与传统磁共振成像联合诊断乳腺疾病

目的探讨扩散加权成像(DWI)与常规MRI征象联合诊断乳腺疾病的模式及诊断效能。资料与方法采用前瞻性研究,99例乳腺疾病患者共109个病变术前行3.0T乳腺MRI及DWI检查,经术后病理或长期随访确诊。乳腺良恶性病变的表观扩散系数(ADC)值进行同一观察者、不同观察者共3次测量,采用受试者操作特征曲线、串联并联诊断试验、机器学习探讨多参数联合对乳腺良恶性疾病的诊断效能。结果 ADC值的观察者内组内相关系数为0.950(95%CI 0.928~0.965);观察者间组内相关系数为0.937(95%CI 0.909~0.956);良性病变与恶性病变的ADC值分别为(1.447±0.377)×10-3 mm2/s、(1.054±0.255)×10-3 mm2/s,差异有统计学意义(P<0.05)。以ADC值1.125×10-3 mm2/s为阈值鉴别良恶性病变的敏感度和特异度分别为82.4%、74.1%,联合其他传统MRI征象可使敏感度、特异度高于单一ADC值诊断。结论 ADC值具有良好的可重复性和稳定性,ADC值与传统MRI征象联合应用可以更好地鉴别乳腺病灶的良恶性。     

超声联合动态光学成像对乳腺小病灶的诊断价值

目前女性乳腺筛查多采用超声技术,但超声对于微小钙化的检出率较低,限制了其对乳腺小病灶良恶性的正确判断.动态光学乳腺成像(dynamic optical breast imaging,DOBI)系统是一种通过分析病灶新血管生成血量和血氧含量来诊断乳腺疾病的新技术.本文旨在观察超声联合DOBI对乳腺小病灶的临床诊断价值.     

乳腺磁共振扩散加权成像的应用

目的：探讨乳腺磁共振扩散加权成像（DWI）检查的可行性,并重点探讨影响DWI图像质量的技术参数。方法：使用GE1．5T磁共振扫描仪及阵列线圈对32例乳腺疾病患者行常规SE序列扫描,其中19例为良性肿瘤,5例炎性病变,6例恶性肿瘤．均经手术及病理证实;另硅胶置入2例。使用体线圈行DWI序列扫描,采用全方位扩散梯度及5个b值扫描。DWI总的扫描时间40s。结果：在DWI序列扫描中,良性和恶性肿瘤均为高信号,计算ADC值可鉴别良性和恶性肿瘤．通过各种扫描参数的合理匹配,可使图像质量的信噪比达到最佳,并减少图像的几何变形。结论：DWI对于检查乳腺病变是一种快速可行并行之有效的技术。     

乳腺疾病患者超声弹性成像与常规超声的临床诊断分析

目的探讨超声弹性成像与常规超声在诊断乳腺疾病上的临床价值。方法将我院筛查出的88例乳腺疾病患者作为研究对象,分别对其进行常规超声和超声弹性成像检查,根据最终的病理学检查结果对比常规超声、超声弹性成像与联合检查在诊断乳腺肿块良恶性上的准确性。结果在诊断良、恶性乳腺肿块上,常规超声的准确度、敏感度、特异度分别为72.73%、66.66%和72.94%,超声弹性成像的准确度、敏感度、特异度分别为84.09%、100.00%和83.53%。超声弹性成像联合常规超声的准确度、敏感度、特异度分别为94.32%、100.00%和95.29%,其准确度和敏感度均明显高于单一常规超声和超声弹性成像(P0.05)。结论常规超声与超声弹性成像在鉴别乳腺疾病良恶性上均有一定价值,超声弹性成像的的诊断敏感性和诊断效能高于常规超声,但二者联合应用效果更为显著,在乳腺疾病筛查过程中建议二者联合应用。     

两种不同视野扩散加权成像在乳腺占位性病变中的应用对比

目的对比小视野和常规视野扩散加权磁共振成像在乳腺占位性病变中的应用价值。方法使用3.0T MR扫描仪对30例乳腺占位性病变的患者进行常规视野DWI(c FOV DWI)和小视野DWI(r FOV DWI)检查,对两种方法获取到图像质量进行评价;同时测量病灶的ADC值进行比较。结果 c FOV、r FOV DWI序列的图像质量评级分别为3.357±0.897、4.536±0.570,P值0.01,有统计学意义;两种方法 DWI测量得到的ADC值在乳腺占位性病变中均无统计学意义,P值均0.05。结论 r FOV DWI与c FOV DWI测量得到的ADC值相似,但r FOV DWI可更清晰显示乳腺占位性病变的形态、边界,提供高分辨率的弥散图像,为乳腺癌的精确诊断提供帮助。     

US-guided diffuse optical tomography for breast lesions: the reliability of clinical experience

Purpose

To prospectively assess the reliability of US-guided diffuse optical tomography (US-DOT) using interobserver agreement for the diagnosis of breast lesions with individual real-time imaging and to assess the interobserver agreement of conventional sonography (US) combined with US-DOT for differentiation between benignity and malignancy breast lesions.

Materials and Methods

An Institutional Review Board approved this study, and all subjects provided written informed consent. 122 breast lesions in 111 patients evaluated with US-guided core biopsy were included. Assessments with US and US-DOT for cases subjected to biopsy were obtained by two radiologists using individual real-time imaging prior to biopsy and were prospectively recorded by each performer. With DOT, the total haemoglobin concentration (THC) for each breast lesion was measured. Histopathological results from US-guided biopsies were used as a reference standard. To assess measurement interobserver agreement, the intraclass correlation coefficient (ICC) and the Bland-Altman plot were used for THC in US-DOT and the kappa values and ROC analysis were used to evaluate the diagnostic performances of the US BI-RADS final assessment in US and combined US and US-DOT.

Results

Of 122 US-guided core biopsied lesions, 83 (68.0%) were diagnosed as benign, and 39 (32.0%) as malignant. Excellent correlation was seen in the THC in US-DOT (ICC score 0.796; 95% confidence interval, 0.708?C0.857). The interobserver agreement in BI-RADS final assessment with US and US-DOT (almost perfect; ???=?0.8618) was improved compared with that of US (substantial agreement, ???=?0.6574). However, the overall areas under the ROC curve did not show significant differences between US and combined US and US-DOT, 0.8894 and 0.8975, respectively (P?=?0.981).

Conclusions

The reliability of THC in US-DOT showed excellent correlation in overall real-time performance. Although the inter-observer agreement for BI-RADS final assessment of US was improved by using US-DOT, the performances of radiologists with respect to the characterization of breast masses as benign or malignant were not significantly improved with US-DOT.     

US-guided diffused optical tomography: a promising functional imaging technique in breast lesions

Objective  

To investigate the feasibility and clinical efficacy of ultrasound (US)-guided diffused optical tomography (DOT) in differentiating malignant breast lesions from benign lesions.     

Benign versus malignant breast masses: optical differentiation with US-guided optical imaging reconstruction

PURPOSE: To investigate prospectively the feasibility of using optical tomography with ultrasonographic (US) localization to differentiate malignant from benign breast masses and to compare optical tomography with color Doppler US. MATERIALS AND METHODS: The study was approved by the local internal review board committee and by the Human Subjects Research Review Board of Army Medical Research and Materiel Command. Signed informed consent was obtained, and the study was HIPAA compliant. Between May 2003 and March 2004, 65 consecutive women (mean age, 51 years; age range, 24-80 years) with 81 breast lesions underwent US-guided biopsy and were scanned with a combined imager. The hand-held probe, which consisted of a centrally located US transducer surrounded by near-infrared sensors, was used to simultaneously acquire coregistered US images and optical data. The lesion location obtained at US was used to guide optical imaging reconstruction. Light absorption was measured at two wavelengths. From these measurements, tumor angiogenesis was assessed on the basis of calculated total hemoglobin concentration. A Student t distribution was used to calculate the statistical significance of mean maximum and mean average hemoglobin concentrations obtained in malignant and benign lesion groups, and P < .001 was considered to indicate a statistically significant difference. RESULTS: Biopsy results revealed eight early stage invasive carcinomas (malignant group) and 73 benign lesions (benign group). The mean maximum and mean average hemoglobin concentrations in the malignant group were 122 micromol/L +/- 26.8 (+/- standard deviation) and 88 micromol/L +/- 24.5, respectively. The mean maximum and mean average hemoglobin concentrations in the benign group were 55 micromol/L +/- 24.8 and 38 micromol/L +/- 17.4, respectively. Both the maximum and average total hemoglobin concentrations were significantly higher in the malignant group compared with the benign group (P < .001). When a maximum hemoglobin concentration of 95 micromol/L was used as the threshold value, the sensitivity, specificity, positive predictive value, and negative predictive value of optical tomography were 100%, 96%, 73%, and 100%, respectively, and the sensitivity, specificity, positive predictive value, and negative predictive value of color Doppler US were 63%, 69%, 19%, and 94%, respectively. CONCLUSION: Findings indicate that optical tomography with US localization is feasible for differentiating benign and early stage malignant breast lesions.     

Phase-contrast diffuse optical tomography pilot results in the breast

RATIONALE AND OBJECTIVES: We sought to investigate the utility of phase-contrast diffuse optical tomography (PCDOT) for differentiation of malignant and benign breast masses in humans and to compare PCDOT with conventional diffuse optical tomography (DOT) for analysis of breast masses in humans. MATERIALS AND METHODS: Thirty-five breast masses were imaged in 33 patients (mean age, 51 years; range, 22-80) using PCDOT. Images characterizing the tissue refractive index, and absorption and scattering coefficients of breast masses were obtained with a finite element-based reconstruction algorithm. Theses images were then analyzed and compared with the biopsy/pathology results for all the cases examined. RESULTS: Malignant lesions tended to have a decreased refractive index, allowing them to be discriminated from benign lesions in most cases, whereas absorption and scattering images were unable to accurately discriminate benign from malignant lesions. The sensitivity, specificity, false-positive value, and overall accuracy for refractive index imaging were 81.8%, 70.8%, 29.2%, and 74.3%, respectively. The accuracy of refractive index imaging increases with increasing patient age. CONCLUSION: Refractive index is a new parameter for optical imaging that may be helpful in differentiating between malignant and benign masses in the breast.     

Effect of vascular haemoglobin concentrations on ultrasound-guided diffuse optical tomography in differentiating benign from malignant breast lesions

Objectives

Ultrasound-guided diffuse optical tomography (US-DOT) can potentially detect breast carcinomas by measuring total tumour haemoglobin concentrations (TTHC). The purpose of this study was to evaluate whether vascular haemoglobin concentrations (VHC) affect the ability of US-DOT to distinguish breast carcinomas from benign.

Materials and methods

In 85 women (97 palpable lesions) referred for core breast biopsy, we measured VHC with a complete blood count and calculated TTHCs for each lesion with US-DOT. Anaemia was defined as a VHC less than 120.0 g/L.

Results

Mean TTHCs were significantly higher in malignant lesions (n?=?53) than in benign lesions (n?=?44), regardless of whether the lesions were from women with anaemia (TTHC, 248.5 vs. 123.3 μmol/L; P?=?0.001) or from those without (TTHC, 229.7 vs. 173.9 μmol/L; P?=?0.016). A cut-off TTHC of 155.1 μmol/L provided 81.3 % sensitivity, 81.8 % specificity and 81.5 % accuracy for detecting malignant tumours in women with anaemia and 78.4 % sensitivity, 54.5 % specificity and 67.1 % accuracy for women without. There was no significant difference in sensitivity (P?=?0.813), specificity (P?=?0.108) and accuracy (P?=?0.162) between the anaemic group and the non-anaemic group.

Conclusions

Vascular haemoglobin concentrations did not affect the ability of US-DOT to differentiate breast carcinomas from benign lesions.

Key Points

? US-DOT can differentiate benign from malignant breast lesions by measuring TTHC. ? No difference in TTHC between the anaemia and non-anaemia group. ? Vascular haemoglobin concentrations do not affect the diagnostic ability of US-DOT.     

Differentiation of cysts from solid tumors in the breast with diffuse optical tomography

RATIONALE AND OBJECTIVES: Near-infrared diffuse optical tomography (DOT) is an emerging imaging technology that has the potential to offer enhanced contrast resolution over the existing technologies for detection and diagnosis of breast cancer. Thus far, the clinical evaluation of DOT has been largely limited to solid tumors. A pilot clinical study focused on DOT imaging of breasts with cysts is presented. MATERIALS AND METHODS: Six cases were studied using the recently developed compact, parallel-detection DOT system. Images characterizing the tissue absorption and scattering were obtained with a finite element-based reconstruction algorithm. The optical images were compared with the mammograms and sonograms. In one case, in vitro measurements of optical properties were conducted for the fluid obtained from needle aspiration. RESULTS: Substantial contrast between cyst and adjacent parenchyma is observed. For the six cases evaluated, the locations and sizes of cysts imaged optically are accurate and consistent with the mammographic and sonographic findings. For the case that aspiration was performed, the absorption and scattering coefficients imaged in the cyst region are quantitatively accurate compared with that measured in vitro from the fluid aspirated. CONCLUSION: This pilot study shows that cysts ranging from 1-4 cm in diameter can be quantitatively imaged. They can be differentiated from solid breast tumors because cysts generally demonstrate lower absorption and scattering coefficients compared with the surrounding normal tissue, whereas solid tumors show concurrent higher absorption and scattering related to the normal tissue.     

Bowel lesions: percutaneous US-guided 18-gauge needle biopsy--preliminary experience.

Ultrasonography-guided percutaneous biopsy was performed with local anesthesia and an 18-gauge needle in 10 patients with bowel-wall lesions. All patients underwent clinical review within 1 month. Biopsy was diagnostic in all patients. There were no complications, and all patients tolerated the procedure well. The technique appears to be safe and had an excellent diagnostic yield in our series.