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。     

多模态超声在乳腺癌鉴别诊断中的应用价值

目的探讨光散射成像(DOT)、常规超声(US)、超声造影(CEUS)、弹性成像(UE)等超声检查技术在乳腺癌鉴别诊断中的应用价值。方法收集本院2018年6月～2019年5月经手术病理确诊的63例乳腺疾病患者资料进行回顾性分析,术前均行DOT、US、CEUS、UE等超声检查,以术后病理为金标准,对比分析各项检查及联合检查的诊断准确率、特异度及灵敏度。结果 63例病灶中,经病理证实为良性病灶29例,恶性34例。DOT的诊断准确率为84.13%,特异度为79.31%;US的诊断准率为80.95%,特异度为79.31%,灵敏度为82.35%;CEUS诊断准确率为74.60%,特异度为75.86%,灵敏度为73.53%;UE诊断准确率为71.43%,特异度为72.41%,灵敏度为70.58%;均明显低于四项联合诊断的95.24%、93.10%及97.06%(P均0.05)。结论 DOT、US、CEUS、UE对于乳腺癌的均有一定的诊断价值,但四项联合检查的诊断价值更高。     

动态光学乳腺成像在乳腺病灶鉴别诊断中的价值分析

目的：分析动态光学乳腺成像（DOBI）在鉴别乳腺良、恶性病灶中的应用价值。方法：对乳腺局灶性病变74例先进行常规超声检查,再根据超声测量病灶最大径分为〈1cm组、1～2cm组和〉2cm组进一步行DOBI扫描,并将诊断结果与病理结果进行对照分析。结果：〈1cm组DOBI诊断的敏感度、特异度和准确率均高于超声检查（P〈0．05）;1～2cm组两种检查无统计学差异（P〉0．05）;〉2cm组DOBI低于超声诊断（P〈0．05）。结论：对〈1cm的乳腺病灶,超声检查后行DOBI扫描可提高诊断的敏感度、特异度和准确率。     

超声造影联合弹性成像对BI-RADS 4类乳腺肿块的诊断价值

目的探讨超声造影(CEUS)联合弹性成像(UE)对BI-RADS 4类乳腺病灶的诊断价值。方法回顾性分析经手术病理证实的190枚BI-RADS 4类病灶的UE及CEUS声像图特点,以手术病理结果为"金标准",采用受试者工作特征(ROC)曲线分别评估两者单独及联合应用调整BI-RADS分类的诊断效能。结果 190枚病灶,病理结果显示良性71枚,恶性119枚。CEUS各增强特点良恶性组间差异均有统计学意义。CEUS、UE及常规超声的受试者工作特征曲线下面积(AUROC)分别为0.848,0.767,0.818,均小于UE联合CEUS调整BI-RADS分类的方法(AUROC为0.935),诊断效能具有统计学意义(P0.01)。常规超声、UE、CEUS的敏感度、特异度、准确率分别为97.5%,67.6%,86.3%;68.1%,76.1%,71.1%;65.5%,91.5%,75.3%。CEUS联合UE调整BI-RADS分类后的敏感度98.3%,特异度88.7%,准确率94.7%。结论 CEUS在乳腺良恶性病灶的鉴别上有一定的应用价值,CEUS联合UE能进一步提高BI-RADS 4类乳腺病灶的良、恶性鉴别诊断。     

实时超声造影对提高乳腺肿瘤BI-RADS分类准确性的价值

目的探讨超声造影对提高乳腺肿瘤乳腺影像报告和数据系统(BI-RADS)分类准确性的价值。资料与方法收集151个乳腺肿瘤的常规超声及超声造影资料,根据常规超声进行BI-RADS分类;并行超声造影检查,结合病灶造影增强扫描特点重新进行分类,与病理结果进行比较,并比较常规超声BI-RADS分类与结合超声造影的BI-RADS分类对乳腺肿物恶性风险分层的评估能力。结果结合超声造影增强扫描特点后,BI-RADS分类的变化主要发生在3类和4A类,常规超声BI-RADS分类评估诊断敏感度、特异度、准确度、阳性预测值、阴性预测值分别为92.2%、52.1%、72.8%、80.5%、75.7%;结合超声造影图像特点后的BI-RADS分类,其诊断特异度、准确度、阴性预测值分别提高至72.9%、86.8%、83.3%,与常规超声比较,差异有统计学意义(P<0.05)。常规超声BI-RADS分类评估ROC曲线下面积为0.802,与结合超声造影后的曲线下面积0.878比较,差异有统计学意义(P<0.05)。结论在常规超声BI-RADS分类的基础上,结合病灶的造影增强模式有助于提高超声BIRADS分类对乳腺肿块恶性风险分层的评估能力。     

X线与超声双联合对乳腺病变诊断价值的探讨

目的：评价和比较乳腺x线摄影、超声成像以及二者联合在乳腺病变诊断中价值。资料与方法：2004年8月-2006年5月，对同时行乳腺X线检查和超声成像的198例患者222个病灶进行了病理检查。根据怀疑乳腺病变的恶性程度，将术前X线检查、超声成像、联合诊断的病变分别分为四级：Ⅰ级一良性；Ⅱ级一不能定性；Ⅲ级可能恶性；Ⅳ级一恶性。前瞻性记录三种方式的分级，并与病理诊断对照。结果：经病理检查诊断的222个乳腺病变中，良性病变158个，恶性病变64个。乳腺X线检查和超声成像的敏感性分别为87．5％和84．4％，特异性均为89．9％，诊断准确率分别为89．2％和88．3％。二者联合对乳腺病变诊断的敏感性95．3％，特异性为91．8％，诊断准确率为92．8％。二者联合的各项指标均优于单纯采用乳腺X线检查和超声成像。结论：联合应用乳腺X线摄影和乳腺超声成像可提高对乳腺病变的诊断准确率。     

对比增强能谱乳腺X线摄影联合超声在乳腺癌中的应用研究

【摘要】目的：研究对比增强能谱乳腺X线摄影（CESM）联合超声在乳腺癌中的临床价值,分析乳腺病灶良恶性评估的诊断效能,提高乳腺癌疾病诊断准确性。方法：回顾性分析本院2019年6月-2020年4月临床诊断的126例乳腺疾病患者的病例资料,所有患者均行CESM检查、超声检查及病理诊断,分析单项检查及联合检查诊断乳腺疾病的符合率,对单项检查乳腺癌病灶测量与病理测量值进行一致性分析,比较CESM、超声与联合检查对乳腺癌疾病诊断效能。结果：以病理诊断为金标准,确诊38 例乳腺癌患者,CESM乳腺癌检出率84.21%（32/38）高于超声恶性检出率78.94%（30/38）,差异无统计学意义（χ2=0.350,P＞0.05）。CESM和超声测量值与病理测量值呈正相关（r=0.943、0.766,P均＜0.001）。诊断乳腺癌效能分析显示,联合检查敏感度、特异度、符合率、阴性预测值及阳性预测值均高于单项CESM、超声检查。结论：CESM与超声联合检查在诊断乳腺癌疾病中能提高疾病灵敏度、特异度及准确率,具有很好的临床应用价值。     

肿块深度对乳腺超声弹性成像检查结果的影响分析

目的探究超声弹性成像(UE)中肿瘤深度对于判断乳腺肿物的良、恶性影响。方法选取本院2017年1月~2018年10月间收治的178例因乳腺肿块行手术切除患者为观察对象,纳入病灶200个。依据肿瘤深度不同分4组。对所有的患者在术前均予以常规超声检查以及超声弹性成像检查,对比不同深度肿瘤的UE成像情况、分析诊断效能(准确度、特异度、灵敏度以及阴、阳性预测值),对比良恶性乳腺肿瘤UE成像检查的阳性率。结果诊断良性病灶114个、恶性病灶86个;D组成像效果与A、B、C组相比的UE成像效果更差(P<0.05);A组特异度与B、C、D组的对比差异有统计学意义(P<0.05);A组准确度显著高于D组,差异有统计学意义(P<0.05),UE成像技术对恶性病灶的诊断阳性率显著更高(P<0.05)。结论在乳腺超声弹性成像检查中,对于乳腺肿物的良、恶性成像质量,诊断的特异度与准确度均受到肿瘤深度的影响。     

超声造影定性分析联合剪切波弹性成像对乳腺BI-RADS 4类肿块的鉴别应用

目的 探讨超声造影（CEUS）定性分析联合剪切波弹性成像（SWE）对乳腺影像报告和数据系统（BI-RADS）4类肿块的鉴别价值。方法 选取BI-RADS 4类的乳腺肿块患者62例,其中良性33例（良性组）,恶性29例（恶性组）。所有患者均经病理检查证实,且行CEUS和SWE检查。结果 CEUS诊断乳腺肿块准确率为67.74%,SWE诊断乳腺肿块准确率为62.90%,CEUS联合SWE诊断乳腺肿块准确率为88.71%。CEUS联合SWE诊断乳腺肿块准确率高于CEUS与SWE检查,差异有统计学意义（P<0.05）。恶性组CEUS评分高于良性组,差异有统计学意义（P<0.05）。恶性组SWE参数Esd、Emean、Emax和Eratio高于良性组,差异有统计学意义（P<0.05）。CEUS联合SWE诊断恶性乳腺肿块灵敏度和特异度高于CEUS和SWE,差异有统计学意义（P<0.05）。结论 CEUS定性分析联合SWE可提高对BI-RADS4类肿块良恶性鉴别诊断准确率。     

彩色多普勒超声与MR诊断乳腺病变的临床价值分析

目的：比较彩色多普勒超声、磁共振动态增强对乳腺病变的临床诊断价值。方法收集经手术与病理证实的95例同时做过超声与M R的101个乳腺病灶,对其二维声像图及CDFI特点与磁共振动态增强影像学表现,对照病理结果进行回顾性分析。结果彩色多普勒与MR动态增强扫描对乳腺良恶性病变定性诊断准确率分别为：超声良性病变诊断正确率73．3％,恶性病灶诊断正确率87．3％;M R良性病变诊断正确率84．3％,恶性病灶诊断正确率92．7％。95个患者共检出101处病灶,其中乳腺癌67例,占66％;纤维瘤23例,占23％,炎性肉芽肿4例,占4％;分叶状肿瘤2例,占2％;囊腺瘤1例,占1％;乳头状瘤4例,占4％。结论超声检查诊断准确性高,适用于乳腺疾病的常规检查;MR空间分辨力及软组织分辨力高,适用于超声检查难以定性的病变及乳腺癌的术前评估。     

恶性浅表淋巴结病变的常规超声及超声造影特征

目的探讨与恶性浅表淋巴结病变相关的常规超声及经静脉超声造影(CEUS)特征。资料与方法对68例患者共68枚淋巴结进行常规超声检查,并对其中62枚行CEUS检查,所有淋巴结均获取病理结果。比较良、恶性浅表淋巴结的常规超声及CEUS特征差异,对各因素分别做受试者工作特征(ROC)曲线,计算其对良、恶性淋巴结病变的鉴别诊断效能。结果良性和恶性浅表淋巴结病变短径、长短径之比、有无淋巴门、周围型/混合型血流、增强是否均匀、增强时有无淋巴门、外周向中心增强、增强时有无灌注缺损等超声特征比较,差异均有统计学意义(P均<0.05),其对良、恶性淋巴结病变的ROC曲线下面积分别为0.687、0.665、0.786、0.676、0.628、0.662、0.725和0.648。结论浅表淋巴结病变短径、长短径之比、有无淋巴门、周围型/混合型血流、增强是否均匀、增强时有无淋巴门、外周向中心增强、增强时有无灌注缺损等超声特征是鉴别诊断良恶性的指标。     

超声造影结合Bosniak标准在良恶性肾囊性病变鉴别诊断中的价值

目的 评价超声造影鉴别良恶性肾囊性病变的准确性,探讨超声造影结合Bosniak标准分级诊断肾囊性病变的可行性.资料与方法 对30例患者的36个肾囊性病灶进行超声造影,分析良恶性肾囊性病变的超声造影征象;按照Bosniak标准对超声造影的表现进行分级诊断,计算其敏感性、特异性、诊断符合率、阳性预测值、阳性似然比、Kappa值及验后概率,分析该方法分级诊断肾囊性病变的准确性.结果 超声造影可显示常规超声不能发现的囊内分隔及实性结构.超声造影结合Bosniak标准诊断肾囊性病变的敏感性、特异性、诊断符合率、阳性预测值、阳性似然比分别为92.9％、90.9％、94.8％、86.7％、10.2,Kappa=0.83;应用超声造影结合Bosniak标准可提高肾囊性病变良恶性诊断的验后概率.结论 超声造影结合Bosniak标准可以提高鉴别诊断肾囊性病变良恶性的准确性.     

相对造影参数在乳腺肿物良恶性鉴别诊断中的价值

目的利用超声造影技术,探讨相对造影参数在乳腺病灶良恶性鉴别诊断中的价值。方法选用造影剂SonoVue,对34例乳腺病灶进行超声造影(良性14例,恶性20例),应用随机配置的Qontraxt定量分析软件,对病灶及病灶旁组织勾勒感兴趣区,测量其声学定量参数,进一步获得相对造影参数。结果病灶的相对峰值强度、相对达峰时间、相对曲线下面积,良恶性病灶之间差异均具有统计学意义(P<0.05)。病灶的相对曲线尖度,良恶性病灶之间差异无统计学意义(P>0.05)。结论乳腺良恶性病灶的超声造影灌注模式各有特点。超声造影研究中,应充分重视病灶周围腺体的增强情况,病灶的相对造影参数有助于良恶性的鉴别诊断。     

Focal liver lesions: can SonoVue-enhanced ultrasound be used to differentiate malignant from benign lesions?

OBJECTIVE: To evaluate whether contrast-enhanced ultrasound (CEUS) with SonoVue could differentiate malignant focal liver lesions (FLLs) from benign lesions and provide lesion type diagnoses. MATERIALS AND METHODS: Four hundred fifty-six patients with 554 FLLs were examined by CEUS with SonoVue using low mechanical index, nonlinear imaging techniques. Each lesion was characterized by 2 independent off-site readers as malignant or benign and given specific lesion type diagnosis, if possible, both at baseline ultrasound (US) and after SonoVue administration (CEUS). The final diagnosis was achieved by histopathology obtained from biopsy or surgical specimens, or by typical manifestation on contrast-enhanced CT or MRI. RESULTS: The diagnostic accuracies of the 2 readers were 41.9% and 35.2% for baseline US, which improved significantly to 87.2% and 87.9% for CEUS (P < 0.05). Interreader agreement also increased with CEUS compared with baseline US (ê value changed from 0.49 to 0.77). The accuracy for lesion type diagnosis was 38.4% and 32.5% for baseline US, which increased to 77.6% and 78.0% for CEUS (P < 0.05). CONCLUSIONS: CEUS with SonoVue improves differentiation between malignant and benign FLLs, and also provides improved lesion type (differential) diagnosis.     

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。     

Predictive model for contrast-enhanced ultrasound of the breast: Is it feasible in malignant risk assessment of breast imaging reporting and data system 4 lesions?

AIM: To build and evaluate predictive models for contrast-enhanced ultrasound (CEUS) of the breast to distinguish between benign and malignant lesions. METHODS: A total of 235 breast imaging reporting and data system (BI-RADS) 4 solid breast lesions were imaged via CEUS before core needle biopsy or surgical resection. CEUS results were analyzed on 10 enhancing patterns to evaluate diagnostic performance of three benign and three malignant CEUS models, with pathological results used as the gold standard. A logistic regression model was developed basing on the CEUS results, and then evaluated with receiver operating curve (ROC). RESULTS: Except in cases of enhanced homogeneity, the rest of the 9 enhancement appearances were statistically significant (P < 0.05). These 9 enhancement patterns were selected in the final step of the logistic regression analysis, with diagnostic sensitivity and specificity of 84.4% and 82.7%, respectively, and the area under the ROC curve of 0.911. Diagnostic sensitivity, specificity, and accuracy of the malignant vs benign CEUS models were 84.38%, 87.77%, 86.38% and 86.46%, 81.29% and 83.40%, respectively. CONCLUSION: The breast CEUS models can predict risk of malignant breast lesions more accurately, decrease false-positive biopsy, and provide accurate BI-RADS classification.     

探讨超声弹性成像对甲状腺良恶性结节鉴别诊断的应用价值

目的:研究超声弹性成像在鉴别甲状腺良、恶性结节临床诊断中的应用价值。方法:对术前52例(93个)甲状腺结节进行常规二维、彩色多普勒超声及弹性成像检查,对弹性成像进行分析,并与病理结果进行对照。结果:93个甲状腺结节中,良性结节64个,恶性结节29个。其良性结节中,47个结节评为1～2分,恶性结节中,27个结节评为4～5分,两组弹性成像评分比较有统计学差异(P<0.01)。其诊断恶性结节的敏感性87.10%、特异性96.77%、准确性93.55%。结论:超声弹性成像对鉴别甲状腺良恶性病变提供很大的帮助。     

乳腺肿瘤高频彩超及超声造影与微血管密度的相关性

目的 分析乳腺良恶性肿瘤高频彩超、超声造影(CEUS)与微血管密度(MVD)的相关性,探讨超声造影对乳腺肿瘤的诊断价值.资料与方法 82例原发性乳腺肿瘤患者于术前行常规高频彩超检查,观察病灶灰阶图像特征及血流特征;启动造影模式行实时灰阶谐波超声造影检查,应用时间-信号强度曲线分析软件分析病灶增强达峰时间(TTP)、峰值强度(PI)、曲线下面积(AUC);采用免疫组化测定肿瘤内MVD,分析超声造影定量参数与MVD的相关性.结果 恶性组肿瘤血流Adler分级低于良性组(P＜0.05);超声造影显像特点:恶性组血管数量多且粗细不等,良性组血流束细窄、平直;恶性组TTP低于良性组,PI及AUC高于良性组(P＜0.05),MVD显著高于良性组(P＜0.001);肿瘤MVD计数随血流Adler分级升高而升高,CDF1血流丰富程度与MVD呈正相关(r=0.456,P＜ 0.01); PI与MVD呈显著正相关(r=0.783,P＜0.01).结论 超声造影能客观评价乳腺肿瘤血供,术前应用CDFI结合超声造影在体检查肿瘤血管,可为早期诊断乳腺肿瘤提供信息.     

Differentiating benign from malignant solid breast lesions: Combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging

Objective

To prospectively evaluate the diagnostic efficacy of conventional ultrasound (US), contrast-enhanced US (CEUS), the combined use of two modalities, and magnetic resonance imaging (MRI) in the differentiation of focal solid breast lesions.

Materials and methods

61 patients with BI-RADS category 3–5 breast lesions detected at conventional US underwent CEUS and MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of conventional US, CEUS, combination of two modalities and MRI for discrimination between benign and malignant breast lesions.

Results

Tissue specimens of 61 breast lesions were obtained either from surgical resection (n = 46) or from needle biopsy (n = 15). Histopathologic diagnosis revealed 28 benign and 33 malignant lesions. The diagnostic performance of conventional US and CEUS in differentiating benign from malignant breast lesions showed no significant difference (P = 0.741). The combination of two modalities significantly improved the diagnostic accuracy compared with either conventional US or CEUS alone (P = 0.031 and P = 0.012, respectively). The area under the ROC curve (A_z) value for the combined use of two modalities for discrimination between benign and malignant breast lesions was 0.94, and that for MRI was 0.91, whereas no statistical difference was found between them (P = 0.296).

Conclusion

The combined use of conventional US and CEUS has a better diagnostic performance than either method alone and displays good agreement with MRI in the differentiation capability for benign and malignant breast lesions.     

Real-time contrast-enhanced ultrasound in diagnosing of focal spleen lesions

Objective

To investigate the features of focal spleen lesions (FSLs) on contrast-enhanced ultrasound (CEUS) imaging.

Materials and methods

CEUS with a blot injection of SonoVue was performed in 48 patients with 75 FSLs (median diameter 2.6 cm) and their perfusion characteristics were analyzed by using contrast pulse sequences (CPS) technique.

Results

Among 19 malignant lesions (10 metastases, 7 lymphoma, 1 hemangiosarcoma, 1 epithelioid hemangioendothelioma) and 56 benign lesion (23 hemangiomas, 14 cysts, 8 infarctions, 4 splenic ruptures, 3 tuberculosis, 2 abscess, 1 pseudoaneurysm, 1 lymphangioma), 25 benign lesions were demonstrated nonenhancement. For malignancy, 50.0% (5/10) metastases and 57.1% (4/7) lymphomas were showed hypoenhancement in the arterial phase, and 18 (94.7%) of malignant lesions were hypo-enhancement in the parenchymal phase. Among 31 benign lesions with enhancement, 27 (87.1%) were showed isoenhancement or hyperenhancement in the arterial phase and 22 (71.0%) lesions were isoenhancement or hyperenhancement in the parenchymal phase. The sensitivity, specificity and accuracy of diagnosis for FSLs were 91.1%, 95.0% and 92.0% for CEUS and 75.0%, 84.2% and 77.3% respectively, for the conventional baseline ultrasound (BUS).

Conclusion

Real-time CEUS can provide valuable information for the diagnosis and differential diagnosis of FSLs.