Deformable mapping using biomechanical models to relate corresponding lesions in digital breast tomosynthesis and automated breast ultrasound images

This work investigates the application of a deformable localization/mapping method to register lesions between the digital breast tomosynthesis (DBT) craniocaudal (CC) and mediolateral oblique (MLO) views and automated breast ultrasound (ABUS) images. This method was initially validated using compressible breast phantoms. This methodology was applied to 7 patient data sets containing 9 lesions. The automated deformable mapping algorithm uses finite element modeling and analysis to determine corresponding lesions based on the distance between their centers of mass (d_COM) in the deformed DBT model and the reference ABUS model. This technique shows that location information based on external fiducial markers is helpful in the improvement of registration results. However, use of external markers are not required for deformable registration results described by this methodology. For DBT (CC view) mapped to ABUS, the mean d_COM was 14.9 ± 6.8 mm based on 9 lesions using 6 markers in deformable analysis. For DBT (MLO view) mapped to ABUS, the mean d_COM was 13.7 ± 6.8 mm based on 8 lesions using 6 markers in analysis. Both DBT views registered to ABUS lesions showed statistically significant improvements (p ≤ 0.05) in registration using the deformable technique in comparison to a rigid registration. Application of this methodology could help improve a radiologist's characterization and accuracy in relating corresponding lesions between DBT and ABUS image datasets, especially for cases of high breast densities and multiple masses.     

乳腺浸润性导管癌影像学表现与组织学分级的相关性

目的 观察全视野数字化乳腺摄影(FFDM)联合乳腺断层摄影(DBT)及超声所见乳腺浸润性导管癌(IDC)征象与组织学分级的相关性.方法 192例IDC经病理证实,其中8例组织学分级Ⅰ级、116例Ⅱ级、68例Ⅲ级;回顾性分析其FFDM联合DBT及超声表现,记录病灶大小、边界、形态、毛刺、恶性钙化、纵横比及有无可疑淋巴结转...     

高频超声和X线钼靶联合诊断小乳腺癌的临床研究

[目的]探讨超声和X线钼靶联合应用诊断小乳腺癌的价值.[方法]43例小乳腺癌和32例良性小肿块于术前联合运用超声和X线钼靶摄片检查进行诊断,并与手术后病理结果进行对照.[结果]小乳腺癌的超声诊断符合率为92.8%,钼靶X线摄片的诊断符合率为86%,两者联合运用,诊断符合率提高到97.7%.[结论]超声和钼靶联合应用能提高小乳腺癌的诊断符合率.     

B超引导下麦默通装置在乳腺微创外科中的应用

【目的】探讨B超引导下麦默通系统在乳腺微创外科中的应用价值。【方法】在B超引导下采用麦默通装置行微创旋切对36例乳腺肿瘤患者进行诊断及治疗。【结果】10例行穿刺活检,其中恶性4例,明确诊断后均行新辅助化疗。26例乳腺肿块均完整切除。术后1月B超随访无原病灶残留和复发,3例出现术后出血并发症．1～2个月后完全吸收。超声引导成功率100％。【结论】B超引导下麦默通乳腺微创旋切术是一种治疗乳腺肿瘤安全、合理、有效、符合美学观点的诊治方法。     

Effect of a Gel Retainment Dam on Automated Ultrasound Coverage in a Dual‐Modality Breast Imaging System

Objective. The goal of this work was to evaluate a possible improvement in ultrasound coverage for a dual‐modality breast imaging system in the mammographic geometry. Methods. A pilot study was performed to evaluate use of a rubber dam to retain ultrasound gel and improve imaging coverage at the breast periphery on a combined imaging system consisting of an ultrasound scanner and a digital x‐ray tomosynthesis unit. Several dams were constructed to encompass the shapes of various sizes of compressed breasts. Visual tracings of the breast‐to‐paddle contact area and breast periphery were made for 8 breasts to estimate coverage area. Two readers independently reviewed the resulting images and were asked to rate the overall breast image quality. Results. The percentages of breast in contact with the paddle were greater (P < .01) and the linear dimensions of breast in contact with the paddle were larger (P < .05) with the rubber dam than without it. With the dam, the mean estimated area of the breast in contact with the paddle increased 14%, whereas the mean increase in the fraction of the total breast area in contact with paddle was 30%. The difference was due to the mean total projected area of the breast decreasing 12% as the dam was pressed against it. The image quality of automated ultrasound with the rubber dam was consistently judged to be superior to that without the dam. Conclusions. This method can enhance the absolute and percentage area of the breast in contact with the paddle, reducing noncontact gaps at the breast periphery. Gently pressing the breast periphery with the dam inserted toward the chest wall improves coverage in automated breast ultrasound scanning.     

Static and Dynamic Cumulative Maximum Intensity Display Mode for Subharmonic Breast Imaging

Objective. The purpose of this study was to test the efficacy of static and dynamic cumulative maximum intensity (CMI) subharmonic imaging (SHI) in breast ultrasound studies. Methods. Contrast‐enhanced SHI was performed in 14 women using a modified LOGIQ 9 scanner (GE Healthcare, Milwaukee, WI) transmitting/receiving at 4.4/2.2 MHz. Following mammography, baseline scans of gray scale ultrasound and power Doppler imaging (PDI) were performed. Contrast‐enhanced PDI and gray scale SHI were performed after contrast agent administration. Static CMI‐SHI is a composite image summarizing blood flow over multiple frames using the maximum intensity projection technique. The dynamic CMI‐SHI mode depicts the gradual inflow pattern of the contrast agent in blood vessels. Both CMI‐SHI modes were set up using a new automated sum‐absolute‐difference–based block‐matching algorithm to reduce noise and blurring and compensate for motion artifacts. Evaluation of the imaging modes for detecting breast cancer was done by an experienced radiologist, blinded to histopathologic findings. Sensitivity, specificity, and receiver operating characteristic (ROC) analyses were computed and compared for all ultrasound imaging modes and mammography. Results Of the 16 lesions, 4 were malignant. The area under the ROC curve (A_z) for the diagnosis of breast cancer was 0.64 for gray scale and PDI, 0.67 for contrast‐enhanced PDI, 0.76 for mammography, 0.78 for SHI, and 0.75 for static CMI‐SHI. For the dynamic CMI‐SHI mode, the A_z increased to 0.90, and this was significantly better than mammography (P = .03). Conclusions. The new dynamic CMI‐SHI mode produced the highest A_z for the diagnosis of breast cancer compared to conventional techniques and thus appears to improve diagnosis of breast cancer relative to conventional techniques, albeit based on a limited patient population.     

钙化灶在超声诊断乳腺肿块中的意义

【目的】探讨钙化灶在超声诊断乳腺肿块中的价值。【方法】检查 2 5 6例乳腺肿块 ,其中乳腺癌 130例 (A组 ) ,乳腺良性肿块 12 6例 (B组 )。使用配备高频线阵探头 (12MHz和 10MHz)的电脑彩色超声仪 ,注意观察乳腺肿块中的钙化灶。所有病例诊断均经病理检查证实。【结果】在乳腺癌组和乳腺良性肿块组中钙化灶的检出率分别为 5 2 %和 9.5 % ,两者比较差异有非常显著性意义 (P <0 .0 1)。乳腺癌组以微小钙化灶最多 ,占76 % (5 2例 ) ,微小钙化灶在乳腺良性肿块中仅占 33% (4例 ) ,两组差异亦有非常显著性意义 (P <0 .0 1)。【结论】超声检出乳腺肿块内钙化灶有助于对肿块良恶性的判断 ;密集分布的微小钙化灶常提示乳腺癌。     

Deformable Mapping Method to Relate Lesions in Dedicated Breast CT Images to Those in Automated Breast Ultrasound and Digital Breast Tomosynthesis Images

This work demonstrates the potential for using a deformable mapping method to register lesions between dedicated breast computed tomography (bCT) and both automated breast ultrasound (ABUS) and digital breast tomosynthesis (DBT) images (craniocaudal [CC] and mediolateral oblique [MLO] views). Two multi-modality breast phantoms with external fiducial markers attached were imaged by the three modalities. The DBT MLO view was excluded for the second phantom. The automated deformable mapping algorithm uses biomechanical modeling to determine corresponding lesions based on distances between their centers of mass (d_COM) in the deformed bCT model and the reference model (DBT or ABUS). For bCT to ABUS, the mean d_COM was 5.2 ± 2.6 mm. For bCT to DBT (CC), the mean d_COM was 5.1 ± 2.4 mm. For bCT to DBT (MLO), the mean d_COM was 4.7 ± 2.5 mm. This application could help improve a radiologist's efficiency and accuracy in breast lesion characterization, using multiple imaging modalities.     

Use of Urokinase in Percutaneous Drainage of Large Breast Abscesses

Objective. The purpose of this study was to evaluate intracavitary urokinase therapy versus irrigation with a saline solution in percutaneous drainage of large breast abscesses. Methods. A prospective randomized study was conducted in 19 nonlactating women (median age, 35.7 years) with breast abscesses of greater than 3 cm. Percutaneous drainage with an ultrasound‐guided catheter was performed in group A patients (saline solution) and group B patients (urokinase). Postdrainage care and ultrasound‐guided drainage control were performed on an outpatient basis. The Student t test, Fisher exact test, χ² test, and Mann‐Whitney U test were used for statistical analysis. Results. Percutaneous drainage with saline or urokinase irrigation was successful in all cases. No statistically significant differences were observed between groups A and B for clinical parameters and sonographic characteristics of the abscesses. However, a statistically significant difference was observed between the two groups for the average drainage times (P < 0.012), which were 3.8 days for the urokinase group and 5.3 days for the saline group. A recurrence was observed in 1 saline group patient who had a diagnosis of a chronic abscess, which was resolved with intracavitary urokinase irrigation. Conclusions. Percutaneous drainage of large breast abscesses in nonlactating women with intracavitary urokinase irrigation is a simple and safe procedure. It reduces the treatment time and improves the clinical course of patients more than conventional drainage with saline irrigation.     

乳腺癌并发甲状腺癌的超声诊断价值

【目的】探讨乳腺癌术后患者应用高频超声诊断甲状腺癌的价值。【方法】对本院2004年1月至2009年10月917例乳腺癌行乳腺癌改良根治术894例和保留乳房的乳腺癌切除术23例。在对乳腺癌患者术后检查和随访时同时应用超声检查甲状腺,发现可疑恶性结节,立即行超声指导下细针抽吸细胞学检查。【结果151例有可疑发现,24倒（47．1％）超声指导下细针抽吸细胞学检查组织中有可疑恶性细胞。917例乳腺癌患者中,有18例（2％）甲状腺术后诊断为癌,并且均为乳头状癌,与普通人群比较差异具有极显著性（P〈0．01）。【结论】乳腺癌患者有极高的甲状腺癌发病率（2％）。超声扫描是早期发现甲状腺癌的重要方法。     

乳腺癌术后早期肩关节功能障碍风险评分系统的构建

目的筛选与乳腺癌术后早期肩关节功能障碍发生有关的预测因素,并以此为基础构建乳腺癌术后早期肩关节功能障碍风险评分系统。方法采用回顾性病例对照研究,便利抽样选择2014年9月至2015年12月在浙江省中医院乳腺科住院并符合纳入标准的患者共110例,应用肩关节活动度(range of motion,ROM)测量金标准,将患者分为病例组(发生肩关节功能障碍)43例和对照组(未发生肩关节功能障碍)67例。收集患者的一般资料、治疗资料、心理及行为资料、社会资料,进行单因素Logistic回归分析和多因素logistic逐步回归(前进法)分析,根据回归分析纳入变量的回归系数和OR值分别建立预测乳腺癌术后早期肩关节功能障碍的Logistic评分系统和Additive评分系统。结果多因素逐步Logistic回归(前进法)分析结果显示,手术类型、家人是否监督、功能锻炼频率、功能锻炼时长、功能锻炼方式种类最终进入回归方程。Logistic评分系统和Additive评分系统分值分别为0~85分和3~22分,判定乳腺癌术后早期肩关节功能障碍高危人群的分值分别为≥52分和≥12.5分。结论乳腺癌术后早期肩关节功能障碍风险评分系统可以筛查乳腺癌术后早期肩关节功能障碍高危人群,为预防患者肩关节功能障碍提供指导和依据。     

Preliminary in Vivo Breast Vibro-acoustography Results with a Quasi-2-D Array Transducer: A Step Forward Toward Clinical Applications

We previously investigated the application of a novel imaging modality, vibro-acoustography (VA), using an annular confocal transducer (confocal VA) integrated into a clinical prone stereotactic mammography system, to detect various breast abnormalities. To shorten the scanning time and provide improved coverage of the breast, we have evolved our imaging system by implementing VA on a clinical ultrasound scanner equipped with a “quasi-2-D” array transducer. We call this technique “quasi-2-D vibro-acoustography” (Q2-DVA). A clinical ultrasound scanner (GE Vivid 7) was modified to perform both ultrasound imaging and VA using an array transducer consisting of a matrix of 12 rows by 70 columns of ultrasound elements. The newly designed system was used to perform VA on patients with either benign or cancerous lesions. Our results indicate that benign and malignant solid breast lesions were easily detected using our newly modified VA system. It was also possible to detect microcalcifications within the breast. Our results suggest that with further development, Q2-DVA could provide high-resolution diagnostic information in the clinical setting and may be used either as a stand-alone or as a complementary tool in support of other clinical imaging modalities.     

乳腺癌二维高频超声显像与病理对比分析

目的:探讨二维高频超声对乳腺癌的诊断价值。方法:对28例乳腺癌患者术前行乳腺高频超声检查,观察其边缘形态、内部回声、后方声象改变及长宽比值,术后对乳腺癌标本进行病理学检查。结果:28例乳腺癌术前超声与术后病理对照,诊断符合率为82.1%(23/28),误诊纤维腺瘤5例(乳腺癌<1 cm);在各病理分型乳腺癌中,其声像改变互有交叉不具特异性。结论:根据超声表现对乳腺癌进行初步诊断有较高价值,而对于小乳腺癌(<1 cm)诊断仍有局限性。     

高频彩色多普勒在乳腺疾病中的应用

目的 评价高频超声及彩色多普勒对乳腺疾病的诊断价值。方法 本研究对经手术证实的28例乳腺癌。20例纤维腺瘤,70例乳腺增生,15例乳腺炎进行二维及多普勒超声检查。结果 乳腺癌的RI值,PI值比纤维腺瘤,乳腺增生、乳腺炎有显著增高而后三组之间无显著差异。结论 高频彩色多普勒超声有助于临床对乳腺疾病的诊断。     

Contrast-Enhanced Ultrasound-Guided Fine-Needle Aspiration for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

The purpose of this study was to assess whether translymphatic contrast-enhanced ultrasound (CEUS) combined with fine-needle aspiration (FNA) can be used pre-operatively to assess the status of axillary lymph nodes in early-stage breast cancer patients. Furthermore, we wanted to determine whether this less invasive method could potentially be a pre-operative surgical strategy. One hundred sixty-four sentinel lymph nodes (SLNs) were detected by CEUS after intradermal injection of microbubbles in 126 cases. One hundred twenty of 126 cases (95.24%) were accurately diagnosed with the SLN-FNA method. All 6 false-negative cases were due to micrometastasis or macrometastasis. There were no false-positive results after CEUS-guided FNA biopsy based on post-operative histopathological results. In conclusion, translymphatic CEUS combined with SLN-FNA is a less traumatic approach that has high accuracy in the pre-operative evaluation of axillary lymph node status. It might have the potential to be as reliable an indicator for axillary lymph node dissection as SLN biopsy.     

X线钼靶联合彩色多普勒超声在乳腺癌筛查中的应用价值

目的探究X线钼靶联合彩色多普勒超声在乳腺癌筛查中的应用价值。方法选择经X线钼靶及彩色多普勒超声检查并经病理学证实为乳腺癌患者109例(126个病灶),对其影像学诊断资料进行回顾性分析,分别计算彩色多普勒超声与X线钼靶及联合诊断符合率。结果109例乳腺癌患者合计126个病灶,其中93例单发乳腺癌,29例为多中心型或多灶型乳腺癌,4例双乳癌;彩色多普勒超声联合X线钼靶诊断、彩色多普勒超声和X线钼靶诊断符合率分别为96.83%、84.92%、79.37%,彩色多普勒超声联合X线钼靶诊断明显高于单一的彩色多普勒超声与X线钼靶诊断,差异均有统计学意义(χ^2分别=10.77、18.31,P均<0.05),彩色多普勒超声与X线钼靶诊断符合率比较,差异无统计学意义(χ^2=1.33,P>0.05)。彩色多普勒超声检查浸润性导管癌、导管原位癌、浸润性小叶癌诊出率较高,X线钼靶漏诊率较高;X线钼靶对10个肿块中细小毛刺可清晰显示,但彩色多普勒超声仅对其中3例进行描述;X线钼靶确定微小钙化灶27例,彩色多普勒超声仅对其中13例进行显示。结论X线钼靶与彩色多普勒超声诊断乳腺癌符合率均较低,但X线钼靶联合彩色多普勒超声诊断乳腺癌能起到互补作用,大幅度提升诊断符合率,筛查联合应用效果较好。     

Image retrieval with principal component analysis for breast cancer diagnosis on various ultrasonic systems.

OBJECTIVES: We present a computer-aided diagnostic (CAD) system with textural features and image retrieval strategies for classifying benign and malignant breast tumors on various ultrasonic systems. Effective applications of CAD have used different types of texture analysis. Nevertheless, most approaches performed in a specific ultrasonic machine do not indicate whether the technique functions satisfactorily for other ultrasonic systems. This study evaluated a series of pathologically proven breast tumors using various ultrasonic systems. METHODS: Altogether, 600 ultrasound images of solid breast nodules comprising 230 malignant and 370 benign tumors were investigated. All ultrasound images were acquired from four diverse ultrasonic systems. The suspicious tumor area in the ultrasound image was manually chosen as the region-of-interest (ROI) subimage. Textural features extracted from the ROI subimage are supported in classifying the breast tumor as benign or malignant. However, the textural feature always behaves as a high-dimensional vector. In practice, high-dimensional vectors are unsatisfactory at differentiating breast tumors. This study applied the principal component analysis (PCA) to project the original textural features into a lower dimensional principal vector that summarized the original textural information. The image retrieval techniques were employed to differentiate breast tumors, according to the similarities of the principal vectors. The query ROI subimages were identified as malignant or benign tumors according to characteristics of retrieved images from the ultrasound image database. RESULTS: Using the proposed CAD system, historical cases could be directly added into the database without a retraining program. The area under the receiver-operating characteristics curve for the system was 0.970+/-0.006. CONCLUSION: The CAD system identified solid breast nodules with comparatively high accuracy in the different ultrasound systems investigated.     

Automated ultrasound scanning on a dual-modality breast imaging system: coverage and motion issues and solutions.

OBJECTIVE: We are developing an automated ultrasound imaging-mammography system wherein a digital mammography unit has been augmented with a motorized ultrasound transducer carriage above a special compression paddle. Challenges of this system are acquiring complete coverage of the breast and minimizing motion. We assessed these problems and investigated methods to increase coverage and stabilize the compressed breast. METHODS: Visual tracings of the breast-to-paddle contact area and breast periphery were made for 10 patients to estimate coverage area. Various motion artifacts were evaluated in 6 patients. Nine materials were tested for coupling the paddle to the breast. Fourteen substances were tested for coupling the transducer to the paddle in lateral-to-medial and medial-to-lateral views and filling the gap between the peripheral breast and paddle. In-house image registration software was used to register adjacent ultrasound sweeps. RESULTS: The average breast contact area was 56%. The average percentage of the peripheral air gap filled with ultrasound gel was 61%. Shallow patient breathing proved equivalent to breath holding, whereas speech and sudden breathing caused unacceptable artifacts. An adhesive spray that preserves image quality was found to be best for coupling the breast to the paddle and minimizing motion. A highly viscous ultrasound gel proved most effective for coupling the transducer to the paddle for lateral-to-medial and medial-to-lateral views and for edge fill-in. CONCLUSIONS: The challenges of automated ultrasound scanning in a multimodality breast imaging system have been addressed by developing methods to fill in peripheral gaps, minimize patient motion, and register and reconstruct multisweep ultrasound image volumes.     

Determination of Breast Cancer Response to Bevacizumab Therapy Using Contrast‐Enhanced Ultrasound and Artificial Neural Networks

Objective . The purpose of this study was to evaluate contrast‐enhanced ultrasound and neural network data classification for determining the breast cancer response to bevacizumab therapy in a murine model. Methods . An ultrasound scanner operating in the harmonic mode was used to measure ultrasound contrast agent (UCA) time‐intensity curves in vivo. Twenty‐five nude athymic mice with orthotopic breast cancers received a 30‐μL tail vein bolus of a perflutren microsphere UCA, and baseline tumor imaging was performed using microbubble destruction‐replenishment techniques. Subsequently, 15 animals received a 0.2‐mg injection of bevacizumab, whereas 10 control animals received an equivalent dose of saline. Animals were reimaged on days 1, 2, 3, and 6 before euthanasia. Histologic assessment of excised tumor sections was performed. Time‐intensity curve analysis for a given region of interest was conducted using customized software. Tumor perfusion metrics on days 1, 2, 3, and 6 were modeled using neural network data classification schemes (60% learning and 40% testing) to predict the breast cancer response to therapy. Results . The breast cancer response to a single dose of bevacizumab in a murine model was immediate and transient. Permutations of input to the neural network data classification scheme revealed that tumor perfusion data within 3 days of bevacizumab dosing was sufficient to minimize the prediction error to 10%, whereas measurements of physical tumor size alone did not appear adequate to assess the therapeutic response. Conclusions . Contrast‐enhanced ultrasound may be a useful tool for determining the response to bevacizumab therapy and monitoring the subsequent restoration of blood flow to breast cancer.     

乳腺X线摄影及彩超对结构扭曲病变的诊断效能比较

目的研究乳腺X线摄影（全数字化乳腺摄影与数字乳腺断层摄影）及彩超对于结构扭曲良恶性病变诊断效能对比研究及结构扭曲在X线征象的分析方法。方法收集本院2013年6月~2018年12月就诊的51例乳腺疾病患者,年龄20~70岁（44.84±8.738岁）,均接受全数字化乳腺摄影、数字乳腺断层摄影及彩超检查且发现单纯结构扭曲征象,同时具有病理结果,根据乳腺影像报告和数据系统进行阅片诊断,比较3种影像学方法的诊断效能及结构扭曲的征象分析。结果Fisher精确算法分析显示,结构扭曲X线征象（中心密度、病灶边缘情况、病变区周围腺体结构）均在良恶性鉴别存在显著性差异（P<0.05）。ROC曲线分析发现,3种检查方式曲线下面积均大于0.5,均具有乳腺疾病诊断价值。3种检查方法,数字乳腺断层摄影敏感度 （ 67.5%）大于全数字化乳腺摄影（ 62.2%）及彩超（61.9%）,特异性数字乳腺断层摄影均高于其他两者。结论数字乳腺断层摄影相对于全数字化乳腺摄影、彩超能更好地观察结构扭曲病变,提高诊断效能。