病变深度对乳腺良恶性病变超声弹性成像诊断效果的影响

目的 探讨占位性病变的深度对乳腺良、恶性病变超声弹性成像诊断效果的影响.方法 选取2010年2月～2014年10月进行超声弹性成像诊断的乳腺占位患者190例,按照能否获得满意弹性图像为标准分为满意组(170例)和不满意组(20例),收集两组患者病灶位置、病灶直径大小等资料,计算不同深度病灶的超声弹性成像的灵敏度、特异度、准确度,并进行统计学分析.结果 深度≤2.0 cm的病灶获得满意弹性成像的数量明显多于＞2.0 cm的病灶,二者图像满意率差异有统计学意义(P＜0.05);直径≤2.0 cm的病灶,图像满意组人数多于图像不满意组(P＜0.05);病灶深度＜0.5 cm时,准确度和特异度最高,＞1.5 cm时灵敏度降低.结论 病灶越浅、脂肪越少、乳房层越薄,越容易得到满意的弹性图像;同等深度时,病灶直径越大,对成像越有利,病灶病变深度会影响成像的准确度、特异度、灵敏度.     

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。     

超声弹性成像及灰阶超声在肝纤维化诊断中的对比研究

目的:比较超声弹性成像(ultrasound elastosonography UE)及灰阶超声在肝纤维化诊断中的应用价值。方法:对120例慢性乙型肝炎患者的肝脏在进行超声引导下穿刺活检前进行超声弹性成像和灰阶超声检查,以病理结果为诊断金标准,分析超声弹性成像和灰阶超声评价肝纤维化的准确度。结果:超声弹性成像诊断肝纤维化的敏感度、特异度、准确度分别为92.5%、85.0%、90.0%。灰阶超声诊断肝纤维化的敏感度、特异度、准确度分别为42.5%、97.5%、60.8%。超声弹性成像联合灰阶超声诊断肝纤维化的敏感度、特异度、准确度分别为:93.7%、95.0%、94.2%。UE诊断准确度高于灰阶超声2=32.59(P<0.05)。UE诊断肝纤维化的受试者特征(ROC)曲线下面积为0.874(95%CI,0.798～0.950)。结论:超声弹性成像在评价肝纤维化较灰阶超声更有价值。     

声脉冲辐射力弹性成像对甲状腺结节良恶性鉴别诊断价值

目的 分析声脉冲辐射力（ARFI）弹性成像对甲状腺结节良恶性鉴别诊断价值。方法 选取2020年6月至2022年11月医院收治的甲状腺结节患者72例（85个结节）为研究对象,均接受常规超声及ARFI弹性成像检查,以组织病理结果为“金标准”,分析ARFI弹性成像鉴别诊断甲状腺结节良性恶。结果 本研究中85结节,经病理明确诊断良性病灶57个,恶性病灶28个;常规超声诊断在85个结节中共检出61个良性病灶,24个恶性病灶,诊断灵敏度60.7%(17/28)、特异度87.8%(50/57)、准确度为78.7%(67/85);恶性组声触诊组织成像（VTI）面积比、剪切波速度（SWV）、SWV比值均高于良性组,差异有统计学意义（P<0.05）;ARFI弹性成像参数绘制受试者工作特征（ROC）曲线结果显示,VTI面积比、SWV、SWV比值及联合诊断甲状腺结节良恶性的曲线下面积（AUC）均>0.7,具有一定诊断价值,且联合诊断价值最高。结论 ARFI弹性成像诊断甲状腺良恶性灵敏度、特异度较高,具有较高诊断价值。     

高频超声及弹性成像对甲状腺微小结节病变中的诊断价值

目的对比分析甲状腺微小癌和甲状腺微结节病变的高频超声及弹性成像的声像图特征,探讨高频超声及弹性成像对微小良恶性甲状腺结节鉴别诊断中的应用价值。方法选取在我院接受甲状腺切除术的99例患者(116个甲状腺结节)。常规高频超声采用半定量评分法判断结节性质,超声弹性成像采用5级评分法判断结节性质。以病理检查为金标准,计算灵敏度、特异度、准确度。结果经病理检查证实,116个甲状腺结节中,良性结节86个,恶性结节30个。常规高频超声诊断甲状腺良恶性结节的灵敏度为60.0%,特异度为69.8%,准确度67.2%;超声弹性成像诊断甲状腺结节的灵敏度为93.3%,特异度为91.9%,准确度为92.2%。灵敏度、特异度、准确度在两种检查方式之间,差异具有统计学意义(P<0.05)。结论超声弹性成像的诊断准确率明显优于常规高频超声检查,值得进一步推广临床使用。     

超声助力式弹性成像和声触诊组织成像量化技术对浅表软组织肿物诊断的价值

目的探讨超声助力式弹性成像(EI)和声触诊组织成像量化(VTQ)技术对浅表软组织肿物的诊断价值。方法回顾性收集经活检或手术病理证实且常规超声诊断有浅表软组织肿物的病人50例,共64个肿物。采用常规超声测量肿物大小、纵横比并观察其形态、边界、内部回声等指标,彩色多普勒观察血流信号,采用助力式EI获得肿物的弹性影像,并进行半定量评分,采用VTQ技术测量剪切波速度(SWV)。以病理结果为金标准,计算常规超声、EI评分和VTQ技术对良恶性浅表软组织肿物的诊断效能。采用Wilcoxon秩和检验比较良恶性肿物间的SWV,绘制SWV的受试者操作特征(ROC)曲线,计算ROC曲线下面积(AUC)。结果64个肿物中,病理诊断良性肿物51个,恶性肿物13个。常规超声诊断浅表软组织肿物良恶性的敏感度、特异度、准确度分别为76.9%(10/13)、90.2%(46/51)、87.5%(56/64),EI诊断的敏感度、特异度、准确度分别为76.9%(10/13)、88.2%(45/51)、85.9%(55/64),EI联合常规超声诊断的敏感度、特异度及准确度分别为84.6%(11/13)、94.1%(48/51)、92.2%(59/64)。VTQ检测恶性肿物的SWV高于良性肿物(P<0.05)。取SWV值2.995 m/s作为诊断阈值时,VTQ鉴别诊断肿物良恶性的AUC为0.983,其敏感度、特异度分别为92.3%、90.2%。结论EI弹性评分可半定量反映肿物组织的硬度信息,VTQ可定量评估肿物组织硬度弹性特征,两种成像模式对鉴别诊断浅表软组织肿物良恶性有一定价值。     

彩色多普勒血流显像与超声弹性成像联合诊断BI-RADS4类乳腺病变

目的 探讨彩色多普勒血流显像(CDFI)与超声弹性成像(UE)联合诊断乳腺影像报告和数据系统(BI-RADS)4类乳腺病变的价值.资料与方法 132例BIRADS4类乳腺病变,根据病变血流Adler半定量分级及弹性评分对BI-RADS分类进行调整,绘制ROC曲线,比较BI-RADS分类及校正BI-RADS分类.结果 132例病灶中,良性病灶75个,恶性病灶57个.CDFI诊断乳腺癌的敏感度为87.72％,特异度为48.00％,准确度为65.15％;UE诊断乳腺癌的敏感度为87.72％,特异度为61.33％,准确度为72.73％.校正BI-RADS分类诊断4类乳腺病变的ROC曲线下面积为0.845,明显高于BI-RADS分类的0.760 (Z=2.963,P＜0.01).结论 CDFI联合UE可以明显提高对BI-RADS 4类乳腺病变的诊断准确率,有效减少不必要的术前活检.     

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。     

超声弹性成像应变率比值法在乳腺良恶性结节鉴别诊断中的应用

目的:探讨超声弹性应变率比值法在乳腺良恶性结节鉴别诊断中的应用。方法:74例共82个病灶均行常规超声检查,测量病灶的应变率比值,并以病理结果作为对照。结果:82个病灶中,良性57个,恶性25个,良、恶性乳腺肿块弹性应变率比值分别为1.71±0.53和3.93±0.85,二者差异有统计学意义(P0.001)。应变率比值法对乳腺良恶性结节的敏感度、特异度、准确度分别为93.1%、94.9%、89.1%。结论:超声弹性应变率比值法有助于乳腺良恶性结节的鉴别,具有一定的临床应用价值。     

实时超声弹性成像诊断甲状腺良恶性结节的可行性及实效性探究

目的:对实时超声弹性成像在甲状腺良恶性结节的诊疗中的可行性和实效性进行探究。方法:选取我院2011-03~2013-05期间104例(共132个结节)患者作为研究对象。术前对所有患者分别利用实时超声弹性成像和常规超声成像进行结节检查并记录结果,然后对所有患者进行手术治疗并依据病理结果确定结节良恶性状态,对各个结果进行比较分析。结果:根据病理结果,132个结节包含94个良性结节和38个恶性结节。超声弹性成像检查结果根据弹性硬度分类得到0~Ⅱ的结节84个,Ⅲ~Ⅳ级48个,敏感度为79.32%(29/38),特异度为78.72%(74/94),准确度为78.03%(103/132);而常规超声检查对应结果敏感度为71.05%(27/38),特异度79.79%(75/94),准确度77.27%(102/132);两者联合检查结果则敏感度为86.84%(33/38),特异度为93.62%(88/94),准确度为91.67%(121/132)。超声弹性成像诊断和常规超声诊断之间无显著差异(P>0.05),而联合诊断的敏感度、特异度和准确度均显著高于前两者(P<0.05)。结论:实时超声成像诊断和常规超声诊断联合使用可以大大提高甲状腺结节诊断准确率。     

超声弹性成像技术及三维成像技术对乳腺肿块诊断的临床价值

目的：探讨超声弹性成像技术结合三维成像技术在乳腺肿块良恶性临床鉴别与诊断中的应用价值。方法本文对125例接受诊治的乳腺肿块者采用超声弹性成像技术结合三维成像技术进行良恶性鉴别和诊断,并与病理结果对照。结果125例患者的139个病灶中恶性病灶19个,占13．67％;良性病灶120个,占86．33％。按照超声弹性成像评分3分以下（包括3分）为良性病灶标准,实时组织弹性成像评分在4分以上（包括4分）为恶性病灶标准,进行超声弹性成像评分鉴别诊断乳腺病灶良恶性的效能分析发现,超声弹性成像评分对良恶性鉴别诊断符合率为89．93％。超声弹性成像技术结合三维成像技术后,从形态结构、内部回声、与周边组织关系及肿块内血流情况,进一步判断乳腺肿块的良恶性,结果显示超声弹性成像技术结合三维成像技术诊断对良恶性鉴别诊断符合率为94．24％。结论超声弹性成像技术结合三维成像技术综合评价乳腺肿块的良、恶性,三维超声能提供更加丰富的三维空间信息,超声弹性成像可以有效发现微小病灶,二者互补,可以明显提高超声影像技术的准确率。     

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。     

常规超声结合弹性成像对乳腺癌的诊断价值

目的:探讨常规超声结合弹性成像(ultrasonic elastography,UE)对乳腺癌诊断的临床价值。方法:502例患者,共567个肿块纳入本研究,分为良性组及恶性组,对比2组患者间临床资料差异有无统计学意义。结果:常规超声联合UE诊断乳腺癌的敏感性为93.8%,特异性为88.1%,准确性为90.3%,敏感性和准确性均高于常规超声,差异有统计学意义(χ2=369.5,P<0.001),同时也高于单项UE(χ2=332.2,P<0.001)。结论:在规范评分指标的前提下常规超声联合UE对鉴别乳腺良恶性肿块具有较高的临床应用价值,可提高诊断乳腺癌的敏感性和准确性,对乳腺癌的早期诊断及术前分期具有重要参考价值。     

Ultrasound breast tumor image computer-aided diagnosis with texture and morphological features

RATIONALE AND OBJECTIVES: Computer-aided diagnosis (CAD) systems based on shape analysis have been proved to be highly accurate in evaluating breast tumors. However, it takes considerable time to train the classifier and diagnose breast tumors, because extracting morphologic features require a lot of computation. Hence, to develop a highly accurate and quick CAD system, we combined the texture and morphologic features of ultrasound breast tumor imaging to evaluate breast tumors in this study. MATERIALS AND METHODS: This study evaluated 210 ultrasound breast tumor images, including 120 benign tumors and 90 malignant tumors. The breast tumors were segmented automatically by the level set method. The autocovariance texture features and solidity morphologic feature were extracted, and a support vector machine was used to identify the tumor as benign or malignant. RESULTS: The accuracy of the proposed diagnostic system for classifying breast tumors was 92.86%, the sensitivity was 94.44%, the specificity was 91.67%, the positive predictive value was 89.47%, and the negative predictive value was 95.65%. In addition, the proposed system reduced the training time compared to systems based only on the morphologic analysis. CONCLUSIONS: The CAD system based on texture and morphologic analysis can differentiate benign from malignant breast tumors with high accuracy and short training time. It is therefore clinically useful to reduce the number of biopsies of benign lesions and offer a second reading to assist inexperienced physicians in avoiding misdiagnosis.     

Value of mammography and combined grey scale ultrasound and ultrasound elastography in the differentiation of solid breast lesions

Aim of the work

The aim of this work was to evaluate the value of ultrasound elastography (UE) in differentiating benign versus malignant solid breast lesions discovered in mammography and compare it with grey scale ultrasound (US) and mammography.

Methods

From May 2011 to May 2013, 114 solid lesions from 100 consecutive patients discovered during mammography were categorized into benign or malignant by mammography and US and further analyzed with UE. The diagnostic results of the cases were compared with histopathologic findings.

Results

Of 114 lesions, 33 were histologically malignant, and 81 were benign. UE was the most specific (95.1%) of the 3 modalities. The accuracy (81.7%) of UE was equal to mammography and was higher than those of US (82.5% and 71.9%, respectively). A combination of UE and US had the best sensitivity (90.9%) and accuracy (93.8%).

Conclusions

Ultrasound elastography is useful for breast lesion characterization and is an easier and cheaper method and more specific than mammography or US alone, but it is operator dependent. When combined with US, detection accuracy can be greatly improved and the combination potentially could reduce unnecessary biopsy.     

联合使用B超与钼靶射线用于诊断乳腺疾病中的应用

目的：探讨使用B超与钼靶X线诊断乳腺良性病变和恶性病变的效果对比。方法分析2014年1月－2016年1月收治的135例乳腺肿瘤患者,分别使用钼靶X线、B超及钼靶X线和B超联合诊断,其结果与术后病理检查结果进行对照,比较三种诊断手段的敏感性、特异性和准确度。结果 B超和钼靶X线诊断乳腺良恶性病变敏感性、特异性及准确度无统计学差意（ P＞0.05）;联合B超和钼靶X线的敏感性、特异性、准确度明显高于单独使用B超和乳腺钼靶X线诊断（ P＜0.05）。结论 B超诊断和乳腺钼靶X线诊断乳腺良恶性病变各有特点,联合使用可提高诊断的准确率,发挥多科协作的优势。     

Real-time ultrasound elastography: Does it improve B-mode ultrasound characterization of solid breast lesions?

Introduction

Elastography is a non-invasive medical imaging technique that detects tumors based on their stiffness (elasticity). Strain images display the relative stiffness of lesions compared with the stiffness of surrounding tissue as cancerous tumors tend to be many times stiffer than the normal tissue, which “gives” under compression. An image in which different degrees of stiffness show as different shades of light and dark is called an elastogram.

Purpose

To prospectively evaluate the sensitivity and specificity of the real-time sonoelastography as compared with B-mode US for distinguishing between benign and malignant solid breast masses. The density of the glandular breast tissue was taken in consideration in addition to the Breast Imaging Reporting and Data System (BI-RADS) categories of the lesions, with biopsy results as the reference standard.

Methods

A total of 216 candidate solid lesions (123 benign and 93 malignant) in 188 patients were examined with 2-dimensional ultrasonography, elastosonography and mammography (for 147 patients). The lesions were classified according to the density of the glandular breast tissue into low density group (D1) and a high density group (D2) and were categorized with the BIRADS score. Elastographic images were assigned an elasticity score of 1 to 5 (1–3, benign; 4 and 5, malignant) according to the Multi-Center Team of Study and the strain ratios of the lesions were measured. Concordance between the imaging findings and histopathologic results was documented. Statistical analysis was performed and sensitivity, specificity and positive and negative predictive values for both elastography and conventional sonography were calculated.

Results

Elastography showed less sensitivity but higher specificity than conventional sonography in the differentiation of benign from malignant solid lesions: B-mode sonography had sensitivity of 85.1%, specificity of 93.9%, a positive predictive value of 92.5% and a negative predictive value of 87.8%, compared with the sensitivity of 80.1%, specificity of 97.1%, a positive predictive value of 96.8% and a negative predictive value of 82.1% for elastography. Elastography was superior to B-mode US in diagnosing solid lesions in the low density group (D1) (96.6% vs. 92.4% specificity) and less in the dense glandular tissue (97.8% vs. 95.9% specificity).

Conclusions

Real-time sonoelastography is an useful technique for the characterization of benign and malignant solid lesions as it increases the diagnostic specificity comparable to B-mode ultrasound, particularly in both ACR 1 and 2, thus reducing the false-positive rate.     

超声剪切波成像联合ACR TI-RADS分类诊断甲状腺结节良恶性的价值

 目的 探讨超声实时剪切波弹性成像联合美国放射学会(ACR)颁布的甲状腺影像报告和数据系统(TI-RADS)分类诊断良恶性甲状腺结节的价值。方法 选择2016-12至2018-12医院收治的甲状腺结节患者277例,均于超声科进行剪切波弹性成像检查获得杨氏模量值,并对超声图像进行TI-RADS分级。根据病理结果将患者分为良性组和恶性组,对比良恶性甲状腺结节杨氏模量值、TI-RADS分级差异,分析杨氏模量值、TI-RADS分级、联合诊断对鉴别良恶性甲状腺结节的价值。结果 本组恶性甲状腺结节75例,良性甲状腺结节202例。良性组甲状腺结节弹性评分、SR值均低于恶性组(P＜0.05),根据ACR TI-RADS分类标准诊断恶性甲状腺结节正确率为88.09%(244/277)。ROC分析结果示联合ACR TI-RADS分类、UE诊断甲状腺癌的效能最高,其曲线下面积(AUC)为0.922(95%CI:0.853~0.991,P=0.000),灵敏度、特异度分别为97.33%、99.50%。结论 UE联合ACR TI-RADS分类可提高对良恶性甲状腺结节的诊断正确率。     

煊影煊流技术联合常规超声及CA125诊断卵巢肿瘤的价值

目的探讨煊影煊流技术(HDlive)联合常规超声检查(US)及CA125在鉴别卵巢肿瘤良恶性的应用价值。方法回顾性分析65例经常规超声拟诊为卵巢肿瘤患者的图像资料,以病理结果为金标准,分析HDlive联合US及CA125对卵巢肿瘤的鉴别诊断价值。结果65例卵巢肿瘤中良性23例,恶性42例;US诊断恶性肿瘤表现多为实性或囊实性、乳头状突起数目≥4等,诊断卵巢肿瘤的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为90.5%、56.5%、78.4%、79.2%、76.5%;恶性卵巢肿瘤煊影表现:含实性成分、乳头形状不规则等,煊流构型主要为Ⅲ型、Ⅳ型等,联合US诊断卵巢肿瘤的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为97.6%、69.6%、87.7%、85.4%、94.11%;恶性肿瘤血清CA125水平明显高于良性肿瘤(P<0.05),诊断卵巢肿瘤的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为85.7%、47.8%、72.3%、75.0%、64.7%;三者联合诊断卵巢肿瘤的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为97.6%、73.9%、89.2%、87.2%、94.4%,诊断价值均高于单一检查(P<0.05)。结论HDlive联合US及CA125在卵巢肿瘤良恶性的鉴别诊断中具有较高的诊断价值。     

超声弹性成像联合常规超声鉴别诊断甲状腺良恶性结节的临床价值

目的：探讨超声弹性成像（ultrasonic elastography,UE）联合常规超声（coventional ultrasonogaphy,CUS）在甲状腺良恶性结节鉴别诊断中的临床价值。方法：应用弹性成像和常规超声分别对98例（119个结节）甲状腺结节患者进行检查,所有病例均以手术后病理诊断作为金标准。比较单独应用常规超声、单独应用弹性成像、弹性成像联合常规超声综合诊断对甲状腺良、恶性结节鉴别诊断的灵敏度（Sen）、特异度（Spe）、粗符合率（CA）、阳性预测值（PV＋）、阴性预测值（PV-）。结果：超声弹性成像联合常规超声鉴别诊断甲状腺良恶性结节的敏感性、特异性和准确性均高于常规超声和弹性成像（P〈0.05）。结论：超声弹性成像与常规超声联合应用可以明显提高对甲状腺良恶性结节的判断,具有重要的临床价值。