超声光散射断层成像对不同大小乳腺病灶的血红蛋白浓度诊断阈值探讨

目的 利用超声光散射断层成像(DOT)研究乳腺病灶的血红蛋白浓度(THC),探讨不同大小乳腺病灶的THC最佳诊断阈值.方法 以进行乳腺病变切除活检术的500个病灶为研究对象,以术后病理结果作为金标准,比较两组不同大小良性病灶间及恶性病灶间THC差异、最佳诊断阈值及诊断效能.结果 共500个乳腺病灶,其中良性病灶265个,恶性病灶235个.＜2 cm组和≥2 cm组的恶性病灶THC均值分别为(193.0±81.3)μmol/L,(249.3±73.6)μmol/L,恶性病灶两组间THC差异有统计学意义(P=0.000);＜2 cm组和≥2 cm组的良性病灶THC均值分别为(117.8±62.0)μmol/L,(131.8±70.0)μmol/L,良性病灶两组间THC差异无统计学意义(P=0.13);对＜2 cm组的病灶,分别以THC146.9 μmol/L,102.2μmol/L为鉴别诊断阈值,DOT的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为74.2％,70.0％,71.7％,62.9％,79.9％和86.7％,44.4％,61.6％,51.6％,83％.对≥2 cm组的病灶,以THC 210.4μmol/L为诊断阈值,DOT的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为74.0％,86.7％,79.1％,89.2％,69.2％.结论 乳腺癌的THC随肿瘤增大而增高,故应采用不同的THC诊断阈值来提高诊断的敏感性、特异性及准确性.     

超声光散射成像诊断乳腺病变

目的 探讨超声光散射成像对乳腺病变诊断的临床可行性及其对常规超声的辅助价值.方法 采用超声光散射乳腺断层成像系统,前瞻性研究101例患者共105个乳腺病变,并与手术病理对照.测量光吸收参数血红蛋白总量(HBT),找出其分布规律及其判断良恶性的诊断阈值,分别计算超声光散射成像、超声与二者联合应用的诊断敏感性、特异性和准确性.结果 105个乳腺病变中,良性51个,恶性54个.51个良性病变的光散射成像HBT均值为(118.10±85.90)μmol/L,54个恶性病变的HBT均值为(237.11±89.63)μmol/L,二者差异有显著统计学意义(P<0.0005).光散射成像HBT值的诊断敏感性87.04%,特异性76.47%,准确率81.90%.常规超声与DOT联合应用的敏感性为85.19%,特异性为88.24%,准确性为86.67%.结论 超声光散射成像可用于鉴别乳腺肿瘤,常规超声与DOT联合应用可显著提高诊断的特异性和准确性,降低假阳性率.     

超声光散射成像联合常规超声诊断乳腺病灶的临床价值

超声光散射断层成像作为一种新兴的功能成像技术,可测量并分析计算病变内部血红蛋白总量和血氧饱和度等光学参数,根据良恶性病灶的血供及血氧含量差异可对病灶行定性诊断.本研究旨在探讨超声光散射成像鉴别乳腺良恶性病灶及其与常规超声联合应用鉴别诊断乳腺病灶的价值. 资料与方法 一、研究对象 2011年5-9月在我院行超声光散射成像检查且经活检病理证实的女性患者102例共136个乳腺病灶,患者年龄18岁～86岁,平均(43±16)岁.人选病例为常规超声显示的实质性病灶.     

超声光散射成像对乳腺肿块的诊断价值及影响因素

目的 评价超声光散射系统对乳腺肿瘤诊断的价值并分析其影响因素.方法 收集乳腺肿瘤患者84例(共88个肿块),术前行超声光散射成像,并测最乳腺肿块的大小和深度.以病理结果作为标准,计算超声光散射系统诊断乳腺恶性肿瘤的灵敏度、特异度等指标,并分析漏诊和误诊的原因.结果 超声光散射成像诊断乳腺恶性肿瘤的灵敏度和特异度分别为86.1%和78.8%,阳性预报值和阴性预报值分别为73.8%和89.1%;乳腺浸润性导管癌的最大血红蛋白浓度值(210±99)μmol/L显著大于腺病(114±90)μmol/L和纤维腺瘤(78±40)μmol/L,P＜0.05;漏诊和误诊与乳腺肿块的病理类型、大小或深度有关,超声可纠正80%(4/5)的漏诊和64%(7/11)误诊.结论 超声光散射系统对常见的乳腺肿块有较好的定性诊断价值,乳腺肿块的病理类型、大小和深度影响诊断的准确性,结合超声声像图观察可降低漏诊率和误诊率.     

乳腺肿块超声光散射成像与微血管密度测定的相关性研究

)μmol/L(P<0.05);MVD测值:良性组11.42±4.64,恶性组24.73±13.29(P<0.05).良、恶性肿块MHC和MVD的相关系数:r良性=0.885,r恶性=0.801.结论 乳腺恶性肿块的MHC和MVD明显高于良性肿块,且良、恶性肿块的MHC和MVD之间均具有显著相关性.超声光散射成像有助于对乳腺良恶性肿块进行更准确、更客观的判断.     

超声光散射成像联合超声弹性成像诊断乳腺病灶的价值研究

目的对比超声光散射成像系统、超声弹性成像技术及二者联合对乳腺病灶鉴别诊断价值的研究。方法回顾经穿刺活检及手术病理证实的96例患者共116个乳腺病变,分析其超声光散射断层成像系统图像及超声弹性成像图像,并与术后病理及穿刺活检结果对照。结果 116个乳腺肿块术后及穿刺活检病理诊断中良性62个,恶性54个,超声光散射对乳腺癌诊断的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为92.6%、71.0%、81.0%、73.5%、91.7%,超声弹性成像技术分别为77.8%、80.6%、79.3%、77.8%、80.6%,二者联合分别为96.3%、93.5%、94.8%、92.9%、96.7%。结论超声光散射成像系统与超声弹性成像技术各有优势,二者结合有助于提高乳腺病灶鉴别诊断的准确。     

超声弹性成像与常规超声的病灶测值变化对乳腺病变的诊断价值

目的 对比不同乳腺病变在超声弹性成像和灰阶超声两种方法中的测值差异,探讨测值增大征象对乳腺恶性病变的诊断价值及其与灰阶超声中病灶的边界特征之间的关系.方法 308例患者332个乳腺病变,术前经常规超声及实时超声弹性成像检查,观察病变的灰阶超声边界特征,在病灶最大切面上分别进行灰阶超声和弹性图病灶测量.全部病变均获得手术病理.结果 332个乳腺病变中,良性166个(50.0%),恶性163个(49.1%),交界性3个(0.9%).弹性成像病灶测值增大的病变共99个,其中恶性病变91个(91.9%),良性病变8个(8.1%),该征象诊断乳腺癌的敏感性为55.8%,特异性为96.9%,准确性为75.7%,阳性预测值91.9%,阴性预测值68.7%.以乳腺病灶的手术病理大小为金标准,弹性成像相比灰阶超声更易高估病变(t=-11.0,P＜0.05).测值增大组中,边界模糊、边缘成角以及毛刺的比例均高于测值减小组和测值不变组(P＜0.05).结论 弹性成像测值增大对诊断乳腺癌的特异性高.灰阶超声表现边界模糊、边缘成角以及毛刺的病变,更易出现弹性成像病灶测值增大.     

超声光散射乳腺成像对乳腺肿瘤定性诊断的临床初步研究

目的探讨超声光散射成像技术(US-guided optical imaging system,OPTIMUS)对乳腺肿块定性的可靠性及其临床意义。方法用OPTIMUS检测乳腺肿块,术前根据其最高血红蛋白浓度(maximum hemoglobin concentration,MHC)值进行乳腺报告与数据系统(breast imaging reporting and data system,BI-RADS)分级,判断良恶性,并与手术、病理结果比较; 结果经OPTIMUS探测,65个乳腺肿块被探测到,超声光散射BI-RADS分级与病理诊断结果比较,诊断止确率为86.2%(56/65),灵敏度为87.0%(20/23),特异度85.7%(36/42),阳性似然比6.087,阴性似然比0.175。良性肿瘤的光散射断层成像(diffused optical imagmg,DOI)示蓝色背景上肿块颜色主要呈蓝色绿色,经良性肿块散射的光子数与正常乳腺组织相似,光子运动的速度与止常组织接近;恶性肿瘤的DOI示蓝色背景上肿块颜色主要呈红色,经恶性肿块散射的光子数则低于正常组织,而光子运动出现加速。良性组与恶性组的MHC和微血管密度(micro vessel density,MVD)差异均有统计学意义(P0.05),即乳腺肿块恶性组的MHC和MVD值均明显高于良性组;无论在良性组和恶性组,MHC与MVD之间均存在显著性相关:r_(良性)=0.885.r_(恶性)=0.801,与MHC对应,良性肿块问质内的微血管稀疏,其MVD值较小;恶性肿块间质内的微血管较密集,其MVD值较大。结论超声光散射成像可以提供较准确和客观的数据,有助于乳腺肿瘤良、恶性的鉴别诊断。     

超声光散射乳腺成像技术在乳腺疾病诊断中的应用

目的 评价超声光散射成像技术(diffuse optical imaging(DOI)with ultrasound localization(UL)在乳腺疾病诊断中的应用价值.方法 采用新奥博为有限公司研制的Optimus Ⅱ型超声光散射乳腺成像系统和百胜Esaote Megas GPX彩色多普勒超声诊断仪,以双盲方式随机选择了49例次进行乳腺检查.这些受检者同时接受了临床检查、乳腺钼靶X-线检查.另有2例新辅助化疗的患者也接受了超声光散射检查.根据北美放射协会制定的BI-RADS分级标准对乳腺病变进行良恶性分级.结果 在49例受检者中,31例被检出患有乳腺疾病,其中5例评为4级以上者经超声引导下穿刺或手术而获得病理结果,包括乳腺癌4例,乳腺腺病1例.4例乳腺癌中有3例光散射成像判定在4级,与病理诊断相符.19例患有良性病变者光散射成像均评为2、3级.结论 超声光散射成像技术在乳腺疾病检查中集形态结构检查与功能检查于一体,可对形态结构信息和功能信息进行综合判断,有助于超声检查对乳腺良恶性病变给予更准确的判断及对乳腺癌患者新辅助化疗疗效的观察.     

超声MicroPure成像技术对乳腺病灶中微钙灶检出的应用价值

目的 探讨应用超声MicroPure成像技术检出乳腺病灶中微钙灶的应用价值.方法 对51例乳腺病灶分别行常规超声与MicroPure成像技术检查,评价MicroPure成像技术检出乳腺病灶内微钙灶的能力及鉴别乳腺病灶良恶性的意义.结果 51例乳腺病灶中,MicroPure成像技术显示乳腺微钙灶(255个)明显高于常规超声(11个),差异具有统计学意义(P＜0.05);乳腺良性病灶组和恶性病灶组中微钙灶的个数没有明显差异,10 mm2范围内微钙灶个数恶性病灶组多于良性病灶组(P＜0.05).结论 MicroPure成像技术显示乳腺病灶中微钙灶的能力明显高于常规超声,但乳腺病灶内微钙灶的总数多少与良恶性之间没有明显相关性,而10 mm2内微钙灶个数恶性病灶组多于良性病灶组.     

Detecting angiogenesis in breast tumors: comparison of color Doppler flow imaging with ultrasound-guided diffuse optical tomography

We investigated the correlation between color Doppler flow imaging (CDFI) and ultrasound (US)-guided diffuse optical tomography (DOT) for detection of breast tumor angiogenesis. Both CDFI and DOT were performed in 214 breast lesions scheduled for biopsy. The lesions were classified as vascular or nonvascular on CDFI and total hemoglobin concentration (THC) was measured by DOT. Sonographic results were correlated with the THC measurements. Pathologic examination showed 118 breast cancers and 96 benign breast masses. When vascularization on CDFI as a sign of malignancy and a cutoff of 140 μmol/L was used, the sensitivity, specificity and accuracy were 83.9, 50.0 and 68.7% for CDFI and 83.9, 66.7 and 76.2% for DOT, respectively. Thirteen (11.0%) nonvascular breast cancers presented high THC levels. Twenty-five (52.1%) vascular benign tumors demonstrated low THC levels. Mean THC did not differ significantly in malignancies with vascular or without vascular (228.14 ± 85.37 μmol/L vs. 191.42 ± 92.59 μmol/L; p > 0.05). Likewise, for benign lesions, the difference between THC values in vascular lesions and nonvascular lesions was not statistically significant (140.86 ± 79.63 μmol/L vs. 110.13 ± 85.05 μmol/L; p > 0.05). Our results suggest that the addition of DOT to CDFI could be helpful for characterizing CDFI nonvascular lesions that are suspicious for malignancy or vascular lesions that are probably benign.     

Diffuse Optical Tomography of the Breast: Initial Validation in Benign Cysts

Purpose  The purpose of this study was to validate a newly developed diffuse optical tomography (DOT) system on benign cysts in the breast. Procedures  Eight patients with 20 benign cysts were included. Study procedures consisted of optical breast imaging and breast magnetic resonance imaging (MRI) for comparison. A reconstruction algorithm computed three-dimensional images for each of the four near-infrared wavelengths used by our DOT system (Philips Healthcare, Best, The Netherlands). These images were combined using a spectroscopic model to assess tissue composition and lesion size. Results  Twenty cysts were analyzed in eight patients. By using the spectroscopic information, 13 of 20 cysts (65%) were visualized with DOT, confirming their high water and low total hemoglobin content. Lesion size and location showed good agreement with MRI; Pearson correlation coefficient was 0.7 (p < 0.01). Conclusions  DOT can visualize benign cysts in the breast and elucidate their high water and low total hemoglobin content by spectroscopic analysis.     

对比超声定位光散射断层成像与彩色多普勒血流显像检测乳腺癌血供

目的 比较超声定位光散射断层成像(DOT)与CDFI检测乳腺癌血供的敏感性。 方法 111例乳腺癌患者,经术后病理证实,共118个瘤灶。术前CDFI将乳腺癌血供分为血流丰富、中等及无血流。常规超声检查明确病变后定位行DOT,测量病变血红蛋白总浓度(THC),以THC 140 μmol/L为阈值,比较DOT与CDFI检测不同大小乳腺癌血流的敏感性。 结果 118个乳腺癌瘤灶中,57个(48.31%)CDFI表现为血流丰富,36个(30.51%)中等血流,25个(21.19%)无血流; DOT 检出99个癌灶(83.90%) 的THC>140 μmol/L。对于≤1 cm、>1~2 cm、>2~3 cm、>3 cm的乳腺癌,CDFI血流显示率分别为28.57% (6/21)、90.20% (46/51)、86.21% (25/29)和94.12% (16/17),THC增高率分别为76.20%、76.50%、93.10%和100%。 结论 DOT可更敏感地检测乳腺癌血管,特别是对于诊断直径≤1 cm的早期乳腺癌,具有潜在临床应用价值。     

A Novel Fluorescent Imaging Agent for Diffuse Optical Tomography of the Breast: First Clinical Experience in Patients

Purpose

This is the first clinical evaluation of a novel fluorescent imaging agent (Omocianine) for breast cancer detection with diffuse optical tomography (DOT).

Procedures

Eleven women suspected of breast cancer were imaged with DOT at multiple time points (up to 24 h) after receiving an intravenous injection of Omocianine (doses 0.01 to 0.1 mg/kg bodyweight). Breast MRI was obtained for comparison.

Results

Histopathology showed invasive cancer in ten patients and fibroadenoma in one patient. With the lowest dose of Omocianine, two of three lesions were detected; with the second dose, three of three lesions were detected; with the two highest doses, none of five lesions were detected. Lesion location on DOT showed excellent agreement with MRI. Optimal lesion-to-background signals were obtained after 8 h. No adverse events occurred.

Conclusions

Lowest doses of Omocianine performed best in lesion detection; DOT using a low-dose fluorescent agent is feasible and safe for breast cancer visualization in patients.     

US-Guided Optical Tomography: Correlation with Clinicopathologic Variables in Breast Cancer

We tested the relat1ionships between total hemoglobin concentration (THC), as measured with ultrasound (US)-guided optical tomography, and clinicopathologic variables in invasive ductal cancers; and we evaluated the clinical significance of THC. Fifty-three patients with 65 invasive ductal carcinomas underwent US-guided biopsy and were scanned with a hand-held probe consisting of a co-registered US transducer and an NIR (near-infrared) imager. The lesion location provided by co-registered US was used to guide optical imaging. Light absorption was measured at two optical wavelengths. From this measurement, tumor angiogenesis was assessed on the basis of calculated THC. We investigated the relationships between maximum THC and clinicopathologic variables (tumor size [≤2 cm or >2 cm], metastasis to lymph node or distant organ, histologic grade, lymphovascular invasion, status of ER, PR, HER2 and Ki-67, and triple negativity). The mean maximum THC in the breast cancers was 223.3 ± 106.3 μmol/L. In univariate analysis, HER2 positivity, tumor size, and Ki-67 positivity showed significant correlations with maximum THC (p < 0.05). In multivariate analysis including tumor size, and ER, PR, HER2, and Ki-67 status, HER2 positivity correlated with maximum THC significantly (p = 0.007, parameter estimate 76.44). Maximum THC correlated with HER2, Ki-67 and tumor size in this group of ductal breast carcinomas. Thus, US-guided diffuse optical tomography (US-DOT) may potentially be used to predict tumor aggressiveness in patients with invasive breast cancers.     

超声光散射成像系统在乳腺肿块鉴别诊断中的应用

目的 探讨超声光散射双模式成像系统在乳腺肿块良、恶性鉴别诊断中的应用价值.方法 采用超声光散射双模式成像系统,检查113例共123个乳腺肿块,并与术后病理进行对照.系统将肿块二维超声特征作数字化处理,并检测肿块组织营养代谢指标血红蛋白总量(HBT)和血氧饱和度(SO_2),最终将二维超声信息和营养代谢参数综合处理,得出综合诊断指数(SDI).分别计算二维超声、光散射和双模式鉴别诊断乳腺良、恶性肿块的敏感度、特异度、正确率.结果 123个乳腺肿块中,良性肿块78个,恶性肿块45个.良性肿块内HBT为(153.02±105.78)明显低于恶性肿块内HBT(232.95±78.22);良性肿块内SO_2(1.0332±0.1641)明显高于恶性肿块内SO_2(0.8794±0.1814);良性肿块内SDI(147.23±53.76)明显低于恶性肿块(243.98±57.27),两组之间比较有统计学意义(P＜0.05).超声光散射双模式诊断系统鉴别诊断乳腺肿块的敏感度为93.33%,特异度为83.33%,准确率为86.99%.结论 在二维超声的基础上联合应用光学技术检测组织的营养代谢可提高鉴别乳腺肿块性质的特异度,提高恶性病例早期诊断的正确率.     

超声弹性成像评价乳腺肿块图像质量的影响因素

目的 探讨超声弹性成像评价可疑乳腺病变中影响其成像质量的因素。方法 对134例患者的155个乳腺肿块行超声实时弹性成像,将图像质量评分为0级(不足)、1级(低质量)、2级(高质量),分析年龄、体质量指数、乳腺密度、病灶大小、病变深度和乳腺厚度与图像质量的关系,以及弹性成像鉴别良恶性肿块的敏感度和特异度。结果 病灶图像质量评估为不足10个,低质量67个,高质量78个。较小的病灶、较浅的病变、病变处乳腺厚度较薄、病理为良性与更高的图像质量明显相关;而年龄、体质量指数、乳腺密度、病变与乳头距离与图像质量无关。病变处乳腺厚度是影响弹性图像质量最重要的因素。高质量、低质量图像鉴别良恶性肿块的敏感度差异有统计学意义。结论 病变处乳腺厚度是影响弹性成像图像质量最重要的因素。较高质量评分的超声弹性成像可提高鉴别乳腺良恶性肿块的敏感度。     

Method to improve the localization accuracy and contrast recovery of lesions in separately acquired X-ray and diffuse optical tomographic breast imaging

Near-infrared diffuse optical tomography (DOT) has the potential to improve the accuracy of breast cancer diagnosis and aid in monitoring the response of breast tumors to chemotherapy by providing hemoglobin-based functional imaging. The use of structural lesion priors derived from clinical breast imaging methods, such as mammography, can improve recovery of tumor optical contrast; however, accurate lesion prior placement is essential to take full advantage of prior-guided DOT image reconstruction. Simultaneous optical and anatomical imaging may not always be possible or desired, which can make the accurate registration of the lesion prior challenging. In this paper, we present a three-step lesion prior scanning approach to facilitate improved accuracy in lesion localization based on the optical contrast quantified by the total hemoglobin concentration (HbT) for non-simultaneous multimodal DOT and digital breast tomosynthesis (DBT) imaging. In three challenging breast cancer patient cases, where no clear optical contrast was present initially, we have demonstrated consistent improvement in the recovered HbT lesion contrast by utilizing this method.     

超声定位光散射断层成像在乳腺肿瘤局部切除术后随访中的应用

目的 探讨超声定位光散射断层成像(US-DOT)在乳腺肿瘤局部切除术后随访中的应用价值。方法 对61例乳腺肿瘤局部切除术后患者(共71个病灶,术后病理证实良性肿瘤41个,恶性肿瘤30个)进行随访,采用US-DOT测量乳腺局部瘢痕内部总血红蛋白浓度(THC),并观察其光吸收图。结果 71个瘢痕的THC与术后时间呈幂函数关系,幂曲线回归方程Y=303.25×X^-0.23(R²=0.57)。术后12个月内,瘢痕THC随时间迅速下降;12个月后THC下降速度减慢,处于较平稳水平。术后同一时间段内,乳腺良、恶性肿瘤术后瘢痕THC差异无统计学意义。结论 乳腺肿瘤局部切除术后瘢痕的THC变化具有一定规律性,有望在术后随访中为鉴别术后瘢痕与复发癌灶提供更多信息。     

Ultrasound segmentation-guided edge artifact reduction in diffuse optical tomography using connected component analysis

Ultrasound (US)-guided diffuse optical tomography (DOT) has demonstrated potential value for breast cancer diagnosis and treatment response assessment. However, in clinical use, the chest wall, poor probe-tissue contact, and tissue heterogeneity can all cause image artifacts. These image artifacts, appearing commonly as hot spots in the non-lesion regions (edge artifacts), can decrease the reconstruction accuracy and cause misinterpretation of lesion images. Here we introduce an iterative, connected component analysis-based image artifact reduction algorithm. A convolutional neural network (CNN) is used to segment co-registered US images to extract the lesion location and size to guide the artifact reduction. We demonstrate its performance using Monte Carlo simulations on VICTRE digital breast phantoms and breast patient images. In simulated tissue mismatch models, this algorithm successfully reduces edge artifacts without significantly changing the reconstructed target absorption coefficients. With clinical data it improves the optical contrast between malignant and benign groups, from 1.55 without artifact reduction to 1.91 with artifact reduction. The proposed algorithm has a broad range of applications in other modality-guided DOT imaging.