实时剪切波弹性成像中乳腺肿块的各向异性对良恶性病灶的诊断价值

目的探讨实时剪切波弹性成像(SWE)中乳腺肿块的各向异性在评价肿块良恶性中的价值。方法收集98例患者共100个病灶的最大直径平面与正交直径平面的弹性图像,记录下BI-RADS分类的结果和肿块的模量参数,计算得到各向异性因子(AF)。以病理结果为金标准构建ROC曲线,比较各模量参数与AF的诊断效能,并分析AF与肿瘤大小、组织学分级的相关性。结果最大直径平面中的Emean、Emax、Eratio、Esd均高于正交直径平面(P<0.001)。恶性肿块中各向异性因子明显高于良性肿块(P<0.001)。各向异性因子AFmean、AFmax、AFratio、AFsd的AUC分别为0.937、0.890、0.919、0.974。Ⅰ级浸润性导管癌AFmax明显低于Ⅱ、Ⅲ级浸润性导管癌(P<0.001、0.006)。结论乳腺肿块的各向异性可由剪切波模量参数进行定量分析,在乳腺肿瘤的良恶性鉴别中有一定的临床应用价值,并且与乳腺癌中的组织学分级具有一定相关性。

The Diagnostic Value of the Anisotropy of the Breast Mass in the Real-time Shear Wave Elastography for Benign and Malignant Lesions

Objective To discuss the value of anisotropy of breast masses in evaluating benign and malignant masses in real-time shear wave elastography(SWE).Methods The elastic images of the maximum diameter plane and the orthogonal diameter plane of 98patients were collected,and the results of BI-RADS classification and the elasticity modulus of the masses were recorded,the anisotropy factor(AF)was calculated.According to the pathological results as the gold standard,ROC curve was constructed,and the diagnostic efficacy of each elasticity modulus and AF was compared.The correlation between AF and tumor size and histological grade was analyzed.Results The Emean,Emax,Eratio,Esd in the maximum diameter plane was higher than that in the orthogonal diameter plane(P<0.001).The anisotropy factor in malignant masses was significantly higher than that in benign masses(P<0.001).The AUC of anisotropy factor AFmean,AFmax,AFratio,AFsd is 0.937,0.890,0.919,0.974,respectively.AFmax of gradeⅠinvasive ductal carcinoma was significantly lower than that of gradeⅡand grade III invasive ductal carcinoma(P<0.001,0.006).Conclusions The anisotropy of breast masses can be quantitatively analyzed by modulus parameters,it has certain clinical application value in the differentiation of benign and malignant breast tumors,and there is a certain correlation between them and histological grade in breast cancer.