乳腺肿块的超声造影特征与病理对照分析  

Characteristic of contrast-enhanced ultrasound and its correlation with pathology for the breast tumor

作　　者：王小燕[1] 贺琰[1] 凌冰[1] 韦海明[2] 康利克[1] 蓝春勇[1] 裴华洁[1] 董小圆[1] 

机构地区：[1]广西壮族自治区人民医院超声科,广西南宁530021 [2]广西壮族自治区人民医院病理科,广西南宁530021

出　　处：《中华肿瘤防治杂志》2016年第10期667-671,676,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：广西科学研究与技术开发计划(桂科攻0592007-2c);广西科学研究与技术开发计划(桂科攻14124004-1-13);广西医疗卫生重点科研课题(重200813)

摘　　要：目的乳腺超声成像是乳腺疾病诊断不可或缺的主要技术,造影技术又克服了传统超声的局限性,极大提高了检测肿块低速血流的敏感性。本研究观察乳腺良恶性肿块的超声图像及超声造影表现,探讨其超声图像及超声造影的特征。方法对2013-01-01-2015-06-30在广西壮族自治区人民医院就诊及手术治疗的451例乳腺肿块患者的超声图像特征、血流情况进行观察及实时超声造影,选用SonoVue超声造影剂,对肿块的高频超声图像、造影增强形态、强度和造影时间-强度曲线特征进行观察,并与病理进行对照分析。结果经病理确诊451例乳腺肿块中,恶性肿块240例,良性肿块211例,超声造影有其特征性表现。(1)恶性肿块表现为进入丰富,分布尚均及不均。其造影强度分别为高增强188例(78.3%),中等增强43例(17.9%),极少至低增强9例(3.8%)。(2)进入肿块的增强范围常超过二维超声图像,周围可见多条粗大的血管进入肿块,恶性肿块范围增大、放射状增强、穿支血管均较良性明显增加,良性肿块可见环状增强,并为特征性改变,共59例(28.0%)。(3)本组恶性肿块超声造影敏感度92.45%,特异度95.91%,阳性预测值96.66%,阴性预测值90.82%。本组恶性肿块二维超声检查敏感度82.63%,特异度65.02%,阳性预测值60.40%,阴性预测值85.29%。结论通过系统地对乳腺恶性肿块超声图像及超声造影表现进行观察,进一步发现了不同乳腺肿块,尤其是恶性肿块的超声造影特征表现,认为超声造影可提高对乳腺肿块低速血流显示的敏感度,并有其特征性表现,有助于乳腺良恶性病变的鉴别诊断及提高诊断准确率。OBJECTIVE Breast ultrasound is a necessary technique for Breast disease. Contrast-enhanced ultra- sound （CEUS） conquers the limitation of conventional ultrasound. The sensitivity of detecting the low velocity blood flow is greatly improved. This paper aimed at observing the performance of conventional ultrasound and CEUS of breast benign and malignant mass and discussing the characteristics of conventional ultrasound and CEUS. METHODS From 1st Janu- ary 2013 to 30th June 2015, the sonographic and hemodynamics regularity characteristics of 451 breast masses were ob- served in the People＇s Hospital of Guangxi Zhuang Autonomous Region. After the injection of SonoVue, the high fre- quency ultrasound image, enhancement form, intensity and the time-intensity curve were analyzed. The results were cor- related with pathology. RESULTS Totally 451 cases were confirmed by the pathology including 240 breast malignant tumors and 211 breast benign tumors. The characteristics were as follows.. The CEUS of breast malignant tumors ap- peared heterogeneous and high or equal enhancement with 188 high enhancement （78. 3%）, 43 equal enhancement （17.9 %） and 9 low enhancement （3.8 % ）. The size of contrast agent area were significantly increased compared with the two-dimensional images. There were multiple large vessels getting into the tumors. The eontrast agent range, radiated enhancement and perforating vessels of breast malignant tumors were increased compared with the benign ones. The en- hancement morphology of the contrast agent into the breast benign tumors showed ring enhancement mostly. Totally 59 benign cases （59/211 ） had this characteristic representation（28.0 % ）. The sensitivity, specificity, positive predictive val- ue and negative predictive value for breast malignant masses were 92.45% ,95.91%, 96.66% and 90. 82% by CEUS re- spectively, while the sensitivity, specificity, positive predictive value and negative predictive value for malignancy were 82.63%, 65.02% ,60.40% and 85.29% by two-dime

关 键 词：乳腺肿块 超声图像 超声造影 病理学 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]