剪切波速度成像定量鉴别乳腺良恶性病灶的临床研究  

Value of shear wave speed imaging in quantitative differentiation of benign and malignant breast lesions

作　　者：姚晓华[1,2] 王丹 刘博姬[1] 贺亚萍 李小龙[1] 赵崇克[1] 徐辉雄 YAO Xiaohua WANG Dan LIU Boji HE Yaping LI Xiaolong ZHAO Chongke XU Huixiong(Department of Medical Ultrasound, Shanghai Tenth People＇s Hospital, Shanghai 200072, China,Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China Department of Medical Ultrasound, Shanghai Jiading Center Hospital, 201800, China)

机构地区：[1]同济大学附属第十人民医院超声医学科,同济大学医学院超声医学研究所,上海200072 [2]上海市嘉定区中心医院,上海201800

出　　处：《肿瘤影像学》2017年第4期272-278,共7页Oncoradiology

摘　　要：目的:探讨一种最新剪切波弹性成像技术——剪切波速度成像(shear wave speed imaging,SWSI)对乳腺良恶性病灶的鉴别价值。方法:选取109例于上海市第十人民医院经手术病理证实的女性患者乳腺病灶共109个。术前乳腺病灶均行普通超声及剪切波弹性成像检查,测得杨氏弹性模量和速度模量,包括平均值(Emean)、SD及以正常乳腺腺体为参照的硬度比值(ratio)。根据病灶最大径,将病灶分为≤10 mm、>10~20 mm、>20 mm三组,以手术病理结果为金标准,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,获取弹性参数,分析其鉴别良恶性病灶的价值。结果:109个病灶中,良性85个,恶性24个。比较不同组内鉴别良恶性病灶的弹性成像参数,除≤10 mm组外,其余组中恶性病灶的杨氏弹性模量及剪切波速度均高于良性病灶,差异有统计学意义(P<0.001)。比较所有参数在各组内鉴别良恶性病灶的诊断效能,Emean优于SD及ratio,差异均有统计学意义(P<0.01)。其中>20 mm组曲线下面积(area under curve,AUC)及诊断效能较其他两组高。以弹性模量及速度的平均值39.20 k Pa、3.51 m/s作为截断值,鉴别乳腺病灶良恶性的灵敏度、特异度分别为86.7%、100%,86.7%、100%,差异均有统计学意义(P<0.001),但组间杨氏弹性模量及速度差异无统计学意义(P>0.05)。结论:SWSI有助于鉴别乳腺病灶良恶性,其弹性参数Emean、SD及ratio为乳腺疾病提供了更多诊断依据。Objective： The aim of this study was to assess the value of a new technique of shear wave speed （SWS） imaging in quantitativy differentiating benign from malignant breast lesions. Methods： 109 breast lesions in109 patients who underwent routine ultrasonography （US） and SWS imaging before surgical excision were analyzed. The quantitative SWS imaging parameters including： Mean and SD of shear wave speed （m/s） and elasticity modulus （kPa） value and ratio referenced as normal breast tissue were obtained, respectively. The lesions were categorized into three groups according to size （group 1, 〈 10 mm; group 2, 10-20 mm; and group 3 〉20 mm）. According to pathologic results, ROC curve was drawn to evaluate the best cut-off value in differentiating benign from malignant lesions. Diagnostic performances of SWS imaging parameters were calculated and compared. Results： There were 85 benign nodules and 24malignant nodules of the 109 breast lesions. The elastic values of malignant nodules were significant higher than those of benign one（all P〈0.001）,except for groupl（~〈 l0 mm）. For diagnostic performance in all groups, the values of E-mean were higher than SD and ratio, （all P〈0.01）.On ROC curve, the area trader the curve （AUC） of group 3 were higher than group 1 and 2. No significant differences of AUC between SWS imaging parameters were found （all P〉0.05）. Taking 39.20 kPa and 3.51 m/s as the cut-off values, sensitivity of 86.7% and 86.7%, specificity of 100% and 100% were achieved （ all P〈0.001）. No significant differences of SWS imaging parameters between Young＇s elastic modulus and shear wave speed （SWS） were found （all P〉 0.05）. Conclusion： The new technique of shear imaging is helpful for the differential diagnosis of breast lesions.

关 键 词：乳腺病灶 剪切波速度成像 弹性模量 

分 类 号：R445.1[医药卫生—影像医学与核医学]