目的：评价二维超声造影、三维能量多普勒及三维超声造影联合应用观察BI-RADS分级4级以上乳腺病灶边缘带的价值。方法：收集经病理证实的超声分级为BI-RADS 4级及以上的乳腺良恶性病灶182例，依次行2D-CEUS、3D-CPA、3D-CEUS检查并存储图像。应用QLab软件对乳腺良恶性病灶边缘带、病灶中央区域、病灶旁乳腺组织进行时间强度曲线分析并进行比较。对乳腺病灶边缘带进行3D-CPA及3D-CEUS重建，按血供丰富程度将图像分为4级。比较3D-CEUS与3D-CPA对乳腺病灶血管结构的显示情况。结果：乳腺癌边缘带超声造影灌注参数不同于中央部及病灶旁乳腺组织（F=7.782 7，P<0.000 1）。癌边缘带与癌中央区域均相对于癌旁乳腺组织呈快进慢退高增强，癌边缘带的造影模式相对于中央区域呈现相对快进慢退高增强（P<0.05）。乳腺良性病灶边缘带与中央区域相对于病灶旁乳腺组织呈快进快退高增强，乳腺良性病灶边缘带相对中央区域呈快进快退等增强（P<0.05）。乳腺癌边缘带的3D-CPA及3D-CEUS血供级别均以Ⅲ级或Ⅳ级为主，且高于乳腺良性病灶边缘带的血供级别（P<0.05）。乳腺癌边缘带的3D-CEUS血供级别高于3D-CPA（P<0.05）。结论：癌边缘带对乳腺癌超声造影的恶性征象的贡献大于癌中央区域。3D-CEUS显示BI-RADS分级4级以上乳腺病灶边缘带的血管结构优于3D-CPA。2D-CEUS联合3D-CPA与3D-CEUS可更好呈现乳腺癌边缘带的血流灌注状态。
Abstract
Objective: To evaluate their application value in observing the marginal zone of breast lesions with BI-RADS grade 4 or above by 2D-CEUS, 3D-CPA and 3D-CEUS. Method: One hundred and eighty-two pathologically proved benign and malignant breast lesions with BI-RADS grade 4 or above received examinations in the order of 2D-CEUS, 3D-CPA and 3D-CEUS. The marginal zone, the central region and the adjacent gland tissue for all lesions were analyzed and compared by time-intensity curve using QLab software. Three dimensional reconstruction of power Doppler and contrast-enhanced images were performed in the marginal zone and 4 levels were divided according to the blood supply. The abilities to display the vascular structure of breast lesions by 3D-CEUS and 3D-CPA were compared. Results: For cancers, the marginal zone had different ultrasonic perfusion parameters from the central region and adjacent normal gland tissue(F=7.782 7, P<0.000 1). Compared with the adjacent tissue, the marginal and central regions showed obvious enhancement with quick access and slow retreat. Compared with the central region, the marginal zone showed medium enhancement with quick access and slow retreat(P<0.05). For benign lesions, the marginal and central zones showed obvious enhancement with quick access and quick retreat in comparison to adjacent normal tissue. Compared with the central region, the marginal zone showed medium enhancement with quick access and quick retreat(P<0.05). 3D-CPA and 3D-CEUS in the periphery of breast cancers were characterized by more blood supply of grade Ⅲ or Ⅳ compared to benign breast lesions(P<0.05). Blood supply levels were higher by 3D-CEUS than by 3D-CPA(P<0.05). Conclusion: The marginal zone contributed more to the malignant imaging features than the central region for contrast-enhanced ultrasound in breast cancer. 3D-CEUS was superior to 3D-CPA in manifesting the blood vascular structure in the marginal zone of breast lesions of BI-RADS grade 4 or above. 2D-CEUS combined with 3D-CPA and 3D-CEUS can better display blood perfusion in the marginal zone of breast cancers.
关键词
乳腺肿瘤 /
超声检查 /
乳房 /
超声检查 /
多普勒 /
彩色
Key words
Breast neoplasms /
Ultrasonography, mammary /
Ultrasonography, Doppler, color
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基金
新疆医科大学附属肿瘤医院科研启动基金（编号：肿2013-12）。
