超声造影对乳腺BI-RADS4B级肿块的诊断价值

摘要

目的 评价超声造影对乳腺BI-RADS4B级肿块的鉴别诊断价值.方法 对常规超声检查后诊断为BI-RADS4B级的60例女性患者(共65个肿块,其中恶性44个,良性21个)进行超声造影检查,术后均行病理证实,比较良恶性肿块的超声造影显像特征及其不同区域的血流灌注参数特征.结果 良性组和恶性组在增强顺序、造影模式、造影后范围有无显著增大方面比较差异均具有统计学意义(P<0.05);但在内部造影剂分布、周边穿入或扭曲血管、充盈缺损方面比较差异均无统计学意义(P>0.05);恶性组边缘带的峰值强度明显高于良性组,恶性组边缘的峰值强度、曲线下面积、消除斜率高于其癌旁正常组织,而平均渡越时间、达峰时间低于其癌旁正常组织,差异均有统计学意义(P<0.05);恶性组边缘带的峰值强度、曲线下面积、消除斜率高于其内部,差异均有统计学意义(P<0.05),而平均渡越时间、达峰时间差异均无统计学意义(P>0.05);良性组边缘带峰值强度、曲线下面积、消除斜率、平均渡越时间、达峰时间与其内部及其癌旁正常组织相比较,差异均无统计学意义(P>0.05).超声造影对BI-RADS4B级恶、良性肿块诊断正确率分别为93.18%(41/44)和76.19%(16/21). 结论 使用超声造影对BI-RADS4B级肿块可以进一步良恶性鉴别,可以提高BI-RADS4B级肿块诊断准确率.%Objective To assess the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of Breast Imaging Reporting and Data System BI-RADS4B breast lesions. Methods Sixty female patients with 65 breast lesions, including 21 benign lesions (benign group) and 44 malignant lesions (malignant group), were diagnosed as BI-RADS4B by conventional ultrasound examination. All the breast lesions underwent CEUS and postoperative path-ological examination. The imaging features and blood perfusion parameters in different regions of the benign and malig-nant breast tumors were compared. Results The benign group and malignant group showed statistically significant dif-ference in enhancement order, contrast model, and whether the lesion was significantly enlarged after CEUS (P<0.05), but not in distribution of contrast agent, penetrating or tortuous surrounding vessels, and filling defect (P>0.05). In CEUS time-intensity curve analysis, the peak intensity (PI) of periphery region was significantly higher in malignant group than that in benign group (P<0.05). Compared to the peficancerous normal breast tissues, the PI, wash-in slope (WIS), area under the curve (AUC) in the periphery region of malignant group were significantly higher or bigger, while the mean transit time (MTT) and time to peak (TTP) were significantly shorter (P<0.05). Compared to the inside region of the malignant group, the PI and WIS, AUC in the periphery region of malignant group were significantly higher or big-ger (P<0.05), but there was no significant difference in the MTT and TTP between the periphery region and inside region (P>0.05). In the benign group, compared to the peficancerous normal breast tissue and inside region, the blood perfusion parameters (PI, WIS, AUC, MTT, TTP) in the periphery region showed no statistically significant differences (P>0.05). The diagnostic accuracy rate of CEUS in malignant breast lesions and in benign breast lesions were 93.18%(41/44) and 76.19%(16/21), respectively. Conclusion CEUS could be applied as a useful adjunct to diagnose BI-RADS4B breast lesions, which can improve the diagnostic accuracy of breast lesions.