彩超对乳腺肿瘤血流频谱及形态学的分析

The value of color ultrasound in analyzing the shape of spectral flow Doppler and blood vessel morphology of the patients with breast masses

目的分析乳腺良、恶性肿瘤的彩超血流形态学及动力学参数,试图为临床提供更多对乳腺癌早期诊断有价值的信息。方法术前1周运用彩色及能量多普勒超声对124例乳腺良、恶性肿瘤患者原发灶的血流形态学以及动力学指标进行分析。结果良性肿瘤以分支型和散在星点状为主,其中散在星点状最为多见,但无特异性。恶性肿瘤以中央穿入型为最特异性的血管形态学特征,特异性为86%。乳腺癌的多普勒血流频谱形态常表现为收缩期加速时间(AT)缩短,峰值前移,频谱形态呈“匕首”形。舒张期频谱形态在小乳癌常表现为流速曲线降幅较大,超过舒张期最高流速的1/2以上,甚至可降至基线水平。血供丰富者,舒张期流速曲线降幅较小,呈动静脉瘘的湍流频谱。纤维腺瘤和乳腺增生的多普勒血流频谱形态常表现为收缩期加速时间较长,峰值居中,频谱形态呈“三角”形。舒张期频谱形态常表现为流速曲线降幅较小。乳腺恶性肿瘤的收缩期峰值流速要高于良性肿瘤,但良恶性肿瘤的阻力指数无明显差异。如以频谱形态特征诊断乳腺癌,其敏感性为83%,特异性96%,可视为特异性的乳腺癌血流频谱形态;如以收缩期峰值流速Vmax>12 cm/s诊断乳腺癌,其敏感性为79%,特异性71%;两者结合诊断乳腺癌其敏感性为89%,特异性98%。结论彩色及能量多普勒超声对乳腺良、恶性肿瘤血流形态学及动力学指标的检测可为临床提供更多对乳腺癌早期诊断有价值的信息。

Objective To detect the diagnostic value by utilizing color ultrasound for breast masses.Method Before surgery one hundred twenty four women with breast masses were studied with color ultrasound. Results （1） Center penetrating vascular structures became more significant in malignant masses as compared with benign masses. （2） In the malignant masses group, peak wave of contractive period often appeared ahead, accelated time often shorter than benign masses , and the wave of diastohc period often descend quickly or the latest wave of diastolic period often did not appear, In the benign masses , peak wave of contractive period often appeared normal, accelated time often longer than malignant masses ,and the wave of diastolic period often descend slowly. （3） Vmax was highly in malignant breast masses than in benign breast masses. RI has not statistically significant inner the masses, the correlation of Vmax and shape of spectral flow Doppler can enhance the sensitivity and specitivity. Conclusion The shape of the vascular inner masses and the spectral flow Doppler is an important index in differential diagnosis of breast masses.