超声造影微血管成像评估乳腺肿瘤血管形态及分布特征

Evaluation of the characters on morphology and distribution of blood vessel in breast tumors with contrast-enhanced ultrasound microvascular imaging

目的探讨超声造影微血管成像在鉴别乳腺肿瘤良、恶性中的临床应用价值。方法对61例乳腺肿瘤患者行超声造影微血管成像检查，评价乳腺肿瘤血管的形态及分布特征，并与病理结果进行对照。利用ROC曲线评估其诊断价值。结果超声造影微血管成像显示乳腺良恶性肿瘤内部及周边血管的分布、形态特征差异有统计学意义（P〈0．05）。以乳腺肿瘤内微血管的分布情况为诊断乳腺肿瘤良恶性的标准，具有较高的敏感性（93．8％），ROC曲线下面积为0．836，诊断价值中等。而通过病灶周围血管情况鉴别则具有较高的特异性（96．6％），ROC曲线下面积为0．913，诊断价值较高。以病灶血管形态及分布整体特征为标准，具有较高的准确性（91．8％），ROC曲线下面积最大为0．961，诊断价值高。结论超声造影微血管成像技术可以评估乳腺肿瘤微血管的灌注情况、肿块内部及周边血管形态及分布特征，显著提高对乳腺肿瘤良恶性的鉴别诊断能力。

Objective To assess the diagnostic value of contrast-enhanced ultrasound microvascular imaging in differentiating between malignant and benign breast tumors. Methods Sixty-one patients with breast tumors were examined by contrast-enhanced ultrasound microvascular imaging, to assess the characters of blood vessel morphology and distribution of breast tumors, and in comparison to pathology. The diagnostic value of microvascular imaging was evaluated using receiver operating characteristic （ROC） curve. Results Contrast- enhanced ultrasound microvascular imaging showed significant differences in morphology and distribution of inner and surrounding vessels in malignant lesions in comparison to benign lesions （ P 〈 0.05）. Using blood vessel distribution of breast tumors as criteria of malignant and benign breast tumors had a highest sensitivity of 93.8%, and the area under ROC curve was 0. 836 ,diagnostic performance was moderate. Using surrounding blood vessels of breast lesions as criteria had a highest specificity of 96.6%, and the area under ROC curve was 0.913, diagnostic performance was better. Using the whole character of blood vessel morphology and distribution of breast tumors as criteria had a highest accuracy of 91.8% ,and the area under ROC curve was 0. 961 ,diagnostic performance was better. Conclusions Contrast-enhanced ultrasound microvascular imaging can evaluate microvascular perfusion and the characters of blood vessel morphology and distribution of breast tumors, and improve obviously the capability in discrimination between malignant and benign breast tumors.