乳腺实性病灶组织多普勒超声弹性成像时间-应变曲线分析

Tissue Doppler and strain curve of tissue Doppler ultrasound elatography of breast solid lesions

目的探讨组织多普勒超声弹性成像(TDUE)时间-应变曲线在乳腺实性病灶定性诊断中的价值。方法对在我院行乳腺超声检查并经手术病理确诊的46例乳腺实性占位性病变患者共54个乳腺实性病灶(良性病灶39个,恶性病灶15个)行TDUE检查。在乳腺良、恶性病灶内及病灶周围乳腺正常脂肪组织内分别建立面积1cm2的圆形感兴趣区(ROI),得到ROI解压时时间-应变曲线。记录乳腺正常脂肪组织、乳腺良性病灶、乳腺恶性病灶解压时最大应变绝对值(max-ARS)。结果 (1)每个乳腺实性病灶及病灶周围乳腺正常脂肪组织均重复测量3次,共得到ROI解压时时间-应变曲线:乳腺正常脂肪组织162条,乳腺良性病灶117条及乳腺恶性病灶45条。(2)乳腺正常脂肪组织162条ROI解压时时间-应变曲线均为正向波形,未出现负向波形;乳腺良性病灶117条ROI解压时时间-应变曲线中正向波形108条,负向波形9条;乳腺恶性病灶45条ROI解压时时间-应变曲线中正向波形12条,负向波形33条。乳腺正常脂肪组织、乳腺良性病灶及乳腺恶性病灶ROI解压时时间-应变曲线形态差异有统计学意义(检验水准修正法,χ2=172.37,P<0.0001)。乳腺正常脂肪组织ROI解压时时间-应变曲线形态与乳腺良性病灶比较差异有统计学意义(Fisher确切概率法,P=0.0003),与乳腺恶性病灶比较差异亦有统计学意义(Fisher确切概率法,P<0.0001);乳腺恶性病灶ROI解压时时间-应变曲线形态与乳腺良性病灶比较差异也有统计学意义(χ2=72.92,P<0.0001)。(3)乳腺正常脂肪组织、乳腺良性病灶和乳腺恶性病灶max-ARS分别为(15.57±8.91)%、(6.78±4.48)%及(1.14±2.71)%,差异有统计学意义(F=104.21,P<0.05)。且乳腺正常脂肪组织max-ARS大于乳腺良性病灶和恶性病灶,差异均有统计学意义(q=1.32、1.85,P均<0.05);乳腺良性病灶max-ARS大于乳腺恶性病灶,差异也有统计学意义(q=0.67,P<0.05)。结论乳腺恶性病灶ROI解压时时间-应变曲线多呈负向波形,乳腺良性病灶max-ARS大于恶性病灶。ROI解压时时间-应变曲线可为判断乳腺实性病灶良恶性提供参考。

Objective To investigate the value of tissue Doppler ultrasound elastography（TDUE） in the diagnosis of breast solid lesions. Methods TDUE was used to examine 46 eases with 54 breast solid lesions（39 benign lesions and 15 malignant lesions）. The pathological confirmations were performed after surgical resection. After a size of lcm2 region of interest（ROI） was placed in the subcutaneous adipose tissue and target lesion, the corresponding type of tissue Doppler and strain cm＇ve was achieved. Maximal absolute relaxed strain （max-ARS） of adipose tissues, benign lesions and malignant lesions were also recorded. Results The elastography was performed 3 times for each solid lesion and adipose tissue adjacent to the lesion. Totally 162 curves of adipose tissues,ll7 curves of benign lesions, and 45 curves of malignant lesions in ROI were acquired with elastographic modality. Two categories of curve, positive wave and negative wave, were achieved. There were all positive waves and no negative waves in 162 curves of adipose tissues. Numbers of positive and negative waves in 117 curves of breast benign lesions were 108 and 9, respectively. Numbers of positive and negative waves in 45 curves of breast malignant lesions were 12 and 33, respectively. The categories of curves among the adipose tissues, benign lesions and malignant lesions had statistically significant difference （ corrected size of test, X^2 = 172.37, P 〈 0. 0001 ）. The difference was significant for the types of curves between adipose tissues and benign lesions （ Fisher exact test, P = 0. 0003 ） and between adipose tissues and malignant lesions （ Fisher exact test,P 〈 0.0001 ）. The types of curves between malignant lesions and benign lesions were also considered statistically significant （X^2 = 72.92 ,P 〈 0. 0001 ）. The mean max-ARS of adipose tissues, benign and malignant lesions was （ 15.57 ± 8.91 ） %, （ 6.78± 4.48 ） % and （ 1.14 ± 2.71 ） %, respectively, and the difference among them was significant （ F = 104.21, P 〈 0.05 ）. The mean max-ARS of adipose tissues was significantly greater than that of benign lesions and malignant lesions （q = 1.32 and 1.85 ,all P 〈 0.05 ）. The mean max-ARS of benign lesions was also statistically larger than that of malignant lesions （ q = 0.67, P 〈 0.05 ）. Conclusions The majority of breast malignant lesions demonstrate negative wave in tissue doppler and strain curve. The max-ARS of benign lesions is greater than that of malignant lesions. Elasticity based on tissue Doppler and strain curve provide evidence for the differentiation of breast benign and malignant lesions.