三维彩色血管能量成像对乳腺肿物血管的定量研究

Quantitative research of vascularity on breast tumor using three-dimensional color power angiography

目的探讨三维彩色血管能量成像(3D-CPA)定量检测乳腺肿物内血管参数对鉴别诊断肿物良恶性的临床价值。方法 61例乳腺肿瘤患者,良性组31例,恶性组30例,对其行3D-CPA重建。采用Vocal分析软件,选择三维能量直方图获得血管形成指数(VI)、血流指数(FI)和血管形成-血流指数(VFI);并对乳腺肿物进行3D-CPA血流分级,比较乳腺良恶性肿物VI、FI、VFI及其与乳腺肿物内血流分级的关系。结果 3D-CPA血流Ⅲ级患者的VI、FI、VFI高于Ⅱ级(P<0.05),以Ⅲ级作为诊断乳腺良恶性标准,敏感性、特异性、准确性分别为91.3%、76.3%、82.0%。恶性组VI、FI、VFI均高于良性组(P<0.05)。以VI≥1.157诊断乳腺恶性肿瘤的敏感性分别为87%,准确性为77%,特异性为68%;以FI≥32.397诊断乳腺恶性肿瘤的敏感性为83%,准确性为67%,特异性为52%;以VFI≥0.426诊断乳腺恶性肿瘤的敏感性为83%,准确性为73%,特异性为61%。结论乳腺肿物3D-CPA血管定量参数VI、FI、VFI与乳腺肿物血流分级结果一致,可用来判断乳腺肿物内部血管丰富程度,恶性肿物参数均高于良性肿物,有助于乳腺良恶性肿瘤的鉴别。

Objective To explore the value of three-dimensional color power angiography （3D-CPA） in differentiating benign and malignant breast tumor using the quantified blood flow related parameters. Methods Sixty-one patients with breast tumors have definite pathological diagnosis, 31 cases were benign and 30 cases were malignant. All patients were examined using 3D-CPA before aspiration biopsy or operation. The following parameters were analyzed using Vocal software by selecting three- dimensional power bar chart, including vaseularization index （VI）, flow index （FI） and vascularization- flow index （VFI）. The blood flow inside breast tumor was graded using 3D-CPA. The relation of VI, FI , VFI and 3D-CPA grades were compared between benign group and malignant group. Results VI, FI and VFI in grade m patients were significantly higher than those in grade I1 patients （P 〈 0.05 ）. Given grade 11I as diagnostic standard of benign and malignant breast tumor, the sensitivity, specificity and accuracy were 91.3%, 76.3% and 82.0%, respectively. VI, FI and VFI in malignant group were significantly higher than those in benign group （P 〈 0.05 ）. Given VI I〉 1.157 as a critical value to diagnose breast malignant tumor, the sensitivity,accuracy and specificity were 87% ,77% and 68%, respectively. Given FI I〉32.397 as a critical value to diagnose breast malignant tumor, the sensitivity, accuracy and specificity were 83%, 67% and 52%, respectively. Given VFI i〉0.426 as a critical value to diagnose breast malignant tumor,the sensitivity, accuracy and specificity were 83%,73% and 61%, respectively. Conclusion VI, FI and FI in 3D-CPA for quantifing tumor vascularity are in accordance with the result of breast tumors vascular grades. They can be used to estimate blood flow inside breast tumors, thus help to distinguish benign and malignant tumor.