乳腺癌病灶大小与超声造影表现的相关性

The correlation between lesion size and contrast-enhanced ultrasound in breast cancer

目的探讨不同病灶大小乳腺癌的超声造影特点是否有差异。方法回顾性分析113例乳腺癌患者119个病灶的超声造影灌注模式。依据超声测得的病灶最大径将病灶分成两组，Ⅰ组（≤2．0cm）47个，Ⅱ组（〉2．0cm）72个。分析所有病变区域的超声造影增强特点及模式，包括增强范围是否大于二维超声显示、增强强度、造影剂分布情况、造影剂进入肿瘤顺序、造影模式、有无穿支血管、有无灌注缺损等指标。结果超声造影在增强强度、是否有灌注缺损及是否有穿支血管等方面与病灶大小有关，〉2．0cm的乳腺癌倾向于高增强、存在灌注缺损及穿支血管等造影特征（P〈0．05）。但超声造影增强范围是否大于二维超声、造影剂分布特点、造影剂进入肿瘤的顺序、造影模式的差异与病灶大小无关（P〉0．05）。乳腺癌无论肿块大小均倾向于造影后增强范围大于二维超声，呈不均匀增强、向心性及整体性充填，灌注模式上以速升速降多见。结论乳腺癌内肿瘤血管的生成是循序渐进的，随着肿瘤体积的增大，血管异质性表现得更加显著，病灶更倾向于不均匀性高灌注，同时伴有灌注缺损及穿支血管，但鉴别良恶性的主要征象——造影模式及增强范围是否大于二维超声显示的范围在乳腺癌的不同大小肿块间具有一致性。

Objective To investigate whether there are differences of the characteristics of the contrast-enhanced ultrasound among breast cancer vary in size. Methods The contrast-enhanced ultrasound perfusion mode were retrospectively analyzed in 113 cases of breast cancer patients with 119 lesions. They were divided into two groups according to the maximum diameter of the lesion based on ultrasound measured,one group （42.0 cm） 47 cases,the other group （〉2.0 cm） 72 cases. The characteristics and mode of contrast-enhanced ultrasound of the lesion were analyzed,including whether is greater than the twodimensional ultrasound in enhanced range, enhanced strength, the distribution of the contrast agent, contrast agent perfusion sequence in lesions, contrast mode, and the existence of perforator vessels and perfusion defects. Results Enhanced strength,the existence of perforator vessels and perfusion defects associated with the size of the lesions. The breast cancer lesions more than 20 cm were apt to higher enhance strength,the presence of perfusion defects, perforator vessels （P 〈0.05）. However, there were something that had nothing to do with the size of the lesions including whether or not contrast-enhanced ultrasound range was greater than the two-dimensional ultrasound range, contrast agent distribution characteristics, contrast agent perfusion sequence in lesions,and differences in contrast patterns （ P〉0.05）. Regardless of breast lesions size,the enhanced range tended to larger than two-dimensional ultrasound range, and contrast-enhanced ultrasound present inhomogeneous,centrality and integrity filling and perfusion mode of quickly rising and falling. Conclusions Within breast tumor angiogenesis is gradual. With the increase of tumor volume,more significant vascular heterogeneity,breast cancer lesion are more prone so uneven high per{usion, accompanied by perfusion defects and perforating vessels, but the main sign of differentiating benign and malignant showed consistency between different sized lumps in breast cancer, which included whether or not contrast mode and enhanced range greater than two-dimensional ultrasonic range.