声脉冲辐射力成像对乳腺肿瘤的诊断价值

Diagnostic value of acoustic radiation force impulse imaging in breast tumor

目的评价声脉冲辐射力成像(ARFI)技术对乳腺良恶性病变的鉴别诊断价值。方法选取84例患者共87个肿块进行常规超声、声触诊组织成像(VTI)及声触诊组织量化(VTQ)检查,得出剪切波速度值,并运用image J软件对VTI图像进行后处理得出肿块的平均光密度值,以病理结果为金标准,绘制受试者工作特征(ROC)曲线,评价ARFI的意义。结果经手术病理证实,87个乳腺肿块中良性病灶56个、恶性病灶31个。恶性病灶VTQ≥3.49m/s(临界值)的病灶数为21个,<3.49m/s为10个。良性病灶VTQ≥3.49m/s病灶数为3个,<3.49m/s为53个。恶性病灶平均光密度值大于或等于202.25(临界值)的病灶数为28个,<202.25为3个。良性病变平均光密度值大于或等于202.25的病灶数6个,<202.25为50个。乳腺良恶性病灶VTQ剪切波速度及VTI平均光密度值比较,差异均有统计学意义(P=0.000)。关于乳腺肿瘤的诊断灵敏度、特异度、阳性预测值、阴性预测值、准确率及约登指数,常规超声分别为96.8%、67.8%、62.5%、97.4%、78.2%、0.645;ARFI分别为93.5%、98.2%、96.7%、96.5%、96.6%、0.917。结论 ARFI成像对乳腺肿瘤诊断的特异度、准确率优于常规超声。

Objective To evaluate the differentiation diagnostic value of acoustic radiation force impulse imaging（ARFI）technique to the benign and malignant breast lesions.Methods A total of 87 breast masses in 84 patients were selected and performed the routine ultrasound,virtual touch imaging（VTI）and virtual touch quantification（VTQ）examination.The shear wave velocity was obtained.The average optical density of the tumor was obtained by processing the VTI images by using the image J software.The pathological results served as the gold standard and the ROC curve was drawn.Finally,the significance of ARFI was evaluated.Results All 87 pathologically verified breast tumors included 31 malignant lesions and 56 benign lesions.In malignant lesions,there were 21 lesions with VTQ value≥3.49（threshold value）and 10 lesions with VTQ value〈3.49.In benign lesions,there were 3lesions with VTQ value≥3.49 and 53lesions with VTQ value〈3.49.In malignant lesions,there were 28 lesions with the mean optical density value≥202.25（threshold value）and 3lesions with the mean optical density value202.25.In benign lesions,there were 6lesions with the mean optical density value≥202.25 and 50lesions with the mean optical density value202.25.There were statistically significant differences in the shear wave velocity measured by VTQ and average optical density measured by VTI between malignant and benign lesions（P=0.000）.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy rate and Youden index of conventional ultrasound were 96.8%,67.8%,62.5%,97.4%,78.2%,0.645,respectively;which for ARFI were 93.5%,98.2%,96.7%,96.5%,96.6% and 0.917,respectively.Conclusion The ARFI is superior to the conventional ultrasound in the specificity and accuracy rate in diagnosing breast tumor.