ARFI技术评估不同深度乳腺良恶性病灶的价值

A study on the value of ARFI in evaluating different depth of breast benign and malignant lesions

目的研究声脉冲辐射力成像技术(ARFI)诊断乳腺良恶性病灶的价值,探讨其诊断价值是否受乳腺病灶深度的影响。方法由两名医师分别对109例患者的109个病灶进行声触诊组织成像技术(VTI)、声触诊组织量化技术(VTQ)。记录不同测量深度肿块的VTI面积、灰阶面积、肿块剪切波速度(SWV)值及同深度正常腺体的剪切波速度(SWV′)数值,计算病灶VTI面积与灰阶面积比S,获得两名医师的平均值S′,另外算出两名医师测得的病灶SWV的平均值与同深度正常腺体SWV′平均值的比值SWV″。分别比较S′与SWV″在良恶性病灶间的差异是否有统计学意义,并利用统计学分析绘制ROC曲线,算出S′及SWV″诊断乳腺恶性疾病的最佳截点值。最后根据病灶距离皮肤表面的深度,将所有良性及恶性病灶分别分为0 mm<D<15 mm、15 mm≤D<30 mm两组,比较良性病灶及恶性病灶的S′、SWV″在这两组间差异是否有统计学意义。结果109例病灶中良性病灶52例,恶性病灶57例。恶性病灶的面积比S′大于良性病灶S′,差异有统计学意义(t=4.16,P<0.001),S′在诊断乳腺恶性病灶的敏感度、特异度、阳性预测值、阴性预测值、约登指数分别为78.95%、69.23%、73.77%、75.0%、0.48。恶性病灶的剪切波速度比SWV″大于良性病灶的SWV″,差异有统计学意义(t=11.63,P<0.001),SWV″在诊断乳腺恶性病灶的敏感度、特异度、阳性预测值、阴性预测值、约登指数分别为78.95%、100%、100%、81.25%、0.79。两组之间良性病灶及恶性病灶的S′与SWV″比较差异均无统计学意义。结论ARFI这项热点技术能够定性和定量的获得病灶信息,有助于诊断乳腺疾病的良恶性。参数S′和SWV″不因为病灶深度的改变而发生显著的变化,结果相对稳定。

Objective To study the value of acoustic pulse radiation imaging(ARFI)in the diagnosis of benign and malignant breast lesions,and to explore whether its diagnostic value is affected by the depth of breast lesions.Methods Virtual touch imaging(VTI)and virtual touch quantification(VTQ)were performed on 109 lesions of 109 patients by two doctors.Recorded VTI area,grayscale area,shear wave velocity(SWV)values of different depths mass and measured SWV′values of normal gland at the same depth,Calculated the ratio of VTI area to gray scale area,then got an average value of two doctors as S′,the ratio of SWV mean value to normal gland mean value SWV′were noted as SWV″.Comparing whether the difference between S′and SWV″in benign and malignant groups were statistically significant,using statistical analysis to draw a ROC curve,the best cut-off point for S′and SWV″diagnosis of malignant breast disease were calculated.Finally,all benign and malignant lesions were divided into two groups,0 mm<D<15 mm and 15 mm≤D<30 mm,according to the depth of the lesions from the skin surface.The difference of S′and SWV″of benign and malignant lesions between the above two groups were statistically significant.Results There were 52 benign lesions and 57 malignant lesions in 109 cases.Area ratio S′of malignant lesions(1.37±0.35)compared with benign lesions(1.14±0.18)was statistically significant(t=4.16,P<0.001).Sensitivity,specificity,positive predictive value,negative predictive value and Yoden index of S′in diagnosing malignant breast lesions were 78.95%,69.23%,73.77%,75.0%and 0.48,respectively.The shear wave velocity ratio SWV″between malignant lesions(6.34±2.66)and benign lesions(1.98±0.49)was statistically significant(t=11.63,P<0.001).Sensitivity,specificity,positive prediction value,negative prediction value,Youden index of SWV″in diagnosis of malignant breast lesions were 78.95%,100%,100%,81.25%and 0.79.There was no significant difference when S′and SWV″of benign lesions in the depth of 0~15 mm compared with depth of 15~30 mm.And so did the malignant lesions.Conclusion ARFI,a hot spot technology,can qualitatively and quantitatively obtain information of breast lesion,which is conducive to diagnose the benign and malignant breast diseases.Parameters S′and SWV″don’t change significantly in different depth,showed relatively stable.