超声造影和超声弹性成像对不可触及BI-RADS 4类乳腺肿块的附加诊断价值研究

The additional value of contrast-enhanced ultrasound and ultrasonic elastography for non-palpable BI-RADS category 4 breast lesions

目的:探讨超声造影(contrast-enhanced ultrasound,CEUS)和超声弹性成像(elastography,ES)技术对临床不可触及且常规超声诊断为乳腺影像报告和数据系统(Breast Imaging Report and Data System,BI-RADS)4类乳腺肿块的附加诊断价值。方法:回顾并分析2019年1月—2022年9月因乳腺肿块入院患者的临床和影像学资料。所有患者均有术后病理学检查结果。患者术前具备常规超声、剪切波弹性成像(shear wave elastography,SWE)及CEUS检查结果。在SWE图像上分析定量和定性指标,CEUS上动脉期指标在造影剂到达时间成像(arrival-time parametric imaging,At-PI)后处理模式下分析。经多因素logistic回归分析获得独立预测指标并比较不同模态诊断效能。结果:最终101例患者的101个病变纳入研究,恶性病变42个,良性病变59个,良恶性组间大小差异无统计学意义。SWE征象中除“硬环征”外,其他征象组间差异有统计学意义(P<0.05)。以At-PI模式分析CEUS观察者间一致性高(0.822~0.921)。多因素logistic回归分析结果表明,SWE预测恶性病变的有效指标为颜色欠/不均匀及最大弹性值(Emax)≥20.45 kPa;CEUS对应指标为增强后形态不规则、造影剂灌注缺损及静脉期造影剂滞留现象。对于不可触及BI-RADS 4类乳腺肿块,联合SWE或CEUS较单独行常规超声均能提升诊断效能(P<0.05),且联合CEUS效能高于联合SWE(P=0.0014),这种提升作用对4a类病变更为明显,对4b类无显著提升作用。结论:对于临床不可触及诊断为BI-RADS 4类的乳腺肿块,联合SWE或CEUS均能提升其诊断能力,且CEUS附加提升效能较SWE更为显著,尤其是对亚分类BI-RADS 4a类的病变。

Objective:To explore the additional diagnostic value of contrast-enhanced ultrasound(CEUS)and ultrasonic elastography(ES)for clinically non-palpable breast mass categorized as Breast Imaging Report and Data System(BI-RADS)4 by conventional ultrasound.Methods:The clinical and imaging data of patients with breast mass admitted in the hospital from January 2019 to September 2022 were retrospectively analyzed.All the patients had pathological results after surgical excision,and the results of ultrasound,shear wave elastography(SWE)and CEUS imaging data as well.The quantitative and qualitative indexes were analyzed on SWE images,and the arterial phase indexes were analyzed on CEUS images under the post-processing mode of arrivaltime parametric imaging(At-PI).Multivariate logistic regression was performed to obtain the independent predictive indexes,and the diagnostic performance of different modes was compared.Results:Finally,101 lesions from 101 patients were included in this study,of which 42 were malignant and 59 were benign,and there was no significant difference in size between the benign and malignant groups.There was a significant difference in all the signs of SWE except“rim sign”between the two groups(P<0.05).The CEUS images were analyzed under the At-PI mode,and high consistency between senior and junior radiologist was obtained(0.822~0.921).The results of multivariate logistic regression analysis indicated that the effective indexes of SWE to predict malignant lesions were reasonably homogenous/heterogeneous in color and Emax≥20.45 kPa.The corresponding indexes of CEUS were shape irregular after enhancement,contrast agent perfusion defect,and contrast agent retention in the venous phase.As for clinically non-palpable breast lesions categorized as BI-RADS 4,ultrasound combined with SWE or CEUS could improve diagnostic performance compared with ultrasound alone(P<0.05),and the performance of combination with CEUS was better than that with SWE(P=0.0014).The improved performance was more obvious for BI-RADS 4a lesions,but there was no significantly improved performance for BIRADS 4b lesions.Conclusion:The combination with SWE or CEUS can improve diagnostic performance for clinically non-palpable breast mass categorized as BI-RADS 4,and the additional performance of combination with CEUS is better than that with SWE,especially for BI-RADS 4a lesions.