1、102中国CT和MRI杂志2023年02月 第21卷 第02期 总第160期【第一作者】李拓，女，副主任医师，主要研究方向：超声医学。E-mail：【通讯作者】李拓论 著Comparative Analysis of Diagnostic Value of Contrast-Enhanced Ultrasound and MRI on Small Breast Cancer(diameter2.0cm)*LI Tuo1,*,ZHANG Jun-peng1,CUI Jun-sheng2.1.Department of Ultrasound,The First Affiliated Hospita
2、l of Nanyang Medical College,Nanyang 473000,Henan Province,China2.Department of Medical Technology,Nanyang Medical College,Nanyang 473000,Henan Province,ChinaABSTRACTObjective To compare and analyze the diagnostic value of contrast-enhanced ultrasound(CEUS)and magnetic resonance imaging(MRI)on small
3、 breast cancer.Methods 65 patients with surgically removed breast masses(diameter2.0 cm)who were diagnosed and treated in the hospital between October 2018 and May 2021 were enrolled as the research subjects.Using clinicopathological diagnosis results as the gold standard,the diagnostic value of con
4、trast-enhanced ultrasound and MRI on small breast cancer was analyzed,and the enhancement characteristics of contrast-enhanced ultrasound and MRI imaging as well as the TIC curve types of contrast-enhanced ultrasound and MRI imaging in patients with benign and malignant lesions were compared.Results
5、 Pathological results showed that among 65 patients with breast masses,there were 33 cases of malignant lesions and 32 cases of benign lesions.The sensitivity,specificity and accuracy rate in the diagnosis of small breast cancer were 81.81%,90.62%and 86.15%of contrast-enhanced ultrasound and were 84
6、.84%,96.87%and 90.76%of MRI respectively.9 cases were misdiagnosed by contrast-enhanced ultrasound(9/65,13.85%),and 6 cases were misdiagnosed by MRI(6/65,9.23%),thus there was no difference in the misdiagnosis rate between the two(P0.05).The number of cases with homogeneous enhancement in contrast-e
7、nhanced ultrasound was less than that in MRI while the number of cases with non-homogeneous enhancement was more than that in MRI(P0.05),and the area of internal perfusion defect was larger than that in MRI(P0.05).Ultrasound imaging time-intensity curve(TIC)results were mostly fast-in and fast-out t
8、ype or fast-in and slow-out type in malignant lesion group,and were mostly slow-in and slow-out type or no enhancement in benign lesion group(P0.05).TIC curve results of MRI imaging were mostly outflow type in malignant lesion group,and were mostly increasing enhanced type,plateau type or no enhance
9、ment in benign lesion group (P0.05)；CEUS均匀增强例数少于MRI，不均匀增强例数多于MRI(P0.05)，内部灌注缺损面积大于MRI(P0.05)；恶性病变组超声影像时间-强度曲线(TIC)结果多表现为快进快出型或快进慢出型，良性病变组超声影像TIC曲线结果多表现为慢进慢出型或无强化(P0.05)；恶性病变组MRI成像TIC曲线结果多表现为流出型，良性病变组MRI成像TIC曲线结果多表现为渐增型、平台型或无强化(P0.05)。1.2 方法 CEUS检查：患者取平卧位并充分暴露双侧乳腺及腋窝，采用彩色多普勒超声诊断仪(GE，Logiq9)，探头频率设置为5.
10、0-10.0 MHz。常规消毒患者检查部位后，将经5.0 ml注射用生理盐水(成都市海通药业有限公司，国药准字H51021980)稀释后的CEUS剂(Bracco，SonoVue)混悬液皮下注射于乳晕的3、6、9、12点位置处，用量为2.4 mL/人，注射时先行回抽以确定无回血，避免穿刺进血管，而后缓慢注射推入，按压注射部位半分钟避免造影剂渗出。注射造影剂的同时启动超声仪内置计时器，以乳头为中心呈放射状顺时针扫描。MRI检查：所有患者检查前禁食4h，取俯卧位，均采用磁共振扫描仪(Philips，Ingenia II 3.0T)，专用双穴乳腺表面线圈，使双乳自然下垂于线圈内。先平扫再进行扩散加权
11、成像及动态增强扫描，扫描范围包括双侧乳腺组织、腋窝。包括常规轴位T1加权成像序列(T1 weighted imaging，T1WI)及T2加权成像序列(T2 weighted imaging，T2WI)及扩散加权成像。T1WI参数设置为：层厚5.0 mm，层距0.5 mm，重复时间4000 ms，回波时间105 ms，视野200 mm240 mm；T2WI参数设置为：层厚5.0 mm，层距0.5 mm，重复时间720 ms，回波时间15ms，视野300 mm360 mm。扩散加权成像b值为0、600。受试者均采用高压注射器经肘前静脉注射钆喷酸葡胺(广州康臣药业有限公司，国药准字H1095027
12、0)，剂量为0.2 mmol/kg，速率2.0 mL/s，注射用生理盐水20 ml，速率2.0 mL/s。半分钟后先行平扫再进行快速梯度回波序列动态增强扫描，层厚2.0 mm，层距0.5 mm，重复时间5.6 ms，回波时间1.0 ms，视野320 mm320 mm。1.3 图像分析 实时评估CEUS及MRI图像中强化区域有无肿块及直径、血流、造影剂灌注及消退情况。采用QontraXt软件进行病灶强度分析，包括增强模式、增强后病变面积、灌注缺损面积、时间-强度曲线类型(time-intensity curve，TIC)等。所得图像均由2名专业影像学诊断医师采取双盲法阅片并进行图像处理。1.4
13、统计学方法 采用SPSS 22.0软件进行相关数据的整理与分析，以乳腺肿块病理结果为“金标准”，四格表法计算CEUS、MRI诊断小乳腺癌的敏感度、特异性、阴性及阳性预测值；计数资料组间对比用卡方(2)检验；计量数据资料给予正态分布及方差齐性检验满足要求，用(-s)表达，采取单因素方差分析，组间行t检验，P0.05视为差异有统计学意义。2 结 果2.1 病理结果 33例恶性病变组中浸润性导管癌22例，单纯癌4例，导管原位癌3例，浸润性小叶癌2例，黏液癌1例，鳞癌1例；32例良性病变组乳腺纤维腺瘤17例，乳腺增生12例，导管内乳头状瘤3例。2.2 CEUS与MRI成像特征比较 CEUS显示：33例
14、恶性病变患者中，信号强化均匀者占24.24%(8/33)，不均匀者占63.64%(21/33)，无强化者占12.12%(4/33)；27例病灶形态不规则，病灶周围血管增多且扭曲，信号增强；4例未能显示出微钙化；2例仅见局部增生者。32例良性病变患者中，信号强化均匀者占50.00%(16/32)，不均匀者占46.88%(15/32)，无强化者占3.12%(1/32)；29例病灶形态规则，血管形态正常；3例病灶区信号肿块边界不清，新生血管增多，走向不规则。MRI成像显示：33例恶性病变患者中，信号强化均匀者占15.15%(5/33)，不均匀者占84.85%(28/33)；病灶边界均呈现局部不清情况
15、，出现浅分叶或毛刺状结节。32例良性病变患者中，信号强化均匀者占96.88%(31/32)，无强化者3.12%(1/30)；31例病灶边界清晰，血管形态规则；1例病灶边界不清，周围血管血流异常。2.3 CEUS与MRI对肿瘤良恶性病变的诊断价值比较 CEUS评估乳腺肿块病变恶性30例、良性35例，误诊3例(3/65，4.62%)，漏诊6例(6/65，9.23%)；MRI评估乳腺肿块病变恶性29例、良性36例，误诊1例(1/65，1.54%)，漏诊5例(5/65，7.69%)，二者诊断准确率比较无差异(2=0.678，P=0.410)。CEUS诊断小乳腺癌的Kappa值为72.34%；MRI诊断
16、小乳腺癌的Kappa值为81.56%，二者与病理诊断结果均有较好的一致性，见表1、2。2.4 CEUS与MRI成像增强特征比较 CEUS与MRI在增强模式方面比较有显著差异，CEUS均匀增强例数少于CEUS，不均匀增强例数多于MRI(P0.05)；CEUS内部灌注缺损面积大于MRI(P0.05)，见表3。2.5 良恶性病变患者CEUS及MRI成像TIC曲线比较 恶性病变组超声影像TIC曲线结果多表现为快进快出型或快进慢出型，良性病变组超声影像TIC曲线结果多表现为慢进慢出型或无强化(P0.05)；恶性病变组MRI成像TIC曲线结果多表现为流出型，良性病变组超声影像TIC曲线结果多表现为渐增型、平台型或无强化(P0.05)，见表4。2.6 典型病例结果分析 见图1-图5。表1 CEUS与MRI诊断结果比较(n)检查方法 病理结果 合计 恶性 良性 CEUS 恶性 27 3 30 良性 6 29 35MRI 恶性 28 1 29 良性 5 31 36表2 CEUS与MRI诊断价值比较(%)检查方法 敏感度 特异度 准确率 阳性预测值 阴性预测值 Kappa值CEUS 81.81 90.62