【摘要】 目的：探讨对比增强能谱乳腺摄影(CESM)结合超声弹性成像对乳腺影像报告和数据系统(BI-RADS)4类乳腺结节性质的鉴别效能。方法：回顾性分析2021年7月至2023年7月期间，来自河北医科大学第四医院的92例经常规超声诊断为BI-RADS 4类乳腺结节的女性患者数据，行CESM和超声弹性成像检查。以病理诊断为金标准。结果：恶性结节患者病灶强化类型及超声弹性成像参数弹性应变率(SR)、弹性模量平均值(Emean)、周围脂肪弹性值(EvT)与良性结节患者比较差异有统计学意义(P<0.05);CESM联合超声弹性成像判断乳腺恶性结节的灵敏度、准确度、阴性预测值分别为98.39%、97.83%、96.67%,高于单项检查，联合判断的特异度(96.67%)、阳性预测值(98.39%)高于CESM单项检查；CESM联合超声弹性成像鉴别BI-RADS 4类乳腺结节性质的结果与病理学检查结果的Kappa值为0.951。结论：CESM结合超声弹性成像对BI-RADS 4类乳腺结节性质鉴别效能高，临床应用价值显著。更多还原

【Abstract】 Objective:To explore the differential efficacy of contrast enhancement spectral mammography(CESM) combined with ultrasound elastography in Breast Imaging Reporting and Data System(BI-RADS) for 4 category of breast nodules.Methods:The data of 92 female patients diagnosed as BI-RADS category 4 breast nodules by regular ultrasound at the Fourth Hospital of Hebei Medical University from July 2021 to July 2023 were retrospective analyzed.They underwent CESM and ultrasound elastography examinations.Using pathological diagnosis as the gold standard.Results:There were statistically significant differences in the lesion enhancement type and ultrasound elastography parameters of elastic strain rate(SR),mean of elastography of lesion(Emean) and ultrasonic elastic modulus of peripheral fat(EvT) between malignant nodule patients and benign nodule patients(P<0.05).The sensitivity,accuracy and negative predictive values of CESM combined with ultrasound elastography in the diagnosis of malignant breast nodules were 98.39%,97.83% and 96.67% respectively,which were higher than those of single examination,and the specificity(96.67%) and positive predictive value(98.39%) of combined diagnosis were higher than those of CESM single examination.The Kappa value between CESM combined with ultrasound elastography for distinguishing the nature of BI-RADS 4breast nodules and pathological examination results was 0.951.Conclusion:CESM combined with ultrasound elastography has high efficacy in distinguishing BI-RADS 4 category breast nodules, and the clinical application value is significant.更多还原