【作者】 季晶晶；

【导师】 张迎春；

【作者基本信息】 苏州大学 ， 影像医学与核医学， 2015， 硕士

【摘要】 研究目的:1.探讨声辐射力脉冲成像技术(acoustic radiation force impulse,ARFI),包括声触诊组织成像(virtual touch tissue imaging,VTI)技术和声触诊组织定量(virtual touch tissue quantification,VTQ)技术在乳腺良恶性肿块鉴别诊断中的应用价值。2.以乳腺肿块内部区域的剪切波速度(shear wave velocity,SWV)平均值,构建受试者工作特性曲线(receiver operator characteristic curve,ROC)获得SWV最佳截断值,为乳腺病变良恶性鉴别提供新的观察指标。3.探讨旧版及新版BI-RADS分级对乳腺肿块良恶性鉴别的诊断价值。4.ARFI技术联合新版BI-RADS分级诊断标准对乳腺肿块良恶性鉴别的诊断价值。资料与方法:本研究入选2014年11月~2015年7月于无锡第二人民医院就诊发现有乳腺肿块的女性患者107例,共123个肿块。所有病例均手术或穿刺活检后经病理证实,其中良性肿块76个,恶性肿块47个。超声诊断仪:Siemens Acuson S2000,具备声辐射力脉冲成像技术。所有肿块均先在二维超声模式下观察乳腺肿块的大小、形态、内部回声、周围组织情况等,然后进入彩色多普勒观察乳腺肿块及周边的血流情况,用频谱多普勒超声技术测量乳腺肿块阻力指数。对肿块进行bi-rads分级后,运用vti技术获取乳腺肿块vti图像,对肿块进行评分。再用vtq技术分别测量肿块内部、肿块边缘处及周围正常乳腺腺体的swv值,各测量5次,取平均值,对以上数据应用统计学软件进行统计分析,判断vtq技术对乳腺肿块良恶性的诊断价值,p<0.05为差异有统计学意义。研究结果:1.vti技术评分法评分1~3分判断为良性,4~5分判断为恶性,鉴别诊断乳腺肿块的准确性、敏感性、特异性分别为87.00%(107/123)、85.11%(40/47)、88.16%(67/76)。vtq技术乳腺良性肿块组肿块内部、边缘及正常乳腺swv平均值分别为2.66±0.99m/s、2.55±0.78m/s、1.92±0.48m/s;乳腺恶性肿块组肿块内部、边缘及正常乳腺swv平均值分别为5.75±2.11m/s、4.43±1.78m/s、2.46±0.57m/s。乳腺良性肿块组与乳腺恶性肿块组肿块内部的swv平均值比较具有统计学差异(p<0.01)。2.以病理结果为金标准,以乳腺肿块内部区域的swv均值构建roc,所得的曲线下面积(areaundercurve,auc)为0.911,约登指数最大值为0.809,该点所对应的swv最佳诊断临界值为3.795m/s,其诊断乳腺肿块的准确性89.43%(110/123)、敏感性80.85%(38/47)、特异性94.74%(72/76)。3.旧版bi-rads分级鉴别诊断乳腺肿块良恶性的准确性79.67%(98/123)、敏感性89.36%(42/47)、特异性73.68%(56/76);新版BI-RADS分级鉴别诊断乳腺肿块良恶性的准确性86.99%(107/123)、敏感性82.98%(39/47)、特异性89.47%(68/76)。新版BI-RADS与旧版BI-RADS分级诊断的准确性、特异性之间有统计学差异(P<0.05)。4.ARFI技术(VTI技术+VTQ技术)联合新版BI-RADS分级诊断标准鉴别诊断乳腺肿块良恶性的准确性、敏感性分别为89.43%、91.49%,均高于单一一种方法,但相互间两两比较均无统计学意义。结论:1.ARFI技术作为二维超声的有效补充,在乳腺良恶性肿块的鉴别诊断方面有较高的临床应用价值,ARFI技术能客观定量定性评价肿块硬度信息,VTI技术可定性鉴别乳腺肿块的良恶性,VTQ技术SWV平均值以3.795m/s为界,可区分乳腺良、恶性肿块。2.新版BI-RADS分级诊断乳腺良恶性肿块的准确性、特异性高于旧版BI-RADS分级。3.ARFI技术与新版BI-RADS联合诊断后,可提高对乳腺肿块良恶性的鉴别诊断能力。更多还原

【Abstract】 Objective:1.To investigate the differential diagnosis application value of acoustic radiation force impulse imaging(ARFI), including virtual touch tissue imaging(VTI) and virtual touch tissue quantitative(VTQ) in benign and malignant breast tumors.2.The shear wave velocity(SWV) of breast tumors within the region average, construct the receiver operating characteristic curve(ROC) to obtain the optimal cut-off value of SWV, providing new observation index for diagnosis of benign and malignant breast tumors.3.To investigate the diagnostic value of the old version and the new version of breast imaging reporting and data system(BI-RADS) grading for the differential diagnosis of breast tumors.4.The diagnostic value of ARFI technology combined with the new version of BI-RADS classification in diagnosis of breast tumors.Materials and methods:This study was selected in November 2014~2015 in July in Wuxi Second People’s Hospital, 107 cases of female patients with breast tumor were found, a total of 123 lumps. All cases were confirmed by pathology after surgery or biopsy, including 76 benign masses and 47 malignant tumors. Ultrasonic diagnostic instrument: Acuson S2000 Siemens, with the acoustic radiation force impulse imaging technology. All tumors were observed in the two-dimensional ultrasound mode to observe the size, shape, internal echo, surrounding tissue, and then into the color Doppler to observe the blood flow of breast tumors and the surrounding area, and the resistance index of breast tumor was measured by using the spectrum Doppler ultrasound technique. After BI-RADS classification of tumor, VTI images of breast tumors were obtained by VTI technology, and the tumors were evaluated. SWV values of the tumors, the edge of the tumor and the surrounding normal mammary glands were measured by VTQ technology, and the average values were measured by 5 times.The statistical software was used to analyze the data. The diagnostic value of VTQ technology for breast tumor benign and malignant, P< 0.05 was statistically significant.Result:1.VTI score 1~3 score was judged to be benign, 4~5 score was malignant, the accuracy, sensitivity and specificity of the differential diagnosis of breast tumors were 87%(107/123), 85.11%(40/47), 88.16%(67/76), respectively. The interior average value of SWV of benign tumors was 2.66±0.99m/s,the average value of SWV surround the benign tumors was 2.55±0.78m/s,the average value of SWV of nomal breast tissue around the benign tumors was 1.92±0.48m/s.The interior average value of SWV of malignancy was 5.75±2.11m/s,the average value of SWV surround the malignancy was 4.43±1.78m/s, the average value of SWV of nomal breast tissue around the malignancy was 2.46±0.57m/s.The average value of SWV in the benign and malignant tumors was statistically different(P< 0.01).2.The pathological results for gold standard, in the inner region of the breast tumor SWV mean to build ROC, the area under the curve(AUC) was 0.911, Youden index maximum value was 0.809, the point corresponding to the best SWV diagnosis critical value was 3.795m/s. The diagnosis of breast tumor accuracy of 89.43%(110/123), sensitivity of 80.85%(38/47), specificity of 94.74%(72/76).3.The old BI-RADS classification of differential diagnosis of benign and malignant breast tumors and the accuracy of 79.67%(98/123), the sensitivity of 89.36%(42/47),specificity of 73.68%(56/76).The new BI-RADS classification of differential diagnosis of benign and malignant breast tumors and the accuracy of 86.99%(107/123), the sensitivity of 82.98%(39/47), specificity of 89.47%(68/76).There was a statistical difference between the accuracy and specificity of the new version of BI-RADS and the old version of BI-RADS(P < 0.05).4.ARFI(VTI+VTQ) technology combined with the new BI-RADS classification diagnostic criteria for the differential diagnosis of breast tumors benign and malignant accuracy, sensitivity were 89.43%, 91.49%, were higher than the single method, but the mutual two two comparisons were not statistically significant.Conclusion:1.As an effective complement to conventional ultrasound, ARFI technology has high clinical value in differential diagnosis of benign and malignant breast tumors. ARFI technology can objectively and quantitatively evaluate the hardness of the tumors. The VTI technology can be used to identify benign and malignant breast tumors. The average value of SWV in 3.795m/s is the boundary, which can distinguish benign and malignant breast tumors.2.The accuracy and specificity of the new BI-RADS classification of malignant breast tumors were higher than that of the old version of BI-RADS.3.ARFI technology combined with the new BI-RADS grade can improve the differential diagnosis of benign and malignant breast lesions.更多还原