Multimodality ultrasonic observation in the marginal zone of breast lesions with BI-RADS grade 4 or above
1.Department of Ultrasonography, the Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830011, China;
2.Department of Radiochemotherapy, the Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China)
Abstract：Objective: To evaluate their application value in observing the marginal zone of breast lesions with BI-RADS grade 4 or above by 2D-CEUS, 3D-CPA and 3D-CEUS. Method: One hundred and eighty-two pathologically proved benign and malignant breast lesions with BI-RADS grade 4 or above received examinations in the order of 2D-CEUS, 3D-CPA and 3D-CEUS. The marginal zone, the central region and the adjacent gland tissue for all lesions were analyzed and compared by time-intensity curve using QLab software. Three dimensional reconstruction of power Doppler and contrast-enhanced images were performed in the marginal zone and 4 levels were divided according to the blood supply. The abilities to display the vascular structure of breast lesions by 3D-CEUS and 3D-CPA were compared. Results: For cancers, the marginal zone had different ultrasonic perfusion parameters from the central region and adjacent normal gland tissue(F=7.782 7, P<0.000 1). Compared with the adjacent tissue, the marginal and central regions showed obvious enhancement with quick access and slow retreat. Compared with the central region, the marginal zone showed medium enhancement with quick access and slow retreat(P<0.05). For benign lesions, the marginal and central zones showed obvious enhancement with quick access and quick retreat in comparison to adjacent normal tissue. Compared with the central region, the marginal zone showed medium enhancement with quick access and quick retreat(P<0.05). 3D-CPA and 3D-CEUS in the periphery of breast cancers were characterized by more blood supply of grade Ⅲ or Ⅳ compared to benign breast lesions(P<0.05). Blood supply levels were higher by 3D-CEUS than by 3D-CPA(P<0.05). Conclusion: The marginal zone contributed more to the malignant imaging features than the central region for contrast-enhanced ultrasound in breast cancer. 3D-CEUS was superior to 3D-CPA in manifesting the blood vascular structure in the marginal zone of breast lesions of BI-RADS grade 4 or above. 2D-CEUS combined with 3D-CPA and 3D-CEUS can better display blood perfusion in the marginal zone of breast cancers.
冷晓玲1，黄国福2，马富成1. BI-RADS分级4级以上乳腺病灶边缘带的多模态超声观察[J]. 中国临床医学影像杂志, 2016, 27(1): 14-18.
LENG Xiao-ling1, HUANG Guo-fu2, MA Fu-cheng1. Multimodality ultrasonic observation in the marginal zone of breast lesions with BI-RADS grade 4 or above. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(1): 14-18.
[1]Kiessling F, Krix M, Heilmann M, et al. Comparing dynamic parameters of tumor vascularization in nude mice revealed by magnetic resonance imaging and contrast-enhanced intermittent power Doppler sonography[J]. Invest Radiol, 2003, 38(8): 516-524．
[2]Fernandez-Aguilara S, Jondetb M, Simonartc T, et al． Microvessel and lymphatic density in tubular carcinoma of the breast: Comparative study with invasive low-grade ductal carcinoma[J]. Breast, 2006, 15(6): 782-785．
[3]Bymes K, White S, Chu Q, et al． High eIF4E, VEGF, and microvessel density in stage Ⅰ to Ⅲ breast cancer[J]. Ann Surg, 2006, 243(5): 684-690．
[4]黄备建，王文平，丁红，等. 小肾癌的超声造影表现[J]. 中华超声影像学杂志，2009，18（5）：425-428.
[5]Jiang J, Chen Y, Zhou YC, et al. Clear cell renal cell carcinoma: Contrast-enhanced ultrasound features relation to tumor size[J]. Eur J Radiol, 2010, 73(1): 162-167.
[6]Zhou X, Yan F, Luo Y, et al. Characterization and diagnostic confidence of contrast-enhanced ultrasound for solid renal tumors[J]. Ultrasound Med Biol, 2011, 37(6): 845.
[7]谷涛，傅庆诏，马酷，等． 三维彩色血管能量成像在诊断乳腺肿瘤及预测肿瘤血管生成的应用价值[J]. 中华超声影像学杂志，2005，14（8）：585-587.
[8]Marie AJ, Louis GD, Marie RC, et al． Performance evaluation of a medical robotic 3D-ultrasound imaging system[J]． Med Image Anal, 2008, 12(3): 275-290.
[9]Luo W, Numata K, Morimoto M, et al. Clinical utility of contrast-enhanced three-dimensional ultrasound imaging with Sonazoid: Findings on hepatocellular carcinoma lesions[J]. Eur J Radiol, 2009, 72(3): 425.
[10]许萍，王怡，汪晓虹，等. 不同病理类型乳腺癌的实时灰阶超声造影研究[J]. 中国超声医学杂志，2013，29（3）：238-242.
[11]王琳，杜晶，方华，等. 乳腺癌超声造影增强特征与肿块大小的相关性研究[J]. 中国超声医学杂志，2011，27（1）：19-22.
[12]陈蓉，张伟国，龚水根，等. 乳腺良性病变常规增强MRI表现与微小血管的关系[J]. 中国医学影像技术，2004，20（3）：423-426.
[13]Ohto M, Kato H, Tsujii H, et al. Vascular flow patterns of hepatic tumor in contrast-enhanced 3-dimensional fusion ultrasonography using plane shift and opacity control modes[J]. J Ultrasound Med, 2005, 24(1): 49-57.
[14]Yukisawa S, Ohto M, Masuya Y, et al. Contrast-enhance three-dimensional fusion sonography of small liver metastases with pathologic correlation[J]. J Clin Ultrasound, 2006, 35(1): 1-8．
[15]施红，余秀华，张宏，等. 三维超声造影在腹部肿瘤血管显示中的应用[J]. 中国医学影像技术，2008，24（8）：1227-1230.
[16]Leen E, Kumar S, Khan SA, et al. Contrast-enhanced 3D ultrasound in the radiofrequency ablation of liver tumors[J]. World J Gastroenterol, 2009, 15(3): 289-299.
2016, Vol. 27 
