Schröder R J, Mäurer J, Hidajat N, Zlowodski M, Schlums D, Weber S, Hosten N, Felix R
Strahlenklinik und Poliklinik, Charité Campus Virchow-Klinikum, Berlin.
Rofo. 1999 Sep;171(3):211-8. doi: 10.1055/s-1999-249.
Prospective evaluation of the diagnostic outcome of plain and signal-enhanced color Doppler sonography for the differentiation between benign and malignant cutis-involving lesions.
39 patients with 40 suspected malignant skin lesions received an preoperative ultrasound examination before and after application of 4 g Levovist i.v. Spectral Doppler, conventional color and power Doppler were performed. The images were analyzed semiquantitatively using a specially developed software. The diagnoses were confirmed by histological analysis (37 cases) or by follow up controls (3 cases).
Whereas the B-mode criteria such as echogenoity, borderline and homogenecity, and the spectral Doppler analysis were not useful for differentiation between malignant and benign lesions, the analysis of the intratumorously visible number of vessels and of the ratio of the vascularized area using a special software, especially after injection of the signal enhancing agent, provided valuable information. In 10 of 18 benign but only in 1 of 22 malignant lesions, no intratumorous vessels were visible after application of Levovist (plain: 10/18 benign and 6/22 malignant lesions). The number of visible vessels increased strongly after signal enhancement. Using a "ratio of the vascularized area (percentage vessel area) > 5%" as a criterion of malignancy, 2 false positive and 2 false negative results were observed after application of Levovist (without/with Levovist sensitivity 73%/91%, specificity 89%/89%).
The signal-enhanced color Doppler sonography provides useful additional information for the differentiation between benign and malignant cutis-involving lesions, especially the semiquantitative vascularization analysis. The latter is superior to B-mode ultrasound and to spectral Doppler analysis. The signal enhancer increases the sensitivity, whereas the specificity remains unchanged.
前瞻性评估普通及信号增强彩色多普勒超声对累及皮肤的良恶性病变的诊断结果。
39例患者共40处疑似恶性皮肤病变，在静脉注射4g 声诺维前后接受术前超声检查。进行频谱多普勒、传统彩色及能量多普勒检查。使用专门开发的软件对图像进行半定量分析。诊断通过组织学分析（37例）或随访对照（3例）得以证实。
B 模式标准如回声性、边界及均匀性，以及频谱多普勒分析对良恶性病变的鉴别无用，而使用特殊软件分析瘤内可见血管数量及血管化面积比例，尤其是在注射信号增强剂后，可提供有价值的信息。注射声诺维后，18处良性病变中有10处未见瘤内血管，而22处恶性病变中仅1处未见（普通检查时：18处良性病变中有10处，22处恶性病变中有6处）。信号增强后可见血管数量显著增加。以“血管化面积比例（血管面积百分比）>5%”作为恶性标准，注射声诺维后观察到2例假阳性和2例假阴性结果（未注射/注射声诺维时敏感性73%/91%，特异性分别为89%/89%）。
信号增强彩色多普勒超声为累及皮肤的良恶性病变的鉴别提供了有用的额外信息，尤其是半定量血管化分析。后者优于B 模式超声和频谱多普勒分析。信号增强剂提高了敏感性，而特异性保持不变。
