Ricci P, Cantisani V, Ballesio L, Pagliara E, Sallusti E, Drudi F M, Trippa F, Calascibetta F, Erturk S M, Modesti M, Passariello R
Dipartimento di Scienze Radiologiche, Università di Roma "La Sapienza", Roma, Italy.
Ultraschall Med. 2007 Feb;28(1):57-62. doi: 10.1055/s-2006-927226.
To assess the efficacy of low mechanical index (MI) real time grey scale contrast-enhanced US (CEUS) in the differentiation of breast lesions in comparison to Magnetic Resonance Imaging (MRI).
50 lesions previously detected at mammography or conventional US were evaluated by means of CEUS and MRI. Contrast-enhanced examinations were performed with a dedicated equipment (Esatune, Esaote, Genoa, Italy), before and after injection of 4.8 ml of Sonovue (Bracco, Milan, Italy). MRI was conducted with a 1.5 T equipment (Siemens Vision Plus, Erlangen, Germany) with bilateral dedicated superficial coil, on T2w STIR and 3D Flash T1w before and 1, 2, 3, 4, 5 minutes after the administration of contrast agent (Gd-DTPA, 1.5 ml/kg). Wash-in and wash-out curves were assessed for both procedures. A specific sonographic quantification software (Qontrast, Bracco, Milan, Italy), based on pixel by pixel signal intensity over time, was used to obtain contrast-enhanced sonographic perfusion maps for each lesion. Mc Nemar test was then calculated.
24 invasive ductal carcinomas, 18 fibroadenomas, 4 fibro-cystic dysplasias, 1 mucinous carcinoma, 1 invasive ducto-lobular carcinoma, 1 intraductal florid papillomatosis and 1 phylloides tumour were diagnosed. Contrast-enhanced sonographic patterns correlated well with those provided by MRI. Sensitivity, specificity, and accuracy of US were: 69.2 %, 66.7 %, and 68 %, respectively. According to the different contrast enhancement patterns and the resulting perfusion maps, all the malignant lesions and 9 out of 12 benign lesions were correctly diagnosed, thus resulting in 87.5 % of specificity and 100 % of sensitivity. Regarding the specificity, there is no difference between US and CEUS with McNemar (p = 0.18). Regarding sensitivity, the difference between contrast-enhanced US and US is significant as calculated with McNemar test (p = 0.013). The three lesions which were incorrectly classified as malignant were two hypervascularised fibroadenomas in young women and a phylloides tumour.
CEUS seems to be a reliable method to differentiate breast lesions, since it provides typical enhancement patterns. Contrast sonographic perfusion curves correlate well with MRI wash in--wash out curves.
评估低机械指数（MI）实时灰阶超声造影（CEUS）与磁共振成像（MRI）相比在鉴别乳腺病变中的效能。
对50个先前在乳腺X线摄影或传统超声检查中发现的病变进行CEUS和MRI评估。使用专用设备（Esatune，意大利热那亚的百胜公司）在注射4.8毫升声诺维（意大利米兰的博莱科公司）前后进行超声造影检查。MRI采用1.5T设备（德国埃尔兰根的西门子Vision Plus）及双侧专用浅表线圈，在注射造影剂（钆喷酸葡胺，1.5毫升/千克）前、后1、2、3、4、5分钟进行T2加权脂肪抑制成像（STIR）和三维快速扰相梯度回波T1加权成像。对两种检查方法均评估其增强及消退曲线。使用基于逐像素信号强度随时间变化的特定超声量化软件（Qontrast，意大利米兰的博莱科公司）获取每个病变的超声造影灌注图。然后计算McNemar检验。
诊断出24例浸润性导管癌、18例纤维腺瘤、4例纤维囊性增生、1例黏液癌、1例浸润性导管小叶癌、1例导管内乳头状瘤病及1例叶状肿瘤。超声造影模式与MRI提供的模式相关性良好。超声的敏感性、特异性和准确性分别为69.2%、66.7%和68%。根据不同的增强模式及所得灌注图，所有恶性病变及12例良性病变中的9例被正确诊断，特异性为87.5%，敏感性为100%。关于特异性，超声与CEUS经McNemar检验无差异（p = 0.18）。关于敏感性，经McNemar检验计算，超声造影与普通超声之间的差异有统计学意义（p = 0.013）。被错误分类为恶性的3个病变为2例年轻女性的高血管化纤维腺瘤和1例叶状肿瘤。
CEUS似乎是鉴别乳腺病变的可靠方法，因为它能提供典型的增强模式。超声造影灌注曲线与MRI增强及消退曲线相关性良好。
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