Forsberg Flemming, Kuruvilla Babita, Pascua Mark B, Chaudhari Manisha H, Merton Daniel A, Palazzo Juan P, Goldberg Barry B
Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
Ultrasound Med Biol. 2008 Sep;34(9):1365-72. doi: 10.1016/j.ultrasmedbio.2008.02.010. Epub 2008 Apr 24.
This study was conducted to compare quantifiable measures of vascularity obtained from contrast-enhanced color flow images of breast lesions to pathologic vascularity measurements. Nineteen patients with solid breast masses received Levovist Injection (10 mL at 300 mg/mL; Berlex Laboratories, Montville, NJ, USA). Color flow images of the mass pre and post contrast were obtained using an HDI 3000 scanner (Philips Medical Systems, Bothell, WA, USA) optimized for clinical scanning on an individual basis. After surgical removal, specimens were sectioned in the same planes as the ultrasound images and stained with an endothelial cell marker (CD31). Microvessel area (MVA) and intratumoral microvessel density (MVD) were determined for vessels 10-19 microm, 20-29 microm, 30-39 microm, 40-49 microm and > or =50 microm in diameter using a microscope and image processing software. From the ultrasound images, the number of color pixels before and after contrast administration relative to the total area of the breast mass was calculated as a first-order measure of fractional tumor vascularity. Vascularity measures were compared using reverse stepwise multiple linear regression analysis. In total, 58 pathology slides (with 8,106 frames) and 185 ultrasound images were analyzed. There was a significant increase in flow visualization pre to post Levovist injection (p = 0.001), but no differences were found between the 11 benign and the eight malignant lesions (p > 0.35). Ultrasound vascularity measurements post contrast correlated significantly with pathology (0.15 < or = r2 < or = 0.46; p < 0.03). The 30-39 microm vessel range contributed most significantly to the MVD relationship (p < 0.001), whereas the MVA was mainly influenced by vessels 20-29 microm (p < 0.004). Precontrast ultrasound only correlated with pathology for relative MVA (r2 = 0.16; p = 0.01). In conclusion, contrast-enhanced color flow imaging provides a noninvasive measure of breast tumor neovascularity, corresponding mainly to vessels 20-39 microm in diameter, when used in a typical clinical setting.
本研究旨在比较从乳腺病变的对比增强彩色血流图像获得的可量化血管指标与病理血管测量结果。19例患有实性乳腺肿块的患者接受了Levovist注射（300mg/mL，10mL；美国新泽西州蒙特维尔市贝林实验室）。使用针对个体临床扫描进行优化的HDI 3000扫描仪（美国华盛顿州博塞尔市飞利浦医疗系统公司）获取肿块在注射造影剂前后的彩色血流图像。手术切除后，将标本切成与超声图像相同的平面，并用内皮细胞标记物（CD31）染色。使用显微镜和图像处理软件确定直径为10 - 19微米、20 - 29微米、30 - 39微米、40 - 49微米和≥50微米的血管的微血管面积（MVA）和瘤内微血管密度（MVD）。从超声图像中，计算注射造影剂前后相对于乳腺肿块总面积的彩色像素数量，作为肿瘤血管分数的一级测量指标。使用反向逐步多元线性回归分析比较血管测量指标。总共分析了58张病理切片（8106帧）和185幅超声图像。注射Levovist后血流可视化有显著增加（p = 0.001），但在11个良性病变和8个恶性病变之间未发现差异（p > 0.35）。注射造影剂后的超声血管测量与病理结果显著相关（0.15≤r2≤0.46；p < 0.03）。30 - 39微米血管范围对MVD关系的贡献最为显著（p < 0.001），而MVA主要受20 - 29微米血管的影响（p < 0.004）。仅注射造影剂前的超声与相对MVA的病理结果相关（r2 = 0.16；p = 0.01）。总之，在典型临床环境中使用时，对比增强彩色血流成像提供了一种乳腺肿瘤新生血管的非侵入性测量方法，主要对应于直径为20 - 39微米的血管。
