Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
J Ultrasound Med. 2010 Aug;29(8):1177-85. doi: 10.7863/jum.2010.29.8.1177.
The purpose of this study was to test the efficacy of static and dynamic cumulative maximum intensity (CMI) subharmonic imaging (SHI) in breast ultrasound studies.
Contrast-enhanced SHI was performed in 14 women using a modified LOGIQ 9 scanner (GE Healthcare, Milwaukee, WI) transmitting/receiving at 4.4/2.2 MHz. Following mammography, baseline scans of gray scale ultrasound and power Doppler imaging (PDI) were performed. Contrast-enhanced PDI and gray scale SHI were performed after contrast agent administration. Static CMI-SHI is a composite image summarizing blood flow over multiple frames using the maximum intensity projection technique. The dynamic CMI-SHI mode depicts the gradual inflow pattern of the contrast agent in blood vessels. Both CMI-SHI modes were set up using a new automated sum-absolute-difference-based block-matching algorithm to reduce noise and blurring and compensate for motion artifacts. Evaluation of the imaging modes for detecting breast cancer was done by an experienced radiologist, blinded to histopathologic findings. Sensitivity, specificity, and receiver operating characteristic (ROC) analyses were computed and compared for all ultrasound imaging modes and mammography. Results Of the 16 lesions, 4 were malignant. The area under the ROC curve (A(z)) for the diagnosis of breast cancer was 0.64 for gray scale and PDI, 0.67 for contrast-enhanced PDI, 0.76 for mammography, 0.78 for SHI, and 0.75 for static CMI-SHI. For the dynamic CMI-SHI mode, the A(z) increased to 0.90, and this was significantly better than mammography (P = .03).
The new dynamic CMI-SHI mode produced the highest A(z) for the diagnosis of breast cancer compared to conventional techniques and thus appears to improve diagnosis of breast cancer relative to conventional techniques, albeit based on a limited patient population.
本研究旨在测试静态和动态累积最大强度（CMI）亚谐波成像（SHI）在乳腺超声研究中的功效。
使用改良的 LOGIQ 9 扫描仪（GE Healthcare，密尔沃基，威斯康星州）在 14 名女性中进行对比增强 SHI，发射/接收频率为 4.4/2.2 MHz。在乳房 X 线摄影后，进行灰阶超声和功率多普勒成像（PDI）的基线扫描。在对比剂给药后进行对比增强 PDI 和灰阶 SHI。静态 CMI-SHI 是一种使用最大强度投影技术综合多个帧血流的复合图像。动态 CMI-SHI 模式描绘了对比剂在血管中的逐渐流入模式。这两种 CMI-SHI 模式都使用新的基于自动求和绝对值差的块匹配算法进行设置，以减少噪声和模糊，并补偿运动伪影。由一位经验丰富的放射科医生对成像模式进行评估，该医生对组织病理学发现一无所知。对所有超声成像模式和乳房 X 线摄影进行了检测乳腺癌的敏感性、特异性和受试者工作特征（ROC）分析，并进行了比较。
在 16 个病灶中，有 4 个是恶性的。灰阶和 PDI 的 ROC 曲线下面积（A（z））为 0.64，增强 PDI 为 0.67，乳房 X 线摄影为 0.76，SHI 为 0.78，静态 CMI-SHI 为 0.75。对于动态 CMI-SHI 模式，A（z）增加到 0.90，这明显优于乳房 X 线摄影（P =.03）。
与传统技术相比，新的动态 CMI-SHI 模式在诊断乳腺癌方面产生了最高的 A（z），因此似乎比传统技术更能提高乳腺癌的诊断，尽管基于有限的患者人群。
