Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China.
Eur J Radiol. 2012 Nov;81(11):2936-42. doi: 10.1016/j.ejrad.2011.12.024. Epub 2012 Jan 18.
The purpose of this study was to evaluate the effectiveness of three-dimensional contrast-enhanced ultrasound in differentiating invasive and noninvasive neoplasms of urinary bladder.
A total of 60 lesions in 60 consecutive patients with bladder tumors received three dimensional ultrasonography, low acoustic power contrast enhanced ultrasonography and low acoustic power three-dimensional contrast-enhanced ultrasound examination. The IU22 ultrasound scanner and a volume transducer were used and the ultrasound contrast agent was SonoVue. The contrast-specific sonographic imaging modes were PI (pulse inversion) and PM (power modulation). The three dimensional ultrasonography, contrast enhanced ultrasonography, and three-dimensional contrast-enhanced ultrasound images were independently reviewed by two readers who were not in the images acquisition. Images were analyzed off-site. A level of confidence in the diagnosis of tumor invasion of the muscle layer was assigned on a 5° scale. Receiver operating characteristic analysis was used to assess overall confidence in the diagnosis of muscle invasion by tumor. Kappa values were used to assess inter-readers agreement. Histologic diagnosis was obtained for all patients.
Final pathologic staging revealed 44 noninvasive tumors and 16 invasive tumors. Three-dimensional contrast-enhanced ultrasound depicted all 16 muscle-invasive tumors. The diagnostic performance of three-dimensional contrast-enhanced ultrasound was better than those of three dimensional ultrasonography and contrast enhanced ultrasonography. The receiver operating characteristic curves were 0.976 and 0.967 for three-dimensional contrast-enhanced ultrasound, those for three dimensional ultrasonography were 0.881 and 0.869, those for contrast enhanced ultrasonography were 0.927 and 0.929. The kappa values in the three dimensional ultrasonography, contrast enhanced ultrasonography and three-dimensional contrast-enhanced ultrasound for inter-reader agreements were 0.717, 0.794 and 0.914.
Three-dimensional contrast-enhanced ultrasound imaging, with contrast-enhanced spatial visualization is clinical useful for differentiating invasive and noninvasive neoplasms of urinary bladder objectively.
本研究旨在评估三维对比增强超声在鉴别膀胱浸润性和非浸润性肿瘤中的有效性。
对 60 例膀胱癌患者的 60 个病灶进行了三维超声、低机械指数超声造影和低机械指数三维对比增强超声检查。使用 IU22 超声扫描仪和容积探头，超声造影剂为 SonoVue。对比特异性超声成像模式为 PI（脉冲反转）和 PM（功率调制）。两位未参与图像采集的读者独立对三维超声、超声造影和三维对比增强超声图像进行了回顾性分析。图像在脱机状态下进行分析。根据肿瘤侵犯肌层的诊断置信度对图像进行 5 级评分。使用受试者工作特征分析评估对肿瘤侵犯肌层的整体诊断置信度。使用 Kappa 值评估两位读者间的一致性。所有患者均获得组织学诊断。
最终病理分期显示 44 例非浸润性肿瘤和 16 例浸润性肿瘤。三维对比增强超声能清晰显示所有 16 例肌层浸润性肿瘤。三维对比增强超声的诊断性能优于三维超声和超声造影。受试者工作特征曲线的曲线下面积（AUC）分别为 0.976、0.967、0.881 和 0.869。三位读者间在三维超声、超声造影和三维对比增强超声的κ 值分别为 0.717、0.794 和 0.914。
三维对比增强超声成像具有增强的空间可视化功能，客观上有助于鉴别膀胱浸润性和非浸润性肿瘤。
