Jia Wan-Ru, Chai Wei-Min, Tang Lei, Wang Yi, Fei Xiao-Chun, Han Bao-San, Chen Man
Department of Diagnostic Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, No. 197 Rui Jin 2nd Road, Shanghai 200025, China.
Department of Radiology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, No. 197 Rui Jin 2nd Road, Shanghai 200025, China.
Eur J Radiol. 2014 Jul;83(7):1098-1105. doi: 10.1016/j.ejrad.2014.03.027. Epub 2014 Apr 12.
To explore the clinical value of three-dimensional contrast enhanced ultrasound (3D-CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) score systems in evaluating breast tumor angiogenesis by comparing their diagnostic efficacy and correlation with biological factors.
3D-CEUS was performed in 183 patients with breast tumors by Esaote Mylab90 with SonoVue (Bracco, Italy), DCE-MRI was performed on a dedicated breast magnetic resonance imaging (DBMRI) system (Aurora Dedicated Breast MRI Systems, USA) with a dedicated breast coil. 3D-CEUS and DCE-MRI score systems were created based on tumor perfusion and vascular characteristics. Microvessel density (MVD), vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMP-2, MMP-9) expression were measured by immunohistochemistry.
Pathological results showed 35 benign and 148 malignant breast tumors. MVD (P=0.000, r=0.76), VEGF (P=0.000, r=0.55), MMP-2 (P=0.000, r=0.39) and MMP-9 (P=0.000, r=0.41) expression were all significantly different between benignity and malignancy. Regarding 3D-CEUS 4 points as cutoff value, the sensitivity, specificity and accuracy were 85.1%, 94.3% and 86.9%, respectively, and correlated well with MVD (P=0.000, r=0.50), VEGF (P=0.000, r=0.50), MMP-2 (P=0.000, r=0.50) and MMP-9 (P=0.000, r=0.66). Taking DCE-MRI 5 points as cutoff value, the sensitivity, specificity and accuracy were 86.5%, 94.3% and 88.0%, respectively and also correlated well with MVD (P=0.000, r=0.52), VEGF (P=0.000, r=0.44), MMP-2 (P=0.000, r=0.42) and MMP-9 (P=0.000, r=0.35).
3D-CEUS score system displays inspiring diagnostic performance and good agreement with DCE-MRI scoring. Moreover, both score systems correlate well with MVD, VEGF, MMP-2 and MMP-9 expression, and thus have great potentials in tumor angiogenesis evaluation.
通过比较三维对比增强超声（3D-CEUS）和动态对比增强磁共振成像（DCE-MRI）评分系统在评估乳腺肿瘤血管生成方面的诊断效能及其与生物学因素的相关性，探讨其临床价值。
采用意大利百胜公司的Esaote Mylab90超声诊断仪及声诺维（意大利Bracco公司）对183例乳腺肿瘤患者进行3D-CEUS检查，采用美国Aurora专用乳腺磁共振成像系统及专用乳腺线圈对患者进行DCE-MRI检查。基于肿瘤灌注和血管特征建立3D-CEUS和DCE-MRI评分系统。采用免疫组织化学法检测微血管密度（MVD）、血管内皮生长因子（VEGF）及基质金属蛋白酶（MMP-2、MMP-9）的表达。
病理结果显示35例乳腺良性肿瘤和148例乳腺恶性肿瘤。良性和恶性肿瘤之间MVD（P = 0.000，r = 0.76）、VEGF（P = 0.000，r = 0.55）、MMP-2（P = 0.000，r = 0.39）和MMP-9（P = 0.000，r = 0.41）的表达均有显著差异。以3D-CEUS 4分为临界值，其敏感性、特异性和准确性分别为85.1%、94.3%和86.9%，与MVD（P = 0.000，r = 0.50）、VEGF（P = 0.000，r = 0.50）、MMP-2（P = 0.000，r = 0.50）和MMP-9（P = 0.000，r = 0.66）相关性良好。以DCE-MRI 5分为临界值，其敏感性、特异性和准确性分别为86.5%、94.3%和88.0%，与MVD（P = 0.000，r = 0.52）、VEGF（P = 0.000，r = 0.44）、MMP-2（P = 0.000，r = 0.42）和MMP-9（P = 0.000，r = 0.35）也具有良好相关性。
3D-CEUS评分系统显示出令人鼓舞的诊断性能，与DCE-MRI评分具有良好的一致性。此外，两种评分系统均与MVD、VEGF、MMP-2和MMP-9表达具有良好相关性，因此在肿瘤血管生成评估方面具有巨大潜力。
