Hu Wenjie, Dong Yi, Zhang Xuemei, Zhang Huiping, Li Fan, Bai Min
Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Clin Hemorheol Microcirc. 2020;75(3):369-382. doi: 10.3233/CH-200826.
To evaluate the clinical value of Arrival-time Parametric Imaging (At-PI) in the differentiation of benign and malignant breast lesions.
For this ethics committee-approved retrospective study, a total of 184 breast lesions in 176 women were included and gray-scale ultrasound, contrast-enhanced ultrasound (CEUS) and At-PI were performed. In CEUS and At-PI, perfusion patterns, perfusion uniformity and color spatial distribution for lesions were analyzed qualitatively and the maximal diameter ratio of the lesion in accumulated parametric images and that in gray-scale images (MDRAI/GI) and area ratio of the lesion in accumuated parametric images and that in gray-scale images (ARAI/GI) were calculated quantitatively. Kappa and Intraclass Correlation Coefficient were used to evaluate the interobserver reproducibility for CEUS and At-PI and the intraobserver reproducibility for At-PI, respectively. The area under receiver operating characteristic (AUC), sensitivity, specificity, accuracy and positive and negative likelihood ratios (PPV, NPV) were calculated for MDRAI/GI and ARAI/GI.
Good interobserver and intraobserver reproducibility for At-PI were identified. In At-PI, there were statistically significant differences in perfusion patterns, color spatial distribution, MDRAI/GI and ARAI/GI between benign and malignant breast lesions (P < 0.05). The AUCs of MDRAI/GI and ARAI/GI were 0.895 and 0.954, respectively, with no significant difference between them (Z = 1.84, P > 0.05). By using the thresholds of 1.125 for MDRAI/GI and 1.21 for ARAI/GI, the sensitivity, specificity, accuracy, PPV and NPV of At-PI were 84.48%, 88.24%, 85.57%, 92.45% and 76.92%, respectively, for MDRAI/GI and 93.10%, 91.18%, 92.39%, 94.74% and 88.57%, respectively, for ARAI/GI.
At-PI is helpful to distinguish benign from malignant breast lesions. And MDRAI/GI and ARAI/GI are useful and efficient features for differential diagnosis.
评估达峰时间参数成像（At-PI）在鉴别乳腺良恶性病变中的临床价值。
本研究经伦理委员会批准，为回顾性研究，共纳入176例女性的184个乳腺病变，均行灰阶超声、超声造影（CEUS）及At-PI检查。在CEUS和At-PI检查中，对病变的灌注模式、灌注均匀性及彩色空间分布进行定性分析，并定量计算累积参数图像中病变的最大直径与灰阶图像中病变最大直径的比值（MDRAI/GI）以及累积参数图像中病变面积与灰阶图像中病变面积的比值（ARAI/GI）。分别采用Kappa检验和组内相关系数评估CEUS和At-PI的观察者间重复性以及At-PI的观察者内重复性。计算MDRAI/GI和ARAI/GI的受试者操作特征曲线下面积（AUC）、敏感性、特异性、准确性以及阳性和阴性似然比（PPV、NPV）。
At-PI具有良好的观察者间和观察者内重复性。在At-PI检查中，乳腺良恶性病变在灌注模式、彩色空间分布、MDRAI/GI及ARAI/GI方面存在统计学差异（P<0.05）。MDRAI/GI和ARAI/GI的AUC分别为0.895和0.954，两者无显著差异（Z=1.84，P>0.05）。以MDRAI/GI阈值1.125和ARAI/GI阈值1.21进行判断，At-PI对于MDRAI/GI的敏感性、特异性、准确性、PPV及NPV分别为84.48%、88.24%、85.57%、92.45%及76.92%，对于ARAI/GI分别为93.10%、91.18%、92.39%、94.74%及88.57%。
At-PI有助于鉴别乳腺良恶性病变。MDRAI/GI和ARAI/GI是鉴别诊断的有用且有效的特征。
