3D 谐波及亚谐波成像在乳腺病灶特征分析中的应用：一项多中心临床试验。
3D Harmonic and Subharmonic Imaging for Characterizing Breast Lesions: A Multi-Center Clinical Trial.
机构信息
Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
South Jersey Radiology, Voorhees, NJ, USA.
出版信息
J Ultrasound Med. 2022 Jul;41(7):1667-1675. doi: 10.1002/jum.15848. Epub 2021 Oct 25.
OBJECTIVE
Breast cancer is the most frequent type of cancer among women. This multi-center study assessed the ability of 3D contrast-enhanced ultrasound to characterize suspicious breast lesions using clinical assessments and quantitative parameters.
METHODS
Women with suspicious breast lesions scheduled for biopsy were enrolled in this prospective, study. Following 2D grayscale ultrasound and power Doppler imaging (PDI), a contrast agent (Definity; Lantheus) was administrated. Contrast-enhanced 3D harmonic imaging (HI; transmitting/receiving at 5.0/10.0 MHz), as well as 3D subharmonic imaging (SHI; transmitting/receiving at 5.8/2.9 MHz), were performed using a modified Logiq 9 scanner (GE Healthcare). Five radiologists independently scored the imaging modes (including standard-of-care imaging) using a 7-point BIRADS scale as well as lesion vascularity and diagnostic confidence. Parametric volumes were constructed from time-intensity curves for vascular heterogeneity, perfusion, and area under the curve. Diagnostic accuracy was determined relative to pathology using receiver operating characteristic (ROC) and reverse, step-wise logistical regression analyses. The κ-statistic was calculated for inter-reader agreement.
RESULTS
Data were successfully acquired in 219 cases and biopsies indicated 164 (75%) benign and 55 (25%) malignant lesions. SHI depicted more anastomoses and vascularity than HI (P < .021), but there were no differences by pathology (P > .27). Ultrasound achieved accuracies of 82 to 85%, which was significantly better than standard-of-care imaging (72%; P < .03). SHI increased diagnostic confidence by 3 to 6% (P < .05), but inter-reader agreements were medium to low (κ < 0.52). The best regression model achieved 97% accuracy by combining clinical reads and parametric SHI.
CONCLUSIONS
Combining quantitative 3D SHI parameters and clinical assessments improves the characterization of suspicious breast lesions.
目的
乳腺癌是女性最常见的癌症类型。这项多中心研究评估了三维对比增强超声通过临床评估和定量参数对可疑乳腺病变进行特征描述的能力。
方法
本前瞻性研究纳入了计划进行活检的可疑乳腺病变女性患者。在进行二维灰阶超声和能量多普勒成像（PDI）后，给予对比剂（Definity；Lantheus）。使用改良的 Logiq 9 扫描仪（GE Healthcare）进行三维谐波成像（HI；发射/接收频率为 5.0/10.0 MHz）和三维次谐波成像（SHI；发射/接收频率为 5.8/2.9 MHz）。五位放射科医生使用 7 分 BIRADS 评分以及病变血管生成和诊断信心，对成像模式（包括标准护理成像）进行独立评分。从时间-强度曲线构建血管异质性、灌注和曲线下面积的参数容积。使用接收者操作特征（ROC）和反向逐步逻辑回归分析，根据病理确定诊断准确性。计算了组内读者间的κ统计量。
结果
219 例病例成功采集数据，活检显示 164 例（75%）为良性，55 例（25%）为恶性病变。SHI 比 HI 显示更多的吻合和血管生成（P <.021），但与病理无差异（P >.27）。超声的准确率为 82%至 85%，明显优于标准护理成像（72%；P <.03）。SHI 提高了 3%至 6%的诊断信心（P <.05），但读者间的一致性为中等至低（κ < 0.52）。通过结合临床阅读和参数 SHI，最佳回归模型达到了 97%的准确率。
结论
结合定量 3D SHI 参数和临床评估可改善可疑乳腺病变的特征描述。
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