Zhang Xiuwen, Cheng Fangyuan, Song Xingjun, Wang Peng, Tian Shuangyan, Zhao Xiaopei, Wang Qing, Zhang Mei
School of Biomedical Engineering, Southern Medical University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.
Quant Imaging Med Surg. 2023 Oct 1;13(10):7029-7040. doi: 10.21037/qims-23-136. Epub 2023 Sep 22.
Neovascularity visualization in breast nodules is challenging due to the limitations of conventional Doppler imaging methods. This study aims to assess the performance of superb microvascular imaging (SMI) in evaluating the microvascularity of breast nodules (diameter ≤2 cm). The comparison of performances of SMI with color Doppler flow imaging (CDFI) and power Doppler imaging (PDI) was made by using a three-factor scoring system of vascularity. This study also investigated the common features of microvascularity in small malignant nodules on SMI for early differentiating from benign nodules.
Ninety-one female patients (with 125 breast nodules) were enrolled in this retrospective study. All the breast nodules were examined by grayscale ultrasonography (US), CDFI, PDI, and SMI. The number, morphologic features, and distribution of blood vessels were scored to evaluate the nodular vascularity in light of the three-factor scoring system. The diagnostic value of SMI for microvascularity in breast nodules was analyzed and compared with CDFI and PDI.
Histological analysis showed 53 malignant and 72 benign nodules. The vascularity grades detected by SMI were significantly different from those of CDFI and PDI (P<0.05). SMI detected 47 grade-IV nodules of the total 125 nodules (37.6%), which was more than those detected by CDFI (10.4%, 13/125) and PDI (12.8%, 16/125), while more grade-I nodules were detected by CDFI (42.4%, 53/125) and PDI (36.8%, 46/125) compared with SMI (21.6%, 27/125). Differences in the vessel number, morphologic features, and distribution between benign and malignant breast nodules were significant on SMI (P<0.05). The vessel number ≥6, penetrating vessels, and a mixed distribution of vessels in peripheral and central nodular tissues were the common features of microvascularity in the grade-IV malignant nodules on SMI, whereas the blood vessels in the benign nodules were straight and branching and peripherally distributed.
In comparison with CDFI and PDI, SMI enhances microvascularity detection, depicts the microvascular architecture in breast nodules and has potential in the differential diagnosis of malignant nodules from benign nodules.
由于传统多普勒成像方法的局限性，乳腺结节中的新生血管可视化具有挑战性。本研究旨在评估超微血管成像（SMI）在评估直径≤2 cm的乳腺结节微血管方面的性能。通过使用血管三因素评分系统，对SMI与彩色多普勒血流成像（CDFI）和能量多普勒成像（PDI）的性能进行了比较。本研究还探讨了SMI上小恶性结节微血管的共同特征，以便早期与良性结节进行鉴别。
91例女性患者（共125个乳腺结节）纳入本回顾性研究。所有乳腺结节均接受了灰阶超声（US）、CDFI、PDI和SMI检查。根据三因素评分系统对血管的数量、形态特征和分布进行评分，以评估结节的血管情况。分析了SMI对乳腺结节微血管的诊断价值，并与CDFI和PDI进行比较。
组织学分析显示有53个恶性结节和72个良性结节。SMI检测到的血管分级与CDFI和PDI的血管分级有显著差异（P<0.05）。在总共125个结节中，SMI检测到47个IV级结节（37.6%），多于CDFI（10.4%，13/125）和PDI（12.8%，16/125）检测到的数量，而与SMI（21.6%，27/125）相比，CDFI（42.4%，53/125）和PDI（36.8%，46/125）检测到更多的I级结节。SMI上良性和恶性乳腺结节在血管数量、形态特征和分布上的差异具有统计学意义（P<0.05）。血管数量≥6、穿入血管以及结节外周和中央组织中血管的混合分布是SMI上IV级恶性结节微血管的共同特征，而良性结节中的血管则是笔直、分支且呈外周分布。
与CDFI和PDI相比，SMI增强了微血管检测能力，描绘了乳腺结节中的微血管结构，在恶性结节与良性结节的鉴别诊断中具有潜力。
