Sohn C, Beldermann F, Frey H, Reinhardt S, Sohn J, Bastert G
Sektion für pränatale und gynäkologische Ultraschalldiagnostik und Therapie Universitätsfrauenklinik Heidelberg.
Radiologe. 1997 Aug;37(8):643-50. doi: 10.1007/s001170050266.
On the assumption that the architecture of blood vessels of malignant tumors, formed by neoangiogenesis, shows characteristics that are different from those of blood vessels of benign tumors or physiological findings, we have tried in the present study to investigate the behavior of these different vessels under increased blood pressure. Using a special stand, the same sonographic section could be stably maintained during an examination time of approx. 4 minutes. Using a new computer program, the color pixels of the employed Angio color technique were quantified and recorded as a function of the measured blood pressure. To increase blood pressure, the patient had to press a hand grip, which practically always caused a systolic blood pressure elevation of more than 15-20 mmHg. Seventy patients with sonographically detected breast tumors were examined; 54 (14 benign and 40 malignant tumors) could be included in the evaluation. We found four typical types of curves: Curve type 1 is associated with an instantaneous increase in blood flow with increased blood pressure, followed by a drop in the blood pressure, with a slow decrease in blood flow as the blood pressure drops (with 29 malignant and 3 benign tumors). Curve type 2 shows a continuous increase in blood flow-though somewhat delayed with respect to the rise in blood pressure-which is also observed when the blood pressure drops (exclusively benign tumors). In curve type 3, maximum blood flow is reached after the blood pressure maximum, and then the blood flow decreases (1 benign and 3 malignant tumors). Curve type 4 features decreased blood flow in spite of increased blood pressure (3 benign and 5 malignant tumors). The described quantification method, in combination with the stand, permits for the first time analysis of a tumor under increased blood pressure as to its blood flow behavior over time in an examination using a challenge test. Here one can find two distinctive curve types (types 1 and 2) that correlate mostly with malignant (type 1) or benign (type 2) breast tumors. Should this tendency be substantiated by additional large-scale studies, it would seem that a new ultrasonic possibility for differential diagnosis has been found.
基于恶性肿瘤血管通过新生血管生成形成的结构显示出与良性肿瘤血管或生理表现不同的特征这一假设，我们在本研究中尝试研究这些不同血管在血压升高时的行为。使用一个特殊的支架，在大约4分钟的检查时间内可以稳定地保持相同的超声切面。使用一个新的计算机程序，对所采用的血管造影彩色技术的彩色像素进行量化，并记录为测量血压的函数。为了升高血压，患者必须挤压一个手柄，这实际上总是导致收缩压升高超过15 - 20 mmHg。对70例超声检测出乳腺肿瘤的患者进行了检查；54例（14例良性肿瘤和40例恶性肿瘤）可纳入评估。我们发现了四种典型的曲线类型：曲线类型1与血压升高时血流立即增加相关，随后血压下降，随着血压下降血流缓慢减少（29例恶性肿瘤和3例良性肿瘤）。曲线类型2显示血流持续增加——尽管相对于血压升高有所延迟——在血压下降时也观察到这种情况（仅为良性肿瘤）。在曲线类型3中，血流在血压达到最大值后达到最大值，然后血流减少（1例良性肿瘤和3例恶性肿瘤）。曲线类型4的特征是尽管血压升高但血流减少（3例良性肿瘤和5例恶性肿瘤）。所描述的量化方法与支架相结合，首次允许在使用激发试验的检查中分析肿瘤在血压升高时随时间的血流行为。在这里可以发现两种独特的曲线类型（类型1和类型2），它们大多与恶性（类型1）或良性（类型2）乳腺肿瘤相关。如果这种趋势能得到更多大规模研究的证实，那么似乎已经发现了一种新的超声鉴别诊断可能性。
