Iovane A, Midiri M, Caruso G, Princiotta C, Lagalla R
Istituto di Radiologia P. Cignolini, Università degli Studi di Palermo.
Radiol Med. 1997 Dec;94(6):583-90.
Integrated imaging plays a fundamental role in the study of periskeletal soft tissue tumors, for both diagnosis and treatment planning. The steady and progressive technologic progress of color Doppler US equipment now permits the integration of conventional morphostructural parameters with the biofunctional data of lesion flow patterns and relative qualitative features. To assess color Doppler capabilities in differentiating benign from malignant soft tissue tumors, we reviewed the B-mode and color Doppler findings of 43 consecutive patients with a palpable periskeletal soft tissue mass. All patients were examined with a real time unit (Ultramark 9 HDI), with a broadband (5-10 MHz) linear transducer operating at 6.5 MHz for Doppler measurements. The PRF was set at 1500 to 800 Hz with 70% color gain; a 100 Hz wall filter was used. We kept the color box in the area of interest as small as possible to keep the frame rate high; pulsed Doppler studies were performed with a small sample volume and 2000 Hz PRF. The following signs were considered: morphostructural features; the presence/absence of color signals; the (peripheral/internal) site of vascular branches, their caliber and course; the number of afferent vascular poles; resistance index. As a rule, malignant masses tend to differ from benign masses for the presence of multiple vascular afferent branches, especially if they have an irregular pattern and caliber, and for the variability of the resistance index measured in different parts of the same mass. Further examinations, performed with second level imaging (CT and MRI) and microhistologic tests, respectively after biopsy and surgical resection, confirmed the high predictive value of color Doppler US, with only 1 false negative and 2 false positives; color Doppler sensitivity and specificity were 94.7% and 91.6%, respectively, which are higher values than those obtained with US alone (63% and 66.6%). Therefore, we believe that color Doppler US can be systematically applied to the study of periskeletal soft tissue masses, integrating conventional US for the correct selection of the patients to be submitted to second level investigations.
综合成像在骨骼周围软组织肿瘤的研究中，对于诊断和治疗规划都起着至关重要的作用。彩色多普勒超声设备持续且渐进的技术进步，如今使得传统形态结构参数能够与病变血流模式及相关定性特征的生物功能数据相结合。为了评估彩色多普勒在鉴别良性与恶性软组织肿瘤方面的能力，我们回顾了43例连续的可触及骨骼周围软组织肿块患者的B超和彩色多普勒检查结果。所有患者均使用实时超声仪（Ultramark 9 HDI）进行检查，采用宽带（5 - 10 MHz）线性探头，在6.5 MHz频率下进行多普勒测量。脉冲重复频率（PRF）设置为1500至800 Hz，彩色增益为70%；使用100 Hz的壁滤波器。我们将彩色取样框尽可能设置在感兴趣区域，以保持高帧率；脉冲多普勒研究采用小取样容积和2000 Hz的PRF。考虑了以下征象：形态结构特征；彩色信号的有无；血管分支的（外周/内部）位置、管径及走行；传入血管极的数量；阻力指数。通常，恶性肿块与良性肿块的不同之处在于存在多个血管传入分支，尤其是当它们具有不规则的模式和管径时，以及同一肿块不同部位测得的阻力指数的变异性。分别在活检和手术切除后，通过二级成像（CT和MRI）及微观组织学检查进行的进一步检查，证实了彩色多普勒超声的高预测价值，仅有1例假阴性和2例假阳性；彩色多普勒的敏感性和特异性分别为94.7%和91.6%，高于单独使用超声获得的值（63%和66.6%）。因此，我们认为彩色多普勒超声可系统地应用于骨骼周围软组织肿块的研究，结合传统超声以正确选择需要进行二级检查的患者。
