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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (12) : 942 -947. doi: 10.3877/cma.j.issn.1672-6448.2016.12.013

所属专题： 乳腺超声； 文献；

浅表器官超声影像学

应变式弹性成像与剪切波弹性成像技术鉴别诊断乳腺良恶性病灶的价值比较
彭晓静1, 李奥1,†(), 叶新华1, 袁涛1   
  1. 1. 210029　南京医科大学第一附属医院超声科
  • 收稿日期:2016-03-08 出版日期:2016-12-01
  • 通信作者: 李奥

Comparison of the diagnostic performances between strain elastography and shear-wave elastography in differentiation of benign and malignant solid breast lesions

Xiaojing Peng1, Ao Li1,†(), Xinhua Ye1, Tao Yuan1   

  1. 1. Department of Ultrasound, the First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
  • Received:2016-03-08 Published:2016-12-01
  • Corresponding author: Ao Li
  • About author:
    Corresponding author: Li Ao, Email:
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彭晓静, 李奥, 叶新华, 袁涛. 应变式弹性成像与剪切波弹性成像技术鉴别诊断乳腺良恶性病灶的价值比较[J]. 中华医学超声杂志（电子版）, 2016, 13(12): 942-947.

Xiaojing Peng, Ao Li, Xinhua Ye, Tao Yuan. Comparison of the diagnostic performances between strain elastography and shear-wave elastography in differentiation of benign and malignant solid breast lesions[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(12): 942-947.

目的

比较应变式弹性成像（SE）与剪切波弹性成像（SWE）技术鉴别诊断乳腺良恶性病灶的价值。

方法

选择2015年1至12月南京医科大学第一附属医院收治的乳腺疾病患者150例共155个乳腺病灶进行SE检查，用改良5分法对病灶进行弹性评分，测量应变率比值（SR）；对病灶进行SWE检查，测量最大弹性模量值Emax、平均弹性模量值Emean、弹性标准差Esd、病灶/脂肪弹性比Eratio。绘制SE、SWE弹性参数鉴别诊断乳腺良恶性病灶构建操作者工作特征（ROC）曲线，计算曲线下面积（AUC）。选取AUC最大的SE及SWE参数，采用McNemar检验比较其鉴别诊断不同乳腺影像报告与数据系统（BI-RADS）分类乳腺良恶性病灶的准确性。

结果

ROC曲线显示，SE参数弹性评分及SR，SWE参数Emax、Emean、Esd及Eratio鉴别诊断乳腺良恶性病灶ROC的AUC分别为0.823、0.810、0.877、0.835、0.881、0.853。ROC的AUC最大的SE、SWE弹性参数分别为弹性评分、Esd。Esd鉴别诊断BI-RADS 4A类乳腺良恶性病灶的准确性高于弹性评分（86.3% vs 64.7%），且差异有统计学意义（χ2=4.639，P<0.05）；Esd鉴别诊断BI-RADS 3类、4B类乳腺良恶性病灶的准确性高于弹性评分，且弹性评分鉴别诊断BI-RADS 4C类及5类乳腺良恶性病灶的准确性高于Esd，但差异均无统计学意义。

结论

SE和SWE技术对乳腺良恶性病灶鉴别诊断均有较高的诊断价值，且价值相当。与BI-RADS分类相结合可以优化弹性成像技术在临床中的选择及应用。

关键词: 乳腺肿瘤, 弹性成像技术, 诊断，鉴别
Objective

To compare the diagnostic performances of strain elastography (SE) and shear-wave elastography (SWE) in differentiating benign and malignant solid breast lesions.

Methods

From January 2015 to December 2015, 150 patients with 155 lesions were examined with SE and SWE respectively in the First Affiliated Hospital with Nanjing Medical University. Elasticity scores on a improved 5-point scale, strain ratio (SR), maximum elasticity (Emax), mean elasticity (Emean), standard deviation of the elasticity (Esd) and the lesion-to-fat elasticity ratio (Eratio) were assessed. The receiver operating characteristic (ROC) curve of SE and SWE parameters were plotted to assess the value in distinguishing benign and malignant breast lesions. The results were compared using the area under the ROC curve (AUC). The accuracy of the parameters with the largest AUC were compared between SE and SWE by McNemar test in different breast imaging reporting and data system (BI-RADS) categories.

Results

The AUC of elasticity scores, SR, Emax, Emean, Esd and Eratio were 0.823, 0.810, 0.877, 0.835, 0.881 and 0.853, respectively. The SE and SWE parameter with the largest AUC were elasticity scores and Esd respectively. The accuracy of Esd was higher than that of elasticity scores (86.3% vs 64.7%) in 4A lesions (2=4.639, P<0.05). There were no significant differences in accuracy in other BI-RADS categories.

Conclusions

Both SE and SWE were helpful for the differentiation of benign and malignant solid breast lesions, and the diagnostic performance of SE and SWE was similar. The optimization of elastography can be achieved by combination with BI-RADS.

Key words: Breast neoplasms, Elasticity imaging techniques, Diagnosis, differential
图3，4 左侧乳腺3点钟方向病灶应变式弹性成像图（图3）与剪切波弹性成像图（图4）。常规超声检查BI-RADS 4A类，弹性评分4分，弹性标准差4.5 kPa。病理结果为腺病瘤
表1 乳腺良恶性病灶SE、SWE弹性参数比较
组别 病灶个数 Emax[kPa，M（QR）] Emean[kPa，M（QR）] Esd[kPa，M（QR）] Eratio[M（QR）] 弹性评分（分，±s） SR[M（QR）]
乳腺良性病灶 97 25.40（20.90~32.85） 14.10（11.25~16.9） 3.90（2.93~5.60） 2.51（1.94~3.34） 2.72±0.78 1.46（1.10~1.70）
乳腺恶性病灶 58 61.50（36.45~135.08） 25.48（17.40~35.19） 11.44（7.28~23.50） 6.77（3.44~12.02） 3.81±0.94 2.08（1.70~2.37）
检验值 ? Z=7.403 Z=6.194 Z=7.134 Z=6.619 t=6.134 Z=4.859
P值 ? <0.01 <0.01 <0.01 <0.01 <0.01 <0.01
表2 弹性评分、Esd鉴别诊断不同BI-RADS分类乳腺良恶性病灶的准确性比较[%（个/个）]
指标 BI-RADS分类
3类（n=41） 4A类（n=51） 4B类（n=19） 4C类（n=21） 5类（n=23）
弹性评分 92.7（38/41） 64.7（33/51） 68.4（13/19） 85.7（18/21） 100（23/23）
Esd 97.5（40/41） 86.3（44/51） 78.9（15/19） 76.2（16/21） 91.3（21/23）
χ2值 0.851 4.639 1.157 1.264 0.648
P值 >0.05 <0.05 >0.05 >0.05 >0.05
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