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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） ›› 2020, Vol. 17 ›› Issue (01) : 33 -38. doi: 10.3877/cma.j.issn.1672-6448.2020.01.007

所属专题： 乳腺超声； 文献；

浅表器官超声影像学

超声与磁共振融合虚拟导航技术在乳腺病变定位中的初步研究
戚瑞祥1, 方建华1, 朱罗茜1, 单嫣娜2, 王炜1, 项晶晶3, 包凌云1,†()   
  1. 1. 310006　浙江大学医学院附属杭州市第一人民医院超声影像科
    2. 310006　浙江大学医学院附属杭州市第一人民医院放射科
    3. 310006　浙江大学医学院附属杭州市第一人民医院病理科
  • 收稿日期:2019-09-07 出版日期:2020-01-01
  • 通信作者: 包凌云
  • 基金资助:
    浙江省医药卫生科技计划项目(2019PY061)

Localization of breast lesions using magnetic resonance imaging/ultrasound image fusion virtual navigation technology: a preliminary study

RuiXiang Qi1, Jianhua Fang1, Luoxi Zhu1, Yanna Shan2, Wei Wang1, Jingjing Xiang3, Lingyun Bao1,†()   

  1. 1. Department of Ultrasound, Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
    2. Department of Radiology, Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
    3. Department of Pathology, Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
  • Received:2019-09-07 Published:2020-01-01
  • Corresponding author: Lingyun Bao
  • About author:
    Corresponding author: Bao Lingyun, Email:
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引用本文：

戚瑞祥, 方建华, 朱罗茜, 单嫣娜, 王炜, 项晶晶, 包凌云. 超声与磁共振融合虚拟导航技术在乳腺病变定位中的初步研究[J]. 中华医学超声杂志（电子版）, 2020, 17(01): 33-38.

RuiXiang Qi, Jianhua Fang, Luoxi Zhu, Yanna Shan, Wei Wang, Jingjing Xiang, Lingyun Bao. Localization of breast lesions using magnetic resonance imaging/ultrasound image fusion virtual navigation technology: a preliminary study[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(01): 33-38.

目的

探讨超声融合磁共振成像（MRI）虚拟导航技术对仅MRI发现的乳腺病变定位的临床价值。

方法

选取2016年6月至2018年12月于浙江大学医学院附属杭州市第一人民医院就诊的21例患者，均行超声及乳腺MRI检查，MRI发现22个超声上未显示的病灶且乳腺影像报告与数据系统（BI-RADS）评估为4类及以上，在俯卧位下行超声与MRI融合虚拟导航下定位，分别对病灶进行穿刺活检或定位后手术切除，与病理结果相对照，以及MRI术前/后对比，统计病变检出率，并分析此类病变的MRI特征及病理类型。

结果

22个病灶中共计20个在虚拟导航下完成定位，检出率为91%。术后病理显示18个（90%）为良性病变，2个（10%）为恶性病变。22个病变中，MRI显示20个（91%）为非肿块样强化，仅2个（9%）为肿块型强化。

结论

超声融合MRI虚拟导航可以有效提高超声隐匿性乳腺病变的检出率，通过超声引导下穿刺活检具有实时、便捷等特点，可在临床推广应用。

关键词: 虚拟导航, 乳腺病变, 磁共振成像, 超声检查
Objective

The purpose of our study was to evaluate the clinical utility of virtual navigation for magnetic resonance imaging (MRI)-detected incidental breast lesions.

Methods

Between June 2016 and December 2018, 21 consecutive patients with 22 BI-RADS category 4 or above lesions that were detected on MRI but occult on second-look ultrasound (US) were enrolled in the study. All suspicious lesions were localized by using US/MRI fusion virtual navigation, and then underwent US-guided biopsy or surgical excision. The detection rate was calculated by comparing pre-/post-operation MRI and pathological results. The MRI features and pathological types of these lesions were analyzed.

Results

A total of 20 lesions were successfully localized using virtual navigation and underwent US-guided biopsy or localization, and the detection rate of virtual navigation was 91%. Eighteen (90%) lesions were proved to be benign lesions, and two (10%) proved to be malignant lesions by pathology. Of the 22 MRI-detected lesions, 20 (91%) manifested as non-mass enhancements and only two (9%) were masses.

Conclusion

Real-time US/MRI fusion virtual navigation can be an effective method for the evaluation of MRI-detected lesions that are not visible on US.

Key words: Virtual navigation, Breast lesion, Magnetic resonance imaging, Ultrasonography
图1 乳腺超声虚拟导航用俯卧位定位架示意图
图2 超声融合磁共振成像虚拟导航。首先对乳头轴位进行平行平面融合匹配，然后对齐乳房轮廓及其他内部解剖标识（图a），适度旋转MRI图像并根据三维重建图像在实时超声图像上寻找相对应的可疑病灶（图b）
图3 44岁女性行虚拟导航下定位及超声引导下定位针标记。图a为动态对比增强磁共振成像图示右乳外上象限不均匀强化灶（白色箭头所示）；图b为虚拟导航定位与磁共振成像相对应的可疑病灶后，在超声引导下定位针标记（红色箭头示穿刺针）；图c为区段切除术后磁共振成像随访示病灶消失；图d为病理结果为硬化性腺病改变，伴导管上皮增生（HE ×100）
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