The Comparison Of Contrast-enhanced Ultrasonography And Contrast-enhanced Magnetic Resonance Imaging In Diagnosis Of BI-RADS-US4B Breast Lesions

Part IThe differential diagnostic value of contrast-enhanced ultrasonography in BI-RADS-US4B breast lesionsPurpose:The purpose of our study was to analyze the imaging characteristics of BI-RADS-US4B breast lesions at contrast-enhanced ultrasonography (CEUS) retrospectively, and to assess the value of CEUS in differential diagnosis of these breast lesions.Methods:From February2012to January2013,72female patients with76breast lesions diagnosed BI-RADS4B at conventional ultrasound enrolled in our study. Before the operations, all of these breast lesions underwent CEUS by a Siemens Acuson Sequoia512scanner equipped with a17L5linear array transducer, contrast pulsed sequences(CPS) technique and autotracking contrast quantification(ACQ)software. The frequency we used in the mode of gray-scale US was10MHz, with7MHz in the modes of Doppler and CEUS, respectively. Mechanical index(MI)was set less than0.2. Contrast agent of SonoVue was included, injection dose was2.4ml. All of the CEUS images were analyzed by two investigators with blind method in two aspects:the morphology and time-intensity curve parameters(including AT, TTP, PI), and in the end the CEUS diagnosis were made accoding to our preliminary study.Results:76BI-RADS4B breast lesions were confirmed47malignant and29benign in histopathology. The morphologic features of shape, margin, penetrating or tortuous surrounding vessels, heterogeneous or homogeneous distribution, whether the lesion was significant enlarged after contrast enhanced were quite different between benign and malignant lesions(P<0.05). And the accuracies of penetrating or tortuous surrounding vessels, heterogeneous distribution, irregular shape to diagnose mammary carcinoma were relatively high,81.6%,78.9%and76.3%respectively. But the parameters(including AT, TTP, PI) had no statistical difference between the benign and malignant lesions in our study(P>0.05). According to the CEUS diagnostic criteria of breast lesion from our previous study,51were diagnosed malignant, while25were diagnosed benign. Its sensitivity was91.5%, specificity72.4%, positive predictive value84.3%, negative predictive value84.0%and accuracy84.2%. In all the histologic types of these76breast lesions, the accuracies of invasive ductal carcinoma, fibroadenoma and ductal carcinoma in situ were relatively higher,94.7%,91.7%and86.7%respectively. And inflammation lesions had the lowest accuracy, all of them were misdiagnosed.Conclusion:CEUS could be applied as a useful adjunct to conventional ultfasonography for BI-RADS4B breast lesions. It can improve the diagnostic accuracy of breast lesions preoperatively, especially for invasive ductal carcinoma, fibroadenoma and ductal carcinoma in situ. PartⅡThe comparison of CEUS and contrast-enhanced magnetic resonance imaging in BI-RADS-US4B breast lesionsPurpose:The purpose of our study was to explore the value of CEUS and contrast-enhanced magnetic resonance imaging(CE-MRI) in differential diagnosis of BI-RADS-US4B breast lesions, by comparing the morphology and dynamic parameters respectively.Methods:From February2012to January2013,29out of72female patients in the first part of research, with30BI-RADS-US4B breast lesions enrolled in this study. All of these lesions underwent both CEUS and CE-MRI preoperatively. The CEUS examinations procedure were the same with the first part, and all CE-MRI examinations were conducted on GE1.5T Signa Twin Speeder with excite, the scan sequences included FSE T1WI, T2WI, STIR, and2D FSPGR plus FSE T1WI. The contrast media was Gd-DTPA, and the dose was0.2mmol/Kg. The CE-MRI scaned5times:right after injection, lmin,2min,4min and7min. Histopathology confirmed19malignant and11benign. Two doctors blinded to the clinical data retrospectively analyzed all the CEUS and CE-MRI images in morphology and dynamic parameters. Finally, we identified all30lesions malignant or benign in CEUS and CE-MRI according to our previous studies. The value of the two modalities in differential diagnosis of BI-RADS-US4B breast lesions from two aspects, morphology and dynamic parameters. And then, we evaluated the relevance and advantage respectively.Results:Two morphological characteristics, shape and distribution, were statistically different between malignant and benign ones in CEUS and CE-MRI(P<0.05). Their accuracies were86.7%,86.7%in CEUS, and70.0%,76.7%in CE-MRI respectively. The CE-MRI had higher diagnostic accuracy in dynamic parameters(Tmax, Emax) and TIC types(80.0%,83.3%and80.0%). While the parameters of CEUS(including AT, TTP, PI) had no statistical difference between the benign lesions and malignant lesions (P>0.05). The overall sensitivity, speciality and accuracy of CEUS were89.4%,81.8%,86.7%, and CE-MRI’s were89.4%,72.7%,83.3%, respectively. There’s no statistical difference between them(P>0.05).Conclusions:Both CEUS and CE-MRI has relatively high diagnostic value in BI-RADS-US4B lesions, however no statistical difference has been found between these two methods in our study. The morphological characteristics of CEUS present high value, while the dynamic parameters and TIC types of CE-MRI perform excellently in BI-RADS-US4B breast lesions.