The Application Of Contrast-enhanced Ultrasound Combined With Conventional Ultrasound In The Diagnosis Of Breast Diseases And A Comparative Study With Enhanced Magnetic Resonance

The diagnostic value of the combination of conventional ultrasound(US)and contrast-enhanced ultrasound(CE-US)in breast lesions at BI-RADS 3-5 gradeObjective: To investigate the diagnostic value of the combination of conventional ultrasound(US)and contrast-enhanced ultrasound(CE-US)in breast lesions at BI-RADS 3-5 grade.Method: 527 breast lesions were evaluated by conventional US and CE-US,using a Mylab Twice ultrasound unit(The Esaote Group,Genova,Italy).CEUS were performed with a LA523 transducer(4-13MHz)while CEUS was performed with a LA522transducer(3-9MHz).Sono Vue(Bracco,Milan,Italy)was used as contrast agent during the CEUS examination which was injected as an intravenous bolus of 2.4ml via a20-gauge syringe into an antecubital vein,followed by a 5ml saline flush.The nodule was scanned for about 4 minutes after bolus injection.The video clip was digitally recorded.A specific sonographic quantification software(Qontrast,Bracco,Milan,Italy)based on pixel by pixel signal intensity over time,was used to obtain colour-coded maps of perfusion parameters of the investigated lesion,namely time-intensity curve.The pattern of contrast enhancement and the related indexes regarding the time-intensity curve were used to describe the lesions,which was also compared with pathological results.Characteristic performance,the type of TIC curve and the parameters of TIC curve were all oberserved.All data were statistically analyzed.All lesions were classified by BI-RADS method and the malignant lesions ranked higher than BI-RADS 4A.Results: Histopathologic diagnosis revealed 254 benign and 273 malignant lesions.Most malignant lesions displayed grown sizes,more vascularity and bending vascular shape after contrast.The difference value of Peak,TTP and AUC betweenmalignant lesion and normal tissue from the difference value between benign lesion and normal tiss showed significant difference,while the index showed no difference between malignant lesion and benign lesion.46.7% of the malignant lesions showed showed a fast-in and fast-out pattern.31.1% showed slow-in and slow-out pattern.33.3% of the benign lesions showed a fast-in and fast-out pattern,44.4% showed slow-in and slow-out pattern,9.9% was similar to the normal tissue.The distribution of types of time-intensity between malignant lesion and normal tissue showed no significant difference.By multivariate Logistic Regression Analysis,grown sizes,more vascularity and bending vascular shape,ill-defined margin were the most valuable variates.Sensitivity,specificity of US in the diagnosis of malignant breast lesions were: 70.5%,97.2 %,respectively.While the combination of US and CEUS showed a sensitivity of 84.4%,a specificity of 98.5%.Conclusions: Compared with conventional US,CE-US combined with conventional US may be more helpful for the BI-RADS classification of breast lesions.Differentiating benign from malignant solid breast lesions:Combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging.Objective: To evaluate the diagnostic efficacy of conventional ultrasound(US),contrast-enhanced US(CEUS),combined use of two modalities,and magnetic resonance imaging(MRI)in the differentiation of focal solid breast lesions.Method: 120 breast lesions were evaluated by conventional US and CE-US,examined by MRI simultaneously,using a Mylab Twice ultrasound unit(The Esaote Group,Genova,Italy).CDUS were performed with a LA523 transducer(4-13MHz)while CEUS was performed with a LA522 transducer(3-9MHz).Sono Vue(Bracco,Milan,Italy)was used as contrast agent during the CEUS examination which was injected as an intravenous bolus of 2.4ml via a 20-gauge syringe into an antecubital vein,followed by a 5ml saline flush.The nodule was scanned for about 4minutes after bolus injection.The video clip was digitally recorded.A 3.0 T scanner with a dedicated surface 8-channel bilateral coil(Siemens,German)was applied for MRI examination of the breast lesions.A specific sonographic quantification software(Qontrast,Bracco,Milan,Italy)based on pixel by pixel signal intensity over time,was used to obtain colour-coded maps of perfusion parameters of the investigated lesion,namely time-intensity curve.The pattern of contrast enhancement and the related indexes regarding the time-intensity curve were used to describe the lesions,which was also compared with pathological results.Characteristic performance and the type of TIC curve were all oberserved.All data were statistically analyzed.All lesions were classified by BI-RADS method and the malignant lesions ranked higher than BI-RADS 4A.Results: Histopathologic diagnosis revealed 46 benign and 74 malignant lesions.Sensitivity,specificity,and accuracy of US in the diagnosis of malignant breast lesions were: 90.14%,95.92 %,and 92.52%,respectively.While CEMRI showed a sensitivity of 88.73 %,a specificity of 95.92%,and an accuracy of 91.67%.The area under the ROC curve(Az)value of the combination of the two modalities for discriminating begion and malignant breast lesions was 0.936,and that of MRI was0.923,no statistical difference was found between them,as well as among groups accordiong to the size.The difference between the two measurements and the distribution was not significant according to a paired t test(P>0.05).The TIC type of malignant lesion and hypervascular fibroadenoma and papillary mostly showed a fast-in and fast-out pattern,but there were no good correlation between them(kappa<0.20).Conclusions: The combined use of conventional US and CEUS displays good agreement with MRI in the differentiation capability for benign and malignant breast lesions.