The Application Of Real-time Grey-Scale Contrast-enhanced Ultrasonography In Differentiation Of Breast Masses

Objective:Observe the perfusion modes of contrast agent and enhanced de grees in breast masses by contrast enhanced ultrasound(CEUS),and get the parameters for the differentiation of breast masses.Materials and Methods:This study consists 87 women(female)patients with 87 breast masses, which underwent contrast enhanced ultrasound examinations without any treatment before.Their ages range were from 16 to 74 years.The lesion sizes: 0.7x0.6cm～15.0x7.0cm.All patients accepted the CEUS after routine ultrasonography of breasts.The pathology was got by biopsy with 16G or/and operation.All the fundamental ultrasound examinations were performed by the S equoia512,which is matched with contrast pulse sequence(CPS)imaging tec hnique and time intensity analysis software:Axius automatic tracking contras t quantification(Axius ACQ)software.The contrast agent(UCA)was SonoVu e(Bracco).Dissove the Sonovue powder with 5ml saline,then dump the solu tion and inject it to patient's body quickly(within 3-5 seconds)by the needle which was set in cubital vein,and then inject 5ml saline to body.This stud y had three parts:Patt1:Observe the perfusion characteristics of the mass'int erior,margin and the peripheral region of 1-3 milimeters beyond mass,and the vasculars which was penetrating or converging on mass when UCA w ashed-in.The types of the mass'interior enhanced modes were:①Interior e nhanced modes were the gross homogeneous(typeⅠ)which included spot enhancement(typeⅠa)and regiment enhancement(typeⅠb);the heterogeneous e nhancement(typeⅡ)which included uneven intensity in masses(typeⅡa)an d small parts of mass were no enhancement(typeⅡb);partial enhancement(t ypeⅢ);only edge enhancement(typeⅣ),respectively.The margin enhance d caracteristics were encircled enhancement,radial enhancement and no chara cteristic enhancement.Then the difference between benign and malignant ma sses had been analyzed according to pathologies.Part2:68 patients with the breast masses(38 benign,30 malignant)were implemented the contrast-en hanced ultrasound inspection.The blood signals of the masses can be got b efore performing the CEUS,then the CEUS is performed.The enhancement of the masses is divided into 4 grades according to the enhancement of b reast which is around the mass(no enhancement,low enhancement,equal e nhancement,and high enhancement as well).Comparing the enhancement of CEUS with the intensity of the blood signals of breast masses.The PIs of all masses and high enhanced masses were calculated by software of A CQ in machine,then they were compared by groups which had been cla ssified by their maximal diameters.Part3:Drawing of the time-intensity cur ves of 54 masses(31benign,23 malignant)and their surrounding tissues by so ftware of ACQ.Obtain the parameters of CEUS and calculate the relative parameters of CEUS.ResultsPart 1:The enhanced modes in 86 of 87 masses have their characeris tic apperances when UCA washed-in.The other 1 case was no enhancement. 1.Among those mentioned above,the typeⅡa,Ⅱb,Ⅳwere different from e ach other(P＜0.05).All masses which belonged to typeⅠa(18 cases)and typeⅣ(6 cases)were benign.Most masses of typeⅡb were malignant ones.2.En circled enhancement of margin were showed in 20 cases(18 benign,2 mali gnant)(P＜0.05),and radial enhancement of margin were showed only in m alignant masses.The enhanment with no special character of margin were sh owed in benign and malignant ones(P＞0.05).3.The enhancement covered mo re than margins in 18 masses.There were 1 benign and 17 malignant masse s(p＜0.01).The region beyond masses'margin corresponded with the peri pheral region of 1-3 milimeters beyond mass with hyperechogenicity in rout ine ultrasonography.The enhancement of vasculars which penetrating or con verging on the masses could be seen both in benign and malignant masses (P＞0.05).Part 2:1.Measured by eyes,we found that the no enhanced ones(4case s)and equal enhanced ones(12cases)were benign,and 1 case of the low e nhanced masses(11cases)was malignant.The high enhanced masses(41case s)were malignant or benign.2.Among the 68 cases,there were 50 cases w hose blood signal's grades were 0～Ⅱbefore CEUS.23 cases were hign en hancement(7 benign,16 malignant),the malignant masses were more than ben ign ones(P＜0.05).All the masses(18cases)which blood signal's grades wer eⅢbefore CEUS were high enhancement.3.About the high enhanced masse s,the parameter of PI had statistical significances when the masses' maxim al diameters were less than 2 centimeters(P＜0.05),and had no statistical si gnificance when their maximal diameters were more than or equal to 2 cen timeters((P＞0.05).Part3:1.The time-intensity curves of benign masses closed to those of surrounding tissues,or showed wash-in slowly and wash-out quickly.But t he time-intensity curves of malignant masses showed wash-in quickly and wash-out slowly(P＜0.05).2.The lesions' relative arrival time,time to peak an d peak intensity were different between benign and malignant masses(P＜0.0 5).But the relative base intensity had no difference between benign and mal ignant masses.Conclusions1.There are some special features of enhanced modes in masses bet ween benign and malignant ones.The typeⅠa,typeⅣof interior and the en circled enhancement of margin were the characteristics of benign mass(P＜0. 05).But the typeⅡb of interior,radical enhancement of margin and band-enh ancement of periphery were the of malignant ones(P＜0.05).2.The CEUS of breast can improve the appreance of the mass's bloo d vessel obviously,especially for malignant masses.About the masses less than 2 centimeters,comparing the enhanced degree of CEUSwith the blood signal's grade of CDFI obtained before,and combining which with the PI of masses was helpful to the differention of masses.The features of no enhan cement,equal enhancement and low enhancement were benign more than m alignant.The high enhanced masses likely malignant ones if their blood sign al's grade wereⅢobtained before CEUS.However,the parameter of PI wa s useless for differential diagnosis of the breast masses if their maximal dia meters were more than or equal to 2centimeters and the blood flow grade wereⅢbefore CEUS.3.More attention should be paid to their surrounding tissues' conditions in the study of lessions'parameters of CEUS.It was more valuable for the differential diagnosis between benign and malignant masses by calculating the relative parameters.The relative parameters of CEUS and the shaps of time-intensity curves were hoped to be helpful in the differentiation of breast masses.