Research On Real-time Gray-scale Contrast-enhanced Ultrasonography In The Diagnosis Of Breast Tumor

Partâ… Breast lesions:Imaging findings at real-time gray-scale contrast-enhanced ultrasonographyPurpose:The purpose of our study was to summarize the imaging characteristics of breast lesions at real-time gray-scale contrast-enhanced ultrasonography(CEUS),and to assess the value of CEUS in differential diagnosis of breast lesions.Methods:All subjects were given written informed consent.From September 2008 to September 2009,187 female patients with 187 breast lesions underwent CEUS by a Siemens Acuson Sequoia 512 scanner equipped with a 17L5 linear array transducer, contrast pulsed sequences (CPS) technique and autotracking contrast quantification(ACQ)software.The frequency we used in the mode of gray-scale US was 10MHz, with 7MHz in the modes of Doppler and CEUS,respectively. Mechanical index(MI)was set less than 0.2.Contrast agent of SonoVue was included, injection dose was 2.4ml.The tumor size,morphologic features,time-intensity curve and contrast parameters were then observed and analyzed. Two investigators blinded to sonographic findings made the assessment on the CEUS imaging data.Results:The morphologic features showed significant differences between benign and malignant lesions(P<0.05).Using the morphologic features of penetrating or tortuous surrounding vessels, irregular shape,heterogeneous distribution as criteria of malignant and benign tumors had the relatively high accuracy of 79.7%,74.3%,74.9%, respectively. The specificity of the feature of perfusion defect was as high as 94.2%. Using the feature of larger size pre-and post-contrast as criteria of malignant and benign tumors had the low accuracy of 59.9%. Using the parameter of time to peak(TTP)more than 15.8s or peak intensity(PI) more than 7.24 as criteria of malignant and benign tumors had the high specificity of more than 90%Conclusion:The imaging features showed significant differences between benign and malignant lesions. The characteristics of penetrating or tortuous surrounding vessels,irregular shape, heterogeneous distribution, perfusion defect,and low TTP or high PI have the high diagnostic value.Partâ…¡Malignant tumors of the breast:contrast-enhanced ultrasonographic findings of different histopathologic typesPurpose:The purpose of our study was to explore the characteristics of different histopathologic types of malignant breast lesions at real-time gray-scale CEUS and evaluate the diagnostic value of CEUS.Methods:The setting of US equipment,the usage of contrast agent and the protocol of US examination were equal to those in part one.101 histopathologically confirmed malignant lesions were recruited. We retrospectively reviewed the contrast-enhanced sonographic findings including morphologic features and the quantitative parameters, correlated with histopathology. Accuracy was then calculated to assess the diagnostic performance of CEUS.Results:The 101 malignancies displayed irregular shape (72[71%]), poorly-defined margin(73[72%]),penetrating or tortuous surrounding vessels(79[78%]),heterogeneous distribution (84 [83%]),including focal perfusion defects (24[24%]).For each histopathologic type,87%of invasive ductal carcinoma(IDC) showed the features of heterogeneous distribution.21(31%) perfusion defects and the low average PI of 4.9 were detected in this type.Ductal carcinoma in situ (DCIS) excellently showed the features of irregular shape (82%),,poorly-defined margin (82%),heterogeneous distribution (94%).While 5(83%) lesions of medullary carcinoma (MC) exhibited regular shape, well-defined margin, homogenous distribution,and high average PI value of 9.6. Invasive lobular carcinoma(ILC)showed the similar enhancement pattern to that of IDC. Intraductal papillary carcinoma displayed high average PI value of 8.1.DCIS, MC and intraductal papillary carcinoma achieved an improved diagnostic accuracy (94%,100% and 100%, respectively).Conclusions:The imaging characteristics of CEUS are remarkably variable in different histopathologic types of breast cancers. It's valuable in the diagnosis of some early and atypical types of the malignancies, which are difficult for conventional ultrasonography.