中华医学超声杂志(电子版)
中華醫學超聲雜誌(電子版)
중화의학초성잡지(전자판)
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2013年
7期
590-595
,共6页
曹小丽%刘瑞华%刘美娟%曹立萍%王丽红%张玉莲
曹小麗%劉瑞華%劉美娟%曹立萍%王麗紅%張玉蓮
조소려%류서화%류미연%조립평%왕려홍%장옥련
超声检查%造影剂%乳腺肿瘤%微血管密度
超聲檢查%造影劑%乳腺腫瘤%微血管密度
초성검사%조영제%유선종류%미혈관밀도
Ultrasonography%Contrast media%Breast neoplasms%Microvessel density
目的探讨乳腺癌患者超声造影表现及其与微血管密度( MVD)的关系。方法对2010年10月至2012年2月青岛大学医学院附属烟台毓璜顶医院45例乳腺癌患者45个肿瘤术前行超声造影检查,利用时间-强度曲线得到乳腺癌肿瘤中心区域、肿瘤边缘区域、肿瘤周围正常乳腺组织血流灌注参数上升时间( RT)、峰值强度( PI)、达峰时间( TTP)、流入斜率( WIS)以及平均渡越时间( MTT)并进行比较;同时将术后病理标本行抗CD34因子免疫组化染色,检测肿瘤MVD;比较不同MVD乳腺癌超声造影增强表现和血流灌注参数。结果45个乳腺癌MVD平均(47.6±14.2)个/高倍视野,其中高MVD组(MVD>48个/高倍视野)21个(46.7%),低MVD组(MVD≤48个/高倍视野)24个(53.3%)。45个乳腺癌超声造影后除2个(4.4%)无增强外,其余43个(95.6%)均出现不同程度增强。其中25个(55.6%)不均匀增强,27个(60.0%)有血流灌注缺损;37个(82.2%)增强形态不规则;25个(55.6%)向心性增强;32个(71.1%)有穿支血管;34个(75.6%)增强边界不清晰。乳腺癌肿瘤中心区域与肿瘤周围正常乳腺组织相比,RT、TTP均缩短[(9.3±3.3)s vs (11.1±3.7)s,(25.3±5.9)s vs (27.5±6.4) s],PI 增高[(12.1±4.6) dB vs (9.2±2.8) dB],WIS 增大(1.0±0.4 vs 0.8±0.3),且差异均有统计学意义(t值分别为-3.001、-4.785、6.987、5.438,P均<0.05);肿瘤边缘区域与肿瘤中心区域相比,TTP缩短[(22.2±6.0) s vs (25.3±5.9) s],PI增高[(15.4±5.1)dB vs (12.1±4.6)dB],WIS增大(1.3±0.5 vs 1.0±0.4),且差异亦均有统计学意义(t值分别为-2.839、3.194、3.151,P均<0.05)。高MVD组乳腺癌不均匀增强、血流灌注缺损发生率均高于低MVD组乳腺癌,且差异均有统计学意义(χ2值分别为4.0179、7.2024,P均<0.05);两组肿瘤增强形态、增强边界及穿支血管差异无统计学意义。高MVD乳腺癌PI高于低MVD组乳腺癌[(18.2±5.6)dB vs (12.9±3.1)dB],且差异有统计学意义(t=-3.738,P<0.05);而2组RT、TTP及WIS差异无统计学意义。结论乳腺癌超声造影具有典型的增强表现,在一定程度上可反映肿瘤微血管分布特征,有可能作为评价肿瘤血管生成的依据之一。
目的探討乳腺癌患者超聲造影錶現及其與微血管密度( MVD)的關繫。方法對2010年10月至2012年2月青島大學醫學院附屬煙檯毓璜頂醫院45例乳腺癌患者45箇腫瘤術前行超聲造影檢查,利用時間-彊度麯線得到乳腺癌腫瘤中心區域、腫瘤邊緣區域、腫瘤週圍正常乳腺組織血流灌註參數上升時間( RT)、峰值彊度( PI)、達峰時間( TTP)、流入斜率( WIS)以及平均渡越時間( MTT)併進行比較;同時將術後病理標本行抗CD34因子免疫組化染色,檢測腫瘤MVD;比較不同MVD乳腺癌超聲造影增彊錶現和血流灌註參數。結果45箇乳腺癌MVD平均(47.6±14.2)箇/高倍視野,其中高MVD組(MVD>48箇/高倍視野)21箇(46.7%),低MVD組(MVD≤48箇/高倍視野)24箇(53.3%)。45箇乳腺癌超聲造影後除2箇(4.4%)無增彊外,其餘43箇(95.6%)均齣現不同程度增彊。其中25箇(55.6%)不均勻增彊,27箇(60.0%)有血流灌註缺損;37箇(82.2%)增彊形態不規則;25箇(55.6%)嚮心性增彊;32箇(71.1%)有穿支血管;34箇(75.6%)增彊邊界不清晰。乳腺癌腫瘤中心區域與腫瘤週圍正常乳腺組織相比,RT、TTP均縮短[(9.3±3.3)s vs (11.1±3.7)s,(25.3±5.9)s vs (27.5±6.4) s],PI 增高[(12.1±4.6) dB vs (9.2±2.8) dB],WIS 增大(1.0±0.4 vs 0.8±0.3),且差異均有統計學意義(t值分彆為-3.001、-4.785、6.987、5.438,P均<0.05);腫瘤邊緣區域與腫瘤中心區域相比,TTP縮短[(22.2±6.0) s vs (25.3±5.9) s],PI增高[(15.4±5.1)dB vs (12.1±4.6)dB],WIS增大(1.3±0.5 vs 1.0±0.4),且差異亦均有統計學意義(t值分彆為-2.839、3.194、3.151,P均<0.05)。高MVD組乳腺癌不均勻增彊、血流灌註缺損髮生率均高于低MVD組乳腺癌,且差異均有統計學意義(χ2值分彆為4.0179、7.2024,P均<0.05);兩組腫瘤增彊形態、增彊邊界及穿支血管差異無統計學意義。高MVD乳腺癌PI高于低MVD組乳腺癌[(18.2±5.6)dB vs (12.9±3.1)dB],且差異有統計學意義(t=-3.738,P<0.05);而2組RT、TTP及WIS差異無統計學意義。結論乳腺癌超聲造影具有典型的增彊錶現,在一定程度上可反映腫瘤微血管分佈特徵,有可能作為評價腫瘤血管生成的依據之一。
목적탐토유선암환자초성조영표현급기여미혈관밀도( MVD)적관계。방법대2010년10월지2012년2월청도대학의학원부속연태육황정의원45례유선암환자45개종류술전행초성조영검사,이용시간-강도곡선득도유선암종류중심구역、종류변연구역、종류주위정상유선조직혈류관주삼수상승시간( RT)、봉치강도( PI)、체봉시간( TTP)、류입사솔( WIS)이급평균도월시간( MTT)병진행비교;동시장술후병리표본행항CD34인자면역조화염색,검측종류MVD;비교불동MVD유선암초성조영증강표현화혈류관주삼수。결과45개유선암MVD평균(47.6±14.2)개/고배시야,기중고MVD조(MVD>48개/고배시야)21개(46.7%),저MVD조(MVD≤48개/고배시야)24개(53.3%)。45개유선암초성조영후제2개(4.4%)무증강외,기여43개(95.6%)균출현불동정도증강。기중25개(55.6%)불균균증강,27개(60.0%)유혈류관주결손;37개(82.2%)증강형태불규칙;25개(55.6%)향심성증강;32개(71.1%)유천지혈관;34개(75.6%)증강변계불청석。유선암종류중심구역여종류주위정상유선조직상비,RT、TTP균축단[(9.3±3.3)s vs (11.1±3.7)s,(25.3±5.9)s vs (27.5±6.4) s],PI 증고[(12.1±4.6) dB vs (9.2±2.8) dB],WIS 증대(1.0±0.4 vs 0.8±0.3),차차이균유통계학의의(t치분별위-3.001、-4.785、6.987、5.438,P균<0.05);종류변연구역여종류중심구역상비,TTP축단[(22.2±6.0) s vs (25.3±5.9) s],PI증고[(15.4±5.1)dB vs (12.1±4.6)dB],WIS증대(1.3±0.5 vs 1.0±0.4),차차이역균유통계학의의(t치분별위-2.839、3.194、3.151,P균<0.05)。고MVD조유선암불균균증강、혈류관주결손발생솔균고우저MVD조유선암,차차이균유통계학의의(χ2치분별위4.0179、7.2024,P균<0.05);량조종류증강형태、증강변계급천지혈관차이무통계학의의。고MVD유선암PI고우저MVD조유선암[(18.2±5.6)dB vs (12.9±3.1)dB],차차이유통계학의의(t=-3.738,P<0.05);이2조RT、TTP급WIS차이무통계학의의。결론유선암초성조영구유전형적증강표현,재일정정도상가반영종류미혈관분포특정,유가능작위평개종류혈관생성적의거지일。
Objective To investigate the relation of contrast-enhanced ultrasound ( CEUS ) characteristics and microvessel density ( MVD ) in the breast cancer .Methods From October 2010 to February 2012, 45 cases of patients with breast cancer were studied in Yantai Yuhuangding Hospital , Affiliated to Qingdao University Medical College .All lesions were examined by CEUS before surgery .The blood perfusion parameters such as rising time (RT),peak intensity(PI),time to peak(TTP),wash-in slope (WIS) and mean transit time ( MTT) were obtained by time-intensity curve ( TIC).Immunohistochemical staining for anti-factor CD34 was performed on surgery specimen and the MVD was evaluated .The CEUS characteristics and blood perfusion parameters between different MVD groups of breast cancer were compared.Results In 45 cases of breast cancer,mean MVD was(47.6 ±14.2)/high power field(HPD). Twenty-one cases(46.7%) were classified as high MVD group(MVD>48/HPD) and 24 cases(53.3%) were classified as lower MVD group ( MVD≤48/HPD) .Besides two cases without contrast agent perfusion in CEUS imaging, blood perfusion was observed in 43 cases (95.6%).Heterogeneous enhancement was observed in 25 cases(55.6%).Local blood perfusion defect was observed in 27 cases(60.0%).Irregular shape was observed in 37 cases(82.2%).Centripetal enhancement was observed in 25 cases(55.6%). Penetrating surrounding vessels was observed in 32 cases(71.1%).Poorly-defined margin was observed in 34 cases(75.6%).Compared with the surrounding normal breast tissue ,RT and TTP of center region of neoplasms was shorter[(9.3 ±3.3)s vs (11.1 ±3.7)s and (25.3 ±5.9)s vs (27.5 ±6.4)s],PI was higher[(12.1 ±4.6)dB vs (9.2 ±2.8)dB],WIS was higher(1.0 ±0.4 vs 0.8 ±0.3) and differences were significant(t =-3.001, -4.785,6.987 and 5.438,all P <0.05).Compared with center region of neoplasms,TTP of periphery region of neoplasms was shorter [(22.2 ±6.0)s vs (25.3 ±5.9)s],PI was higher[(15.4 ±5.1)dB vs (12.1 ±4.6)dB],WIS was larger(1.3 ±0.5 vs 1.0 ±0.4) and differences were significant(t=-2.839,3.194 and 3.151,all P<0.05).The detection rate of blood perfusion defect and heterogeneous enhancement was higher in the high-MVD group than in the low-MVD group(χ2 =4.0179 and 7.2024,both P <0.05).While the enhancement shape,margin and penetrating vessels showed no statistical difference between the two groups .Breast neoplasms in the high-MVD group had higher PI than those in the low-MVD group[(18.2 ±5.6)dB vs (12.9 ±3.1)dB,t=-3.738,P<0.05].While the RT, TTP and WIS showed no statistical difference between the two groups ( t=-0.798,-0.760 and -0.378, all P>0.05).Conclusion CEUS characteristics of breast lesions were associated with MVD ,which may reflect the microvessel distributional characteristics of neoplasm and may be one of bases used to evaluate neoplasm angiogenesis .