超声造影与增强核磁对不同大小非肿块型乳腺病变的诊断价值研究
Study on the Diagnostic Value of Contrast-Enhanced Ultrasound and Enhanced MRI for Non-Mass-Like Breast Lesions of Different Sizes
DOI: 10.12677/acm.2025.1592540, PDF,   
作者: 杨 鹤：新疆医科大学研究生学院，新疆 乌鲁木齐；杜 静, 翟 虹*, 宋少威, 赵 青：新疆医科大学第四附属医院超声科，新疆 乌鲁木齐
关键词: 非肿块型乳腺病变；超声造影；增强核磁；诊断价值；Non-Mass-Like Breast Lesions； Contrast-Enhanced Ultrasound； Enhanced MRI； Diagnostic Value
摘要: 目的：探讨超声造影与增强核磁对不同大小非肿块型乳腺病变的诊断价值。方法：选取经病理确诊且资料完整的非肿块型乳腺病变患者100例，所有患者在手术前均接受了乳腺超声造影和增强核磁检查。根据病变大小分为两组：最大径 ≤ 10 mm (47个病灶)和最大径 > 10 mm (53个病灶)。回顾性分析良恶性NML的超声造影特征，并绘制ROC曲线以评估超声造影与增强核磁在不同大小NML诊断中的诊断效能。结果：在最大径 ≤ 10 mm组和最大径 > 10 mm组中，恶性NML与良性NML的超声造影特征在增强时间、增强模式、增强均匀性、滋养血管情况、增强形状及增强范围等方面存在显著差异，且均具统计学意义(P < 0.05)。恶性NML的超声造影特征表现为早期增强、高增强、不均匀增强、有滋养血管、增强形状不规则及增强范围扩大。ROC曲线分析显示，对于最大径 ≤ 10 mm的NML，超声造影诊断的AUC为0.717，略高于增强核磁的0.705，差异无统计学意义(P > 0.05)；而对于最大径 > 10 mm的NML，超声造影的AUC为0.764，低于增强核磁的0.870，差异具有统计学意义(P < 0.05)。结论：对最大径 ≤ 10的NML，超声造影与增强核磁的诊断价值相当；而对最大径 > 10 mm的NML，增强核磁的诊断价值更高，二者均对鉴别乳腺良恶性NML有一定价值，当患者不适用增强核磁时，超声造影是一种可靠的替代方案。
Abstract: Objective: This study explores the diagnostic value of contrast-enhanced ultrasound and enhanced MRI for non-mass-like breast lesions of different sizes. Methods: A total of 100 patients with pathologically confirmed non-mass-like breast lesions were selected, and all patients underwent contrast-enhanced ultrasound and enhanced MRI before surgery. The lesions were divided into two groups based on size: ≤10 mm (47 lesions) and >10 mm (53 lesions). The contrast-enhanced ultrasound features of benign and malignant NML were retrospectively analyzed, and ROC curves were plotted to evaluate the diagnostic efficacy of contrast-enhanced ultrasound and enhanced MRI for NML of different sizes. Results: In the ≤10 mm and >10 mm groups, there were significant differences in the contrast-enhanced ultrasound features of malignant and benign NML regarding enhancement time, enhancement pattern, enhancement uniformity, feeding vessels, enhancement shape, and enhancement range, all with statistical significance (P < 0.05). The contrast-enhanced ultrasound features of malignant NML included early enhancement, high enhancement, non-uniform enhancement, presence of feeding vessels, irregular enhancement shape, and expanded enhancement range. ROC curve analysis showed that for NML ≤ 10 mm, the AUC of contrast-enhanced ultrasound was 0.717, slightly higher than that of enhanced MRI at 0.705, with no statistically significant difference (P > 0.05); whereas for NML > 10 mm, the AUC of contrast-enhanced ultrasound was 0.764, lower than that of enhanced MRI at 0.870, with a statistically significant difference (P < 0.05). Conclusion: For NML ≤ 10 mm, the diagnostic value of contrast-enhanced ultrasound is comparable to that of enhanced MRI; however, for NML > 10 mm, enhanced MRI has a higher diagnostic value. Both methods have certain value in distinguishing benign from malignant NML. When enhanced MRI is not suitable for patients, contrast-enhanced ultrasound can serve as a reliable alternative.
文章引用：杨鹤, 杜静, 翟虹, 宋少威, 赵青. 超声造影与增强核磁对不同大小非肿块型乳腺病变的诊断价值研究[J]. 临床医学进展, 2025, 15(9): 663-670. https://doi.org/10.12677/acm.2025.1592540

参考文献

[1] Sickles, E.A., D’Orsi, C.J., Bassett, L.W. and Burnside, E.S. (2013) ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. American College of Radiology.
[2] Ito, T., Ueno, E., Endo, T., Omoto, K., Kuwajima, A., Taniguchi, N., et al. (2023) The Japan Society of Ultrasonics in Medicine Guidelines on Non-Mass Abnormalities of the Breast. Journal of Medical Ultrasonics, 50, 331-339. [Google Scholar] [CrossRef] [PubMed]
[3] Qu, X., Song, Y., Zhang, Y. and Qing, H. (2019) Value of Ultrasonic Elastography and Conventional Ultrasonography in the Differential Diagnosis of Non-Mass-Like Breast Lesions. Ultrasound in Medicine & Biology, 45, 1358-1366. [Google Scholar] [CrossRef] [PubMed]
[4] Park, K.W., Park, S., Shon, I., Kim, M., Han, B., Ko, E.Y., et al. (2021) Non-Mass Lesions Detected by Breast US: Stratification of Cancer Risk for Clinical Management. European Radiology, 31, 1693-1706. [Google Scholar] [CrossRef] [PubMed]
[5] Choe, J., Chikarmane, S.A. and Giess, C.S. (2020) Non-Mass Findings at Breast US: Definition, Classifications, and Differential Diagnosis. RadioGraphics, 40, 326-335. [Google Scholar] [CrossRef] [PubMed]
[6] Zhang, F., Jin, L., Li, G., Jia, C., Shi, Q., Du, L., et al. (2021) The Role of Contrast-Enhanced Ultrasound in the Diagnosis of Malignant Non-Mass Breast Lesions and Exploration of Diagnostic Criteria. The British Journal of Radiology, 94, Article 20200880. [Google Scholar] [CrossRef] [PubMed]
[7] Wang, Z.L., Li, N., Li, M. and Wan, W.B. (2015) Non-Mass-Like Lesions on Breast Ultrasound: Classification and Correlation with Histology. La radiologia medica, 120, 905-910. [Google Scholar] [CrossRef] [PubMed]
[8] Walker, C.M., Rosado-de-Christenson, M.L., Martínez-Jiménez, S., Kunin, J.R. and Wible, B.C. (2015) Bronchial Arteries: Anatomy, Function, Hypertrophy, and Anomalies. RadioGraphics, 35, 32-49. [Google Scholar] [CrossRef] [PubMed]
[9] Hille, H., Vetter, M. and Hackelöer, B. (2011) The Accuracy of BI-RADS Classification of Breast Ultrasound as a First-Line Imaging Method. European Journal of Ultrasound, 33, 160-163. [Google Scholar] [CrossRef] [PubMed]
[10] 王伟, 赵丹, 兰晶, 等. 多模态超声成像评分法对非肿块型乳腺病变良恶性的鉴别诊断价值[J]. 中国超声医学杂志, 2022, 38(10): 1097-1100.
[11] Wang, F., Wang, W., Sun, N., Ma, L. and Zhang, Q. (2023) Diagnostic Value of Multimodal Ultrasound Strategies in the Differentiation of Non-Mass-Like Breast Lesions. Journal of Clinical Ultrasound, 51, 848-856. [Google Scholar] [CrossRef] [PubMed]
[12] Zhang, J., Cai, L., Pan, X., Chen, L., Chen, M., Yan, D., et al. (2022) Comparison and Risk Factors Analysis of Multiple Breast Cancer Screening Methods in the Evaluation of Breast Non-Mass-Like Lesions. BMC Medical Imaging, 22, Article No. 202. [Google Scholar] [CrossRef] [PubMed]
[13] 高峰, 贾超, 李刚, 等. 超声造影BI-RADS分类诊断乳腺非肿块型病变良恶性的应用研究[J]. 肿瘤影像学, 2020, 29(6): 525-530.
[14] Xu, P., Yang, M., Liu, Y., Li, Y., Zhang, H. and Shao, G. (2020) Breast Non-Mass-Like Lesions on Contrast-Enhanced Ultrasonography: Feature Analysis, Breast Image Reporting and Data System Classification Assessment. World Journal of Clinical Cases, 8, 700-712. [Google Scholar] [CrossRef] [PubMed]
[15] Li, S.Y., Niu, R.L.,Wang, B., et al. (2023) Determining Whether the Diagnostic Value of B-Ultrasound Combined with Contrast-Enhanced Ultrasound and Shear Wave Elastography in Breast Mass-Like and Non-Mass-Like Lesions Differs: A Diagnostic Test. Gland Surgery, 12, 282-296. [Google Scholar] [CrossRef] [PubMed]
[16] Balleyguier, C., Opolon, P., Mathieu, M.C., Athanasiou, A., Garbay, J.R., Delaloge, S., et al. (2009) New Potential and Applications of Contrast-Enhanced Ultrasound of the Breast: Own Investigations and Review of the Literature. European Journal of Radiology, 69, 14-23. [Google Scholar] [CrossRef] [PubMed]
[17] Liu, W., Zong, M., Gong, H.Y., Ling, L.J., Ye, X.H., Wang, S. and Li, C.Y. (2020) Comparison of Diagnostic Efficacy between Contrast-Enhanced Ultrasound and DCE-MRI for Mass-and Non-Mass-Like Enhancement Types in Breast Lesions. Cancer Management and Research, 12, 13567-13578. [Google Scholar] [CrossRef] [PubMed]
[18] Kuhl, C.K. (2019) Abbreviated Magnetic Resonance Imaging (MRI) for Breast Cancer Screening: Rationale, Concept, and Transfer to Clinical Practice. Annual Review of Medicine, 70, 501-519. [Google Scholar] [CrossRef] [PubMed]
[19] 余丽平, 康春梅, 何志安, 等. 超声造影联合常规超声与磁共振成像对乳腺恶性非肿块病变的诊断价值比较研究[J]. 中国医学装备, 2025, 22(5): 72-77.
[20] 赵盈, 赵楠, 王寅中, 等. MRI诊断乳腺非肿块强化病变的研究进展[J]. 磁共振成像, 2025, 16(4): 186-191.
[21] 赵霞, 李秉营, 时光喜, 等. MRI灌注定量分析对非肿块强化乳腺病变的诊断价值[J]. 影像诊断与介入放射学, 2022, 31(6): 440-445.
[22] 蒋丰敏. MRI、超声对乳腺非肿块样强化病变诊断价值比较[J]. 中国CT和MRI杂志, 2022, 20(8): 102-104.

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