摘要目的 探讨三维剪切波弹性成像(three-dimensional shear wave elastography,3D-SWE)在乳腺肿块良恶性鉴别诊断中的应用价值.方法 选取超声检出并经手术病理证实的乳腺肿块患者67例,共96个肿块,其中良性组54个,恶性组42个.定量诊断:应用2D及3D-SWE模式,评估肿块的硬度,绘制2D-SWE及3D-SWE各参数ROC曲线,并求得其诊断乳腺肿块良恶性的敏感性和特异性.定性诊断:根据弹性彩色图像分类法将病灶的弹性图像分为Ⅰ ～ Ⅳ型.结果 定量诊断结果:①良、恶性组间比较,2D-SWE切面及3D-SWE三个正交切面上的平均值(Emean)、最大值(Emax)及标准差(SD)值的差异均有统计学意义(P<0.05);②组内比较,2D-SWE与3D-SWE之间的Emean、Emax及SD值的差异无统计学意义(P>0.05);③2D-SWE、3D-SWE的三个正交切面上的Emean、Emax及SD值在诊断乳腺肿块良恶性上均具有较高的诊断效能,但2D-SWE与3D-SWE两者间比较差异无统计学意义(P>0.05).弹性彩色模式的定性诊断结果:Ⅰ型和Ⅱ型占良性肿块二维弹性切面及三维三个正交切面的的绝大部分;而Ⅲ型和Ⅳ型占恶性肿块二维弹性切面及三维三个正交切面的的绝大部分.恶性组中Ⅲ型在3D-SWE冠状面出现的频率高于其他三种图像类型(P<0.05).结论 定量诊断方面,2D-SWE与3D-SWE均有利于鉴别乳腺肿块良恶性,但是两者的诊断效能并无差异;定性诊断方面,3D-SWE比2D-SWE可提供更多的诊断信息,尤其是3D-SWE的冠状面.

abstractsObjective To investigate the application value of three-dimensional shear wave elastography( 3D-SWE) in diagnosis of malignant and benign breast masses . Methods Sixty-seven patients with total 96 masses diagnosed by ultrasound and verified with surgical pathological analysis were selected . The masses were divided into benign group ( 54 masses ) and malignant group ( 42 masses ) . The quantitative diagnosis was performed using two-dimensional shear wave elastography ( 2D-SWE) and 3D-SWE to evaluate the hardness of the masses . Receiver operating characteristic ( ROC ) curves of 2D-SWE and 3D-SWE were drawn to calculate the sensibility and specificity in diagnosis of breast masses . The qualitative diagnosis was performed according to the elastic color image classification to classify the elastic images of the lesions into type Ⅰ - Ⅳ . Results The quantitative diagnosis:① There were significant differences in Emean ,Emax and SD on planes of 2D-SWE and three orthogonal planes of 3D-SWE between the two groups ( P <0 .05) ;② There was no significant difference in Emean ,Emax and SD of two groups between 2D-SWE and 3D-SWE ( P > 0 .05) ;③ Emean ,Emax and SD on planes of 2D-SWE and three orthogonal planes of 3D- SWE both exhibited high diagnostic performance . However , there was no significant difference in Emean ,Emax and SD between 2D-SWE and 3D-SWE ( P >0 .05) . The qualitative diagnosis of elastic color mode:type Ⅰ and type Ⅱ account for most planes of 2D-SWE and three orthogonal planes of 3D-SWE in benign masses ,while type Ⅲ and type Ⅳ account for most in malignant masses . Among the malignant group ,type Ⅲ on the 3D-SWE coronal planes was significantly more than other three types ( P < 0 .05) .Conclusions For quantitative diagnosis ,2D-SWE and 3D-SWE are both beneficial to differentiate benign from malignant masses ,but there is no difference in diagnostic efficacy ;for qualitative diagnosis ,3D-SWE can provide more diagnostic information than 2D-SWE ,especially on the coronal planes of 3D-SWE .