评估软组织肿瘤的徒手超声应变弹性成像。

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Journal of Ultrasound Pub Date : 2024-09-01 Epub Date: 2024-07-25 DOI:10.1007/s40477-024-00893-w
Fabio Sandomenico, Gianluigi De Rosa, Orlando Catalano, Maria Iovino, Gabriella Sandomenico, Antonio Corvino, Antonella Petrillo
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引用次数: 0

摘要

研究目的本研究的目的是评估各种软组织表层病变的弹性成像,将这些病变的弹性成像特征与 Asteria 建立的弹性成像评分(ES)系统相关联:方法:研究了 40 名患有不同软组织表层病变的患者,包括脂肪瘤、裂隙瘤、神经瘤、表皮包涵囊肿、"过境 "黑色素瘤转移、动静脉畸形和巨细胞瘤。超声检查结合彩色多普勒和弹性成像模块进行。B 型超声检查的标准是病变的回声、边缘和结构均匀性。彩色多普勒的标准是不规则且主要是结节内的血管。根据 Asteria 针对软组织的分类,ES 1-4 与组织硬度的增加有关。随后,我们在每个单一的 B 型和彩色多普勒标准中增加了 ES 3 和 ES 4,从而跨越了两个恶性肿瘤参数。所有推测诊断均通过临床数据或组织病理学结果得到证实:结果:低回声外观的诊断效果最好。敏感性为 87%,特异性为 71%,阳性预测值(PPV)为 80%,阴性预测值(NPV)为 80%,诊断准确率为 80%。与临床和活检数据有很好的相关性,边缘不规则的表现最差,不均匀性居中。彩色多普勒的敏感性为 74%,特异性为 82%,PPV 为 85%,NPV 为 70%,诊断准确率为 77.5%。弹性成像的敏感性为 87%,特异性为 94%,PPV 为 95%,NPV 为 84%,诊断准确率为 90%。低回声外观+ES3/ES4组合的敏感性为83%,特异性为100%,PPV为100%,NPV为81%,诊断准确率为90%。边缘不规则+ES3/ES4组合的敏感性为43%,特异性为100%,PPV为100%,NPV为59%,诊断准确率为67.5%。病变不均匀+ ES3/ES4 组合的敏感性为 65%,特异性为 94%,PPV 为 94%,NPV 为 68%,诊断准确率为 78%。彩色多普勒与 ES3/ES4 的组合显示灵敏度为 69.5%,特异性为 100%,PPV 为 100%,NPV 为 71%,诊断准确率为 82.5%。在组合评估中,特异性显著增加,使健康受试者被正确归类为阴性,假阳性减少,这也转化为 PPV 的增加:结论:仅靠弹性成像不足以进行正确的诊断分类,必须将其视为研究软组织病变的附加参数。虽然 B 型恶性病变标准与 ES3/ES4 有很好的一致性,但灵敏度并没有显著提高。超声评估,尤其是对浅表病变的评估,不能脱离常规弹性成像检查的综合方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Free-hand ultrasound strain elastography in evaluation of soft tissue tumors.

Objective: The purpose of this study is to evaluate elastography in a wide spectrum of soft tissue superficial lesions by correlating the elastographic characteristics of these lesions with the elastographic score (ES) system established by Asteria.

Methods: Forty patients with different superficial lesions of the soft tissues were studied, including lipomas, schwannomas, neuromas, epidermal inclusion cysts, "in transit" melanoma metastasis, arterio-venous malformation, and giant-cell tumor. An ultrasound examination was performed combined with color-Doppler and elastographic module. The B-mode criteria were echogenicity, margins, and structural homogeneity of the lesion. The color-Doppler criterion was irregular and mainly intra-nodular vascularization. ES 1-4 was attributed, in relation with the increasing tissue stiffness, according to the classification of Asteria adapted for soft tissues. Subsequently, we added to each single B-mode and color-Doppler criterion the ES 3 and 4, thus crossing two parameters of malignancy. All the presumptive diagnoses formulated were confirmed with the clinical data or with the histopathological result.

Results: The hypoechoic appearance had the best diagnostic performance. Sensitivity was 87%, specificity 71%, positive predictive value (PPV) 80%, negative predictive value (NPV) 80%, and diagnostic accuracy 80%. There was a good correlation with the clinical and biopsy data, the irregularity of margins the worst performance, the inhomogeneity an intermediate. Color-Doppler had sensitivity 74%, specificity 82%, PPV 85%, NPV 70% and diagnostic accuracy 77.5%. Elastography had sensitivity 87%, specificity 94%, PPV 95%, NPV 84%, and diagnostic accuracy 90%. The combination hypoechoic appearance + ES3/ES4 showed sensitivity 83%, specificity 100%, PPV 100%, NPV 81%,and diagnostic accuracy of 90%. The combination of irregularity of margins + ES3/ES4 showed sensitivity 43%, specificity 100%, PPV 100%, NPV 59%, and diagnostic accuracy of 67.5%. The combination of inhomogeneity of the lesion + ES3/ES4 showed sensitivity 65%, specificity 94%, PPV 94%, NPV 68%, and diagnostic accuracy of 78%. The combination of the color-Doppler with the ES3/ES4 showed sensitivity 69.5%, specificity 100%, PPV 100%, NPV 71%, and diagnostic accuracy of 82.5%.In the combined evaluation, there was a significant increase in specificity, allowing healthy subjects to be categorized as correctly negative, with a reduction in false positives which also translates into an increase in PPV.

Conclusions: Elastography alone is not sufficient for a correct diagnostic classification and must be considered as an additional parameter in the study of soft-tissue lesions. Although there was a good agreement between B-mode malignancy criteria and ES3/ES4, there is no significant improvement in sensitivity. Ultrasound assessment, especially of superficial lesions, cannot be separated from an integrated approach that foresees the additional and routine use of the elastographic examination.

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来源期刊
Journal of Ultrasound
Journal of Ultrasound RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
4.10
自引率
15.00%
发文量
133
期刊介绍: The Journal of Ultrasound is the official journal of the Italian Society for Ultrasound in Medicine and Biology (SIUMB). The journal publishes original contributions (research and review articles, case reports, technical reports and letters to the editor) on significant advances in clinical diagnostic, interventional and therapeutic applications, clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and in cross-sectional diagnostic imaging. The official language of Journal of Ultrasound is English.
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