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Ultrasonographic Detection of Vascularity of Focal Breast Lesions: Microvascular Imaging Versus Conventional Color and Power Doppler Imaging
Ultrasonic Imaging ( IF 2.3 ) Pub Date : 2021-07-08 , DOI: 10.1177/01617346211029542
Tommaso Vincenzo Bartolotta 1, 2 , Alessia Angela Maria Orlando 1 , Maria Ilenia Schillaci 1 , Luigi Spatafora 1 , Mariangela Di Marco 1 , Domenica Matranga 3 , Alberto Firenze 3 , Alessandra Cirino 1 , Raffaele Ienzi 1
Affiliation  

To compare microvascular flow imaging (MVFI) to conventional Color-Doppler (CDI) and Power-Doppler (PDI) imaging in the detection of vascularity of Focal Breast Lesions (FBLs). A total of 180 solid FBLs (size: 3.5–45.2 mm) detected in 180 women (age: 21–87 years) were evaluated by means of CDI, PDI, and MVFI. Two blinded reviewers categorized lesion vascularity in absent or present, and vascularity pattern as (a) internal; (b) vessels in rim; (c) combined. The presence of a “penetrating vessel” was assessed separately. Differences in vascularization patterns (chi2 test) and intra- and inter-observer agreement (Fleiss method) were calculated. ROC analysis was performed to assess performance of each technique in differentiating benign from malignant lesions. About 103/180 (57.2%) FBLs were benign and 77/180 (42.8%) were malignant. A statistically significant (p < .001) increase in blood flow detection was observed for both readers with MVFI in comparison to either CDI or PDI. Benign FBLs showed mainly absence of vascularity (p= .02 and p= .01 for each reader, respectively), rim pattern (p < .001 for both readers) or combined pattern (p = .01 and p = .04). Malignant lesions showed a statistically significant higher prevalence of internal flow pattern (p < .001 for both readers). The prevalence of penetrating vessels was significantly higher with MVFI in comparison to either CDI or PDI (p < .001 for both readers) and in the malignant FBLs (p < .001). ROC analysis showed MVFI (AUC = 0.70, 95%CI = [0.64–0.77]) more accurate than CDI (AUC = 0.67, 95%CI = [0.60–0.74]) and PDI (AUC = 0.67, 95%CI = [0.60–0.74]) though not significantly (p = .5436). Sensitivity/Specificity values for MVFI, PDI, and CDI were 76.6%/64.1%, 59.7%/73.8% and 58.4%/74.8%, respectively. Inter-reader agreement with MVFI was always very good (k-score 0.85–0.96), whereas with CDI and PDI evaluation ranged from good to very good. No differences in intra-observer agreement were noted. MVFI showed a statistically significant increase in the detection of the vascularization of FBLs in comparison to Color and Power-Doppler.



中文翻译:

乳腺局灶性病变血管的超声检测:微血管成像与传统的彩色和能量多普勒成像

比较微血管血流成像 (MVFI) 与传统的彩色多普勒 (CDI) 和功率多普勒 (PDI) 成像在检测局灶性乳腺病变 (FBL) 的血管分布方面。通过 CDI、PDI 和 MVFI 评估了 180 名女性(年龄:21-87 岁)中总共检测到的 180 个固体 FBL(大小:3.5-45.2 毫米)。两名盲审员将病变血管分布分类为不存在或存在,以及血管分布模式为 (a) 内部;(b) 边缘的船只;(c) 合并。单独评估“穿透血管”的存在。血管化模式的差异(chi 2测试)和观察者内和观察者间的一致性(Fleiss 方法)。进行 ROC 分析以评估每种技术在区分良恶性病变方面的性能。大约 103/180 (57.2%) FBL 是良性的,77/180 (42.8%) 是恶性的。 与 CDI 或 PDI 相比,使用 MVFI 的两个读取器的血流检测都有统计学显着性 ( p < .001) 增加。良性 FBL 主要显示没有血管分布( 每个读取器分别为p =  .02 和p = .01)、边缘模式( 两个读取器的p < .001)或组合模式(p  = .01 和p = .04)。恶性病变显示出统计学上显着更高的内部流动模式患病率( 两个读者的p < .001)。与 CDI 或 PDI 相比,MVFI 穿透血管的发生率显着更高( 两个读取器的p < .001)和恶性 FBLs ( p  < .001)。ROC 分析显示 MVFI (AUC = 0.70, 95%CI = [0.64–0.77]) 比 CDI (AUC = 0.67, 95%CI = [0.60–0.74]) 和 PDI (AUC = 0.67, 95%CI = [ 0.60–0.74]),但不显着(p  = .5436)。MVFI、PDI 和 CDI 的灵敏度/特异性值分别为 76.6%/64.1%、59.7%/73.8% 和 58.4%/74.8%。与 MVFI 的读者间协议总是非常好(k-score 0.85–0.96),而 CDI 和 PDI 的评估范围从好到非常好。观察者内协议没有差异。与彩色和功率多普勒相比,MVFI 显示 FBL 血管化的检测在统计学上显着增加。

更新日期:2021-07-08
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