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[摘要] 目的：探讨彩色多普勒血流成像（CDFI）对乳腺良恶性肿块的诊断价值。方法：用CDFI对经病理证实的218例乳腺实质性肿块进行超声检查，并与病理结果进行对照分析。结果：218例肿块经病理诊断，178例（81.7%）为良性肿块，40例（18.3%）是恶性肿块。超声检查与病理诊断良性肿块的符合率为92.7%，恶性肿块的符合率为85.0%。良性肿瘤中以均匀低回声为主，周边可伴有包膜回声，形态较规则，无钙化灶，内部无血流信号或可见少许彩色血流信号，较大纤维瘤内可见丰富的彩色血流信号。恶性肿瘤形态不规则，边界不清，边缘呈多角形或蟹足样，内部多呈低回声，无包膜，肿块内出现形态不一，呈细点状、斑片状、团状、条状、线状，以细点状多见的钙化灶。良性肿块、恶性肿块的血流阻力指数分别为0.60±0.05、0.74±0.07，两者比较，差异有统计学意义（P＜0.05）。结论：彩超对鉴别乳腺良恶性肿瘤有很好的临床应用价值。
[关键词] 乳腺肿块；彩色多普勒血流显像；血流阻力指数
[中图分类号] R445.1 [文献标识码] B [文章编号] 1674-4721（2011）03（c）-089-02
The diagnostic value of CDFI on breast masses
DAI Chaohong, JIANG Jing, ZHAO Yingbin
Ultrasound Department, Xiangtan Central Hospital, Hunan Province, Xiangtan 411100, China
[Abstract] Objective: To evaluate color Doppler flow imaging (CDFI) of benign and m alignant breast tumor diagnosis. Methods: 218 pathologically confirmed cases of breast solid mass were detected by CDFI, and results were compared with pathological analysis. Results: 218 cases of pathologically diagnosed, 178 patients (81.7%) were benign, 40 patients (18.3%) were m alignant tumor. Compliance rate between ultrasonography and pathological diagnosis of benign tumors was 92.7%, in line with m alignant tumors was 85.0%. Benign tumors showed mainly a uniform low echo, associated with echo around the capsule, which form was regular, no calcification, no blood flow or visible within a few color Doppler signals, the larger fibroids could be seen the rich color flow within the signal. M alignancy were irregular, ill-defined, polygonal edges or crab-like, mostly within the low echo, no capsule, the mass appeared in different form, was fine point-like, patchy, tangled, strip, linear, more common in fine punctate calcification. Benign and m alignant tumors of the blood flow index were respectively 0.60±0.05, 0.74±0.07, both had significant differences (P 良性肿块、恶性肿块的血流阻力指数分别为0.60±0.05、0.74±0.07，两者比较，差异有统计学意义（P＜0.05）（表2）。
3 讨论
乳腺肿块是乳腺癌最常见的症状，约90%的患者是以该症状前来就诊的。随着肿瘤知识的普及，防癌普查的开展，这一比例或许还会增加。乳腺组织位置表浅，干扰因素少，十分适用于超声检查。而且应用彩超诊断乳腺肿块，简单易行，安全无创，无放射性，可重复检查，患者易接受。超声检查主要应用于乳腺小叶增生、炎症、囊肿、纤维瘤及乳腺癌等疾病。其中主要是发现早期乳腺癌，以及对腋窝及锁骨上有无肿大淋巴结的检查，鉴别乳腺肿块的良恶性以及追踪观察病变的发展和演变，为临床诊断及治疗提供可靠的科学依据[2-3]。
二维超声结合CDFI可以清晰显示正常乳腺组织的结构、病变形态、大小及位置等，为乳腺疾病的早期诊断及良恶性肿瘤的鉴别诊断提供了准确的影像学信息，尤其是对临床触诊≥1.0 cm的肿块，可以清晰显示肿块的部位、数目、形态、大小、性质、内部回声、有无钙化灶、血流信息等。通过声像图特征分析，可以明确肿瘤的良恶性。本项目结果显示，超声检查与病理诊断良性肿块的符合率为92.7%，恶性肿块的符合率为85.0%。癌肿向周围组织浸润而形成的强回声带，正常乳房结构破坏以及肿块上方局部皮肤增厚或凹陷等图像，均为诊断乳腺癌的重要参考指标。恶性肿瘤影响局部钙磷代谢而形成的针尖样钙化被认为是乳腺恶性肿块的特征[4-6]。
乳腺良恶性肿块内血流多普勒频谱也存在较大差异：良性肿块表现为收缩期上升及下降速度均缓慢，峰值流速低，舒张期血流较丰富；恶性肿块常表现为收缩期峰值前移，升降波陡直，舒张期起始波在收缩期下降波中点以下，舒张末期无血流或舒张末期反向血流频谱。由于CDFI血流速度受角度的影响较大，而血流阻力指数不受角度影响，所以血流指数可作为鉴别良恶性肿块的指标，本项目良性肿块、恶性肿块的血流阻力指数分别为0.60±0.05、0.74±0.07，故可将RI>0.70作为诊断乳腺癌的重要指标。应特别重视某一部位虽未见明显肿块图像，但彩色血流信号异常丰富的情况，因为这往往提示有不典型增生或原位癌。
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（收稿日期：2011-01-18）
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