目的：评价超声造影对BI-RADS 4级乳腺肿块的进一步鉴别诊断的价值。方法通过分析64个BI-RADS-US 4级乳腺的实时灰阶超声造影征象和时间-强度曲线定量参数（AT、TTP、PI），进行超声造影良恶性鉴别诊断，并与术后病理检查结果进行对照。结果64个BI-RADS-US 4级乳腺肿块，术后病理结果为恶性29个，良性35个，良恶性组间在造影后形态、造影剂分布，边界、周围扭曲或穿入血管、造影后有无明显增大方面差异较明显（P<0.05），而在定量参数中，达峰时间（TTP）和峰值强度（PI）在良恶性组间有较明显差异（P<0.05），本组64个常规超声BI-RADS-US4级乳腺肿块中，造影诊断为恶性32个，良性32个，诊断敏感性89.7%，特异性82.9%，准确率86%。其中对浸润性导管癌、纤维腺瘤的诊断准确性较高。结论超声造影实时灰阶征象结合时间-强度曲线分布可对常规超声BI-RADS4级乳腺肿块进一步良恶性鉴别诊断。%Objective To assess the value of contrast-enhanced ultrasonography(CEUS)in differential diagnosis of BI-RADS 4 breast lesions. Methods The CEUS findings of 64 breast lesions of BI-RADS 4,including morphologic features and time-intensity curve parameters(AT,TTP, PI)were analyzed,and in the end the CEUS diagnoses were made according to our preliminary study results.Histology results were served as golden reference.Results Of all the 64 BI-RADS 4 breast 1esions that were confirmed by histopatho1ogy results,29 were malignant and 35 were benign. The differences of morphologic features of shape,margin,penetrating or tortuous surrounding vessels,heterogeneous or homogeneous distribution, whether the lesion was significant enlarged after contrast enhanced between benign and malignant lesions were with statistical significant(P<0.05). And the diffbrences of the parameters(including TTP,PI)between the benign and malignant lesions were with statistical significant in our study(P<0.05).32 lesions were diagnosed as malignant,while 32 lesions were diagnosed as benign with CEUS.Its sensitivity,specificity and accuracy were 89.7%,82.9% and 86%.In a11 the histological types of these 64 breast 1esions,the diagnostic accuracies for invasive ductal carcinoma,fibroadenoma were relatively higher. Conclusion CEUS could be applied as a useful adjunct to conventional ultrasonography for BI-RADS 4 breast lesions.
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