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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:833-842 • 0278-4297

Microvascular Architecture of Breast Lesions

Evaluation With Contrast-Enhanced Ultrasonographic Micro Flow Imaging

Jing Du, MD, Feng-Hua Li, MD, Hua Fang, MD, Jian-Guo Xia, MD and Cai-Xia Zhu, MD

Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

Address correspondence to Feng-Hua LI, MD, Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Rd, 200127 Shanghai, China. E-mail: fenghua-li{at}163.com

Objective. The purpose of this study was to evaluate the effectiveness of micro flow imaging (MFI) of the microvascular architecture with contrast-enhanced ultrasonography for classification of breast lesions as benign or malignant and the microvascular architectural patterns. Methods. Contrast-enhanced ultrasonography and MFI were performed in 61 women with breast lesions. The microvascular morphologic and distribution features of the breast tumors were evaluated with MFI. Receiver operating characteristic curve analysis was used to evaluate the diagnostic value of MFI, and the microvascular architectural patterns were analyzed. Results. Surgical pathologic analysis showed 29 benign and 32 malignant lesions. For MFI, the area under the receiver operating characteristic curve (Az) value for the overall features of the blood vessels for classification of breast lesions was 0.94. The accuracy, sensitivity, and specificity were 90.2% (55/61), 93.8% (30/32), and 86.2% (25/29), respectively. The Az value for the morphologic and distribution features of peripheral blood vessels was 0.91, which was significantly higher than the Az value for the morphologic and distribution features of interior vessels (P = .019). The microvascular architecture of the 61 lesions was categorized into 3 patterns: treelike, root hair–like, and crab claw–like. Benign lesions mainly displayed the treelike pattern (17 [58.6%]); malignant lesions tended to display the crab claw–like pattern (20 [62.5%]); and the root hair–like pattern was shown in both benign and malignant lesions (11 [37.9%] and 8 [25%], respectively). The microvascular architecture showed significant differences between benign and malignant lesions (P < .001). Conclusions. Micro flow imaging can clearly delineate the microvascular architecture of breast lesions and can aid in discrimination between benign and malignant breast lesions.

Key Words: breast lesion • contrast-enhanced ultrasonography • micro flow imaging • receiver operating characteristic curve • vascular architecture

Abbreviations: Az, area under the receiver operating characteristic curve • CEUS, contrast-enhanced ultrasonography • CnTI, contrast-tuned imaging • HCC, hepatocellular carcinoma • MFI, micro flow imaging • MI, mechanical index • NPV, negative predictive value • PPV, positive predictive value • ROC, receiver operating characteristic

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.