The clinical value of Arrival-time Parametric Imaging using contrast-enhanced ultrasonography in differentiating benign and malignant breast lesions

Article type: Research Article

Authors: Hu, Wenjie^{a; 1} | Dong, Yi^{b; 1} | Zhang, Xuemei^c | Zhang, Huiping^a | Li, Fan^{a; *} | Bai, Min^{a; *}

Affiliations: [a] Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China | [b] Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China | [c] Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Correspondence: [*] Corresponding author: Fan Li, PhD and Min Bai, PhD, Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Hai Ning Road, Shanghai 200080, China. E-mail: medicineli@163.com (Fan Li); E-mail: baimin101@126.com (Min Bai).

Note: [1] Wenjie Hu and Yi Dong have contributed equally to this article and can be considered co-first authors.

Abstract: OBJECTIVES:To evaluate the clinical value of Arrival-time Parametric Imaging (At-PI) in the differentiation of benign and malignant breast lesions. METHODS:For this ethics committee-approved retrospective study, a total of 184 breast lesions in 176 women were included and gray-scale ultrasound, contrast-enhanced ultrasound (CEUS) and At-PI were performed. In CEUS and At-PI, perfusion patterns, perfusion uniformity and color spatial distribution for lesions were analyzed qualitatively and the maximal diameter ratio of the lesion in accumulated parametric images and that in gray-scale images (MDRAI/GI) and area ratio of the lesion in accumuated parametric images and that in gray-scale images (ARAI/GI) were calculated quantitatively. Kappa and Intraclass Correlation Coefficient were used to evaluate the interobserver reproducibility for CEUS and At-PI and the intraobserver reproducibility for At-PI, respectively. The area under receiver operating characteristic (AUC), sensitivity, specificity, accuracy and positive and negative likelihood ratios (PPV, NPV) were calculated for MDRAI/GI and ARAI/GI. RESULTS:Good interobserver and intraobserver reproducibility for At-PI were identified. In At-PI, there were statistically significant differences in perfusion patterns, color spatial distribution, MDRAI/GI and ARAI/GI between benign and malignant breast lesions (P < 0.05). The AUCs of MDRAI/GI and ARAI/GI were 0.895 and 0.954, respectively, with no significant difference between them (Z = 1.84, P > 0.05). By using the thresholds of 1.125 for MDRAI/GI and 1.21 for ARAI/GI, the sensitivity, specificity, accuracy, PPV and NPV of At-PI were 84.48%, 88.24%, 85.57%, 92.45% and 76.92%, respectively, for MDRAI/GI and 93.10%, 91.18%, 92.39%, 94.74% and 88.57%, respectively, for ARAI/GI. CONCLUSIONS:At-PI is helpful to distinguish benign from malignant breast lesions. And MDRAI/GI and ARAI/GI are useful and efficient features for differential diagnosis.

Keywords: Contrast-enhanced ultrasound, Arrival-time Parametric Imaging, benign and malignant breast lesions

DOI: 10.3233/CH-200826

Journal: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 369-382, 2020