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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5791_Библиотеки_им_академика_М_И_Перельмана.pdf
Fig. 4.5 (continued)
714.4 Color and Power Doppler Imaging
b5
b6
72
Fig. 4.5 (continued)
4 Ultrasound Diagnosis of Breast Cancer
b7
b8
Fig. 4.5 (continued)
734.5 Pulsed Doppler Imaging
b9
lesions (in 100 % of tumors larger than 4 cm in
size and in 76 % of tumors smaller than 2 cm).
The vessels in malignant neoplasms were characterized with irregular caliber (narrow and dilated
segments), collaterals, and branching. Smirnova
( 1995 ) and Tro fi mova ( 2000a, b ) observed
absence of vascularity in 85–95 % of lesions and
consider that blood vessels can be detected only
within the tumors of the size larger than 2 cm
and are associated with expressed cellular
proliferation.
According to Shevchenko ( 1999 ) , absence of
neovascularization in a solid breast lesion, which
is highly suspicious for cancer, does not permit to
exclude its malignant nature. Almost 31 % of
cancers appear avascular. Alternatively, CDI can
detect vessels in normal breast.
Some authors report a “twinkling” artifact
with CDI due to microcalci fi cations within cancer
structure ( Gromov and Kubova 2004 ; Trufanov
et al. 2009 ) .
CDI has some disadvantages, such as aliasing
in cases of high velocities, background noise, and
dependence on the angle between the US beam
and blood fl ow.
Power Doppler imaging (PDI) permits to
obtain angle-independent images of smaller vessels with more accurate contours that increase
diagnostic value of Doppler mapping (Fig. 4.6 ).
PDI quality is characterized by low dependence
on the angle between blood fl ow and US beam
and no aliasing effect. Noise is ef fi ciently reduced
since the noise energy is constantly low, and
blood fl ow exhibits signi fi cantly higher energy.
Therefore, PDI is three to fi ve times more sensitive than CDI. PDI is capable to de fi ne larger
number of vessels (as compared with CDI) in all
breast malignancies, especially in in fi ltrative
carcinoma.
PDI disadvantages are high dependence on
motion of surrounding structures with movement
artifacts and coloring of perivascular areas.
The sensitivity of Doppler mapping can be
signi fi cantly increased by means of intravenously
introduced US contrast agents ( contrast ultra-
sound , CUS) by analogy to contrast enhancement
at CT and MRI. Contrast agents signi fi cantly
improve imaging of small vessels. The number
imaged vessels increases from 36 % to 95 %.
4.5 Pulsed Doppler Imaging
Pulsed-wave Doppler mode displays the obtained
data as a curve, which permits the analysis of
velocities and spectral parameters of blood fl ow
74
4 Ultrasound Diagnosis of Breast Cancer
and calculation of several indexes, such as peak
systolic velocity (PSV), end-diastolic velocity
(EDV), resistive index (RI), and pulsatility index
(PI) (Fig.
4.7 ).
Pulsed-wave Doppler is used to measure blood
fl ow indexes in large afferent breast arteries, vessels of breast parenchyma, and vessels within
breast lesions.
Tro fi mova ( 2002 ) considers that assessment
of blood fl ow only within breast lesion is enough.
Nevertheless, in cases of in fi ltrative cancer, there
appears the necessity to compare vascular pattern
with contralateral area in the other breast. Sohn
et al. ( 1997 ) report the value of pulsed Doppler
data of blood fl ow in branches of lateral thoracic
artery, pectoral branch of the thoracoacromial
trunk, and medial mammary branches of the
internal thoracic (internal mammary) artery of
affected and normal breast.
Pulsed Doppler can con fi rm blood fl ow
enhancement within a lesion in comparison with
that in normal parenchyma; in rare cases,
Fig. 4.6 Breast carcinoma.
PDI. ( a ) Avascular lesion.
( b ) Well-vascularized tumor
a1
a2
Fig. 4.6 (continued)
754.5 Pulsed Doppler Imaging
a3
a4
76
Fig. 4.6 (continued)
4 Ultrasound Diagnosis of Breast Cancer
b1
b2
Fig. 4.6 (continued)
774.5 Pulsed Doppler Imaging
b3
b4
78
Fig. 4.6 (continued)
4 Ultrasound Diagnosis of Breast Cancer
b5
b6
Fig. 4.6 (continued)
794.5 Pulsed Doppler Imaging
b7
b8
80
Fig. 4.7 Breast cancer.
Pulsed-wave Doppler
4 Ultrasound Diagnosis of Breast Cancer
vascularization is identical. The intensity of blood
fl ow of the lesion is often related not so much
with its morphological structure but with its size
( Lelyuk and Lelyuk 2007 ) . According to Svensson
( 1997 ) , the indexes of blood fl ow in the vessels of
a malignant tumor directly depend on its volume,
and enlargement in size results in the increase of
spectral characteristics. Haylenko et al. ( 2005 )
reported that the indicators of blood fl ow in
malignancies with CDI and PDI also exhibit
direct correlation with lesion’s volume.
Many researchers analyzed different parameters of vascularization and suggest the following
Doppler criteria of malignancy: high DSV of
intranodular blood fl ow ( Teh 1998 ), high RI
(Sohn et al. 1997 ) , and high PI (Zabolotskaya
2006 ) . In the opinion of De Albertis et al. ( 1995 ) ,
breast carcinoma is characterized with presence
of several (more than 2) vascular areas, high PSV,
and high PI.
According to Harchenko et al. ( 1993a, b ) ,
PSV in the vessels of normal breast tissue is