中文摘要：

目的 探讨乳腺良恶性肿瘤及其不同灌注区域血流动力学指标以及血管生成相关分子表达的差异性。方法应用超声造影时间-强度曲线（TIC）定量分析技术检测30例乳腺恶性肿瘤、30例乳腺纤维腺瘤边缘及中心部区域灌注参数及平均灌注参数峰值强度（PI），曲线下面积（AUC）、达峰时间（TTP），廓清时间（WOT），免疫组化技术检测CD34、VEGF、Flk-1／KDR在两组肿瘤中的表达。结果恶性组TIC形态多数（87．88％，29／33）呈速升缓降型，良性组多数（80．00％，12／15）呈缓升速降型。恶性组平均AUC、WOT大于良性组（P〈0．05），平均PI、TTP两组间无统计学差异（P〉0．05）。恶性组病灶边缘的PI、AUC、WOT、TTP与病灶中心各参数相比有统计学差异（P〈0．05），良性组病灶边缘的PI、AUC、WOT、TTP与病灶中心相比无统计学差异（P〉0．05）。恶性组MVD显著高于良性组（P〈0．05），微血管丰富区位于癌巢边缘。VEGF及Flk-1／KDR在恶性组血管内皮细胞尤其癌巢边缘呈强阳性表达，在良性组血管内皮细胞几乎不表达（P〈0．05）。结论实时超声造影灌注曲线、各平均灌注参数及区域灌注参数的差异为乳腺良恶性肿瘤的鉴别诊断提供了重要依据。针对VEGF或Flk-1／KDR为靶点进行乳腺癌特异性分子显像可能为乳腺癌的准确诊断提供新的思路，癌灶边缘可能是下一步进行乳腺癌分子影像观察的重点靶区。

英文摘要：

Objective To compare the differences in histological morphology, hemodynamics and angiogenesis related molecules between benign and malignant tumor, as well as differences between the different perfusional regions in tumors of the same type. Methods 30 cases with malignant breast carcinoma and 30 cases with fibroadenoma were inspected by contrast enhanced ultrasound with time-intensity quantitive analysis. Perfusion index like peak intensity （PI）, area under the curve （AUC）, time to peak （TTP） and wash-out time （WOT） were collected both inside and at the margin of focus. The expression of CD34, VEGF, Flk-1/KDR in both two groups were measured with immuhistochemical technique. Results The curve of malignant tumor group was characterized as ascend rapidly and drop slowly while the benign group presented as ascend slowly and drop rapidly. The AUC and WOT of malignant tumor group were significantly higher than that of benign group, while the PI and TTP had no statistical difference. In malig nant tumor group, PI, AUC and WOT of the margin of focus were significantly higher that of inside region of focus, while TTP was the opposite. However, there is no statistical differences between the perfusion parameter inside and outside of focus in benign group. The distribution of CD34 in breast carcinoma was heterogeneous. The micro vessels densely distributed and diffused around the margin of cancer nest. The MVD of malignant group （34.48±8.34） was significantly higher than that of benign group （18.65±4.69） . Expression of VEGF. the high VEGF expression dis tributed diffusely or focally at the margin of cancer nest and necrotic tissue. The VEGF expression between malignant and benign group had significant difference. Expression of Flk-1/KDR. Flk-1/KDR expressed diffusely or focally in breast carcinoma, especially high at the margin of cancer nest and necrotic tissue. The Flk-1/KDR expression between malignant and benign group had significant difference. Conclusions The perfusion pattern, modality of