目的 讨论微血流成像（MFI）联合实时剪切波弹性成像（SWE）引导穿刺在BI-RADS 4类乳腺结节精准诊断中的临床价值。 方法 前瞻性选取2020年1月至2024年12月医院收治的218例乳腺结节患者（共224个结节）作为观察组，进行MFI、SWE检查，分析乳腺良恶性结节的影像特征，评估乳腺结节的血管血流分级和弹性硬度值，logistic回归分析乳腺结节良恶性影响因素，分析两种方法的诊断价值。 结果 224个结节均经病理证实，其中良性结节65个，恶性结节159个。恶性结节形态不规则、边缘不完整、微钙化例数高于良性结节（P < 0.05）。恶性结节血流分级0级、Ⅰ级例数低于良性结节（P < 0.05），Ⅱ级、Ⅲ级例数高于良性结节（P < 0.05）；恶性结节SWE弹性比值Eratio 3.25 ± 0.56高于良性结节的2.54 ± 0.22（P < 0.05）。logistic回归分析结果显示，结节形态不规则、结节边缘不光整、微钙化、SMI血流分级、SWE弹性硬度值均为鉴别乳腺良恶性病灶的独立影响因素（P < 0.05）。SMI、SWE单独检查与病理结果一致性一般（P < 0.05），MFI联合SWE检查与病理结果一致性较好（P < 0.05）。MFI联合SWE诊断乳腺良恶性结节的敏感度、特异度、准确度、阴性预测值高于单项检测（P < 0.05）。 结论 MFI联合SWE引导穿刺在BI-RADS 4类乳腺结节精准诊断中的价值较高。

Objective To discuss the clinical value of micro flow imaging （MFI） combined with real-time shear wave elastography （SWE） guided puncture in the precise diagnosis of BI-RADS type 4 breast nodules. Methods A total of 218 patients with breast nodules （224 nodules in total） admitted to the hospital from January 2020 to December 2024 were selected as the research subjects. MFI and SWE examinations were conducted to analyze the imaging features of benign and malignant breast nodules， evaluate the vascular blood flow grade and elastic hardness value of breast nodules， logistic regression was used to analyze the influencing factors of benign and malignant breast nodules， and analyze the diagnostic value of the two methods. Results All 224 nodules were pathologically confirmed， including 65 benign nodules and 159 malignant nodules. The number of malignant nodules with irregular morphology， incomplete edges and microcalcification was higher than that of benign nodules （P < 0.05）. The number of cases with blood flow grades 0 and I of malignant nodules was lower than that of benign nodules （P < 0.05）， while the number of cases with grades Ⅱand Ⅲ was higher than that of benign nodules （P < 0.05）. The SWE elastic ratio Eratio of malignant nodules was 3.25 ± 0.56， which was higher than that of benign nodules at 2.54 ± 0.22（P < 0.05）. The results of Logistic regression analysis showed that irregular nodule morphology， irregular nodule margins， microcalcification， MFI blood flow grade， and SWE elastic hardness value were all independent influencing factors for differentiating benign and malignant breast lesions （P < 0.05）. The consistency between the individual examinations of MFI and SWE and the pathological results was average （P < 0.05）， while the combined examination of MFI and SWE had a better consistency with the pathological results （P < 0.05）. The sensitivity， specificity， accuracy and negative predictive value of MFI combined with SWE in diagnosing benign and malignant breast nodules were higher than those of single detection （P < 0.05）. Conclusion MFI combined with SWE-guided puncture has a relatively high value in the precise diagnosis of BI-RADS type 4 breast nodules.