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目的:探讨超声造影(CEUS)在乳腺非肿块样病灶(NMLs)中的应用价值。方法:前瞻性地选择2019年1月1日至12月31日于浙江大学医学院附属第二医院就诊的乳腺NMLs患者30例(30个病灶)纳入研究，依据乳腺影像报告及数据系统(Breast Imaging Reporting And Data System，BI-RADS)评估NMLs，行CEUS检查，以造影后病灶增大、“蟹爪”征为可疑恶性征象，病灶存在可疑恶性征象则维持原BI-RADS分类，无可疑恶性征象则对原BI-RADS分类行降级，以病理诊断为金标准，评价CEUS能否为初始BI-RADS分类结果提供进一步诊断信息，并分析各指标与乳腺NMLs良恶性的相关性。结果:30例患者30个乳腺NMLs初始BI-RADS 4A类15例、4B类9例、4C类6例，其中22例(73.3%)良性，8例(26.7%)恶性。造影征象中良恶性病变在增强均匀性、是否出现快进、增强后病灶有无增大和有无“蟹爪”征方面差异有统计学意义(n P<0.05)，而增强后病灶增大和“蟹爪”征与恶性乳腺NMLs相关(n r＝0.49、0.62，均n P<0.05)，依据CEUS征象对NMLs原BI-RADS分类降级17例(均为良性)，维持原分类不变13例(5例阳性，8例恶性)。BI-RADS分类诊断乳腺NMLs敏感性为100%，特异性为0，阳性预测值26.7%；CEUS联合BI-RADS分类诊断敏感性为100%，特异性为54.5%，阳性预测值44.4%，CEUS联合BI-RADS分类显著提高单独应用BI-RADS分类在乳腺NMLs中的诊断特异性和阳性预测值(54.5%对0，44.4%对26.7%)。n 结论:良恶性病变在增强均匀性、是否出现快进、增强后病灶有无增大和有无“蟹爪”征方面差异有统计学意义，而增强后病灶增大和“蟹爪”征与恶性乳腺NMLs相关，CEUS联合BI-RADS分类可显著提高乳腺NMLs诊断的特异性和阳性预测值，对BI-RADS分类有一定的辅助价值。“,”Objective:To evaluate the diagnostic value of contrast enhanced ultrasound (CEUS) in non-mass like breast lesions (NMLs).Methods:Thirty patients with 30 breast NMLs from January 1, 2019 to December 31, 2019 in the Second Affiliated Hospital, Zhejiang University School of Medicine were included. Breast Imaging Reporting And Data System (BI-RADS) was used to evaluate the breast NMLs. Whether CEUS could provide further diagnostic information for the initial BI-RADS classification were evaluated. The correlations between benign and malignant breast NMLs were also analyzed.Results:The number of BIRADS 4A, 4B, 4C were 15, 9, and 6 respectively.Among them, 22 cases (73.3%) were benign and 8 cases (26.7%) were malignant. There were statistically significant differences between benign and malignant lesions in enhancement uniformity, wash-in, enlargement and crab claw sign(n P<0.05). While the tumor enlargement and crab claw sign were correlated with malignant breast NMLs (n r=0.49, 0.62, n P<0.05). Seventeen cases (all benign) were degraded according CEUS, and 13 cases (5 benign and 8 malignant) remained unchanged. The sensitivities, specificities and positive predictive values of BI-RADS classification and the combination of CEUS and BI-RADS for breast NMLs were 100%, 0, 26.7%, and 100%, 54.5%, 44.4%, respectively. The CEUS significantly improved the diagnostic specificity and positive predict value of BI-RADS classification in breast NMLs (54.5% vs 0, 44.4% vs 26.7%).n Conclusions:The differences between benign and malignant breast NMLs in enhancement uniformity, wash-in, tumor size enlargement and crab claw sign are significant. The tumor size enlargement and crab claw sign are correlated with malignant breast NMLs. The CEUS is helpful for BI-RADS classification in the diagnosis of breast NMLs.