超声造影鉴别诊断附件区包块的良恶性

Contrast-enhanced ultrasound for differential diagnosis of adnexal masses

目的探讨CEUS用于鉴别诊断妇科附件区包块良恶性的应用价值。方法对44例常规妇科超声显示附件区包块声像图不典型的患者行CEUS检查,用SonoLiver软件分析造影剂的时间-强度曲线(TIC)及动态血管模式,对比病理结果,分析CEUS在鉴别诊断附件区包块良恶性的价值。结果①CEUS图像及动态血管模式全面显示了组织微血管的血流走向及分布,对性质、来源不明的包块有鉴别诊断意义。②动态血管模式下各所选区域的TIC分析显示,良性肿瘤及其末梢血管的造影剂呈逐渐低灌注,TIC波峰低平;恶性肿瘤及其末梢血管的造影剂呈快速高灌注,TIC波峰高尖。③良、恶性肿瘤的TIC上升时间(RT)和达峰时间(TTP)差异有统计学意义(P<0.05),ROC曲线分析得到RT≥16.50 s、TTP≥20.28 s为诊断肿瘤良性的最佳截点,常规超声结合上述RT和TTP截点诊断肿瘤良性ROC曲线下面积增大。结论 CEUS图像及其动态血管模式对判断附件区包块的性质、来源具有意义。造影剂的不同灌注特征及TIC参数RT、TTP有助于鉴别附件区良、恶性肿瘤。

Objective To observe the value of contrast-enhanced ultrasound（CEUS） in differential diagnosis of adnexal masses.Methods Totally 44 patients with complicated adnexal masses were examined with CEUS and then analyzed with time-intensity curve（TIC） and dynamic vascular pattern using SonoLiver Software.The results of CEUS were compared with those of pathological examination,and the differential diagnostic value of CEUS was analyzed.Results ①CEUS and the dynamic vascular pattern completely displayed the trend and distribution of blood flow,being helpful to differential diagnosis of adnexal masses of unknown nature and origin.②Different selected regions were analyzed with its TIC at the Dynamic vascular pattern,benign tumors and the peripheral vessels showed hypoperfusion,and the crest of masses were flat.On the contrary,malignant tumors and the peripheral vessels showed hyperperfusion,and the crest of masses were sharp.③The Rise Time（RT） and Time To Peak（TTP） of TIC were significant different in benign and malignant tumors（P〈0.05）.Taking RT ≥16.50 s and TTP ≥20.28 s as cut-off value for diagnosis of benign tumors,the area under the ROC curve increased when the routine ultrasound combined with RT and TTP cut-off value（0.94 vs 0.79）.Conclusion CEUS may help in determining the nature and source of adnexal masses.The characteristics with different infusion and parameters with RT and TTP may also help to differential diagnosis of benign and malignant adnexal tumors.