经阴道超声造影与经阴道彩色多普勒超声在子宫内膜癌术前诊断中的对比研究

Comparative study for transvaginal contrast-enhanced ultrasound and transvaginal color Doppler sonography in preoperative diagnosis of endometrial cancer

目的探讨经阴道超声造影(TVS-CEUS)技术在子宫内膜癌术前诊断中的临床应用价值。方法 27例子宫内膜癌患者术前均进行经阴道彩色多普勒超声(TVCDS)和TVS-CEUS检查,评估局部病灶的大小及范围,与病理结果进行对照,分析子宫内膜癌病灶的造影时间-强度曲线(TIC)形态及参数。结果子宫内膜癌的造影增强模式表现为整体快速充盈,增强及消退早于未受累肌层,较常规TVCDS更能清晰显示病灶的边界,获得的病灶大小的测值更客观准确;子宫内膜癌感兴趣区的TIC形态呈速升速降型,波峰较尖锐,定量参数的受试者工作特征曲线分析发现,增强强度(EI)无诊断价值;造影剂到达时间(AT)、达峰时间(TTP)、增强时间(ET)、上升斜率(RSR)、半消退时间(HWOT)、下降早期斜率(HWSR)均>0.5,有诊断意义(P<0.05);按曲线下面积值进行等级划分,AT对子宫内膜癌诊断价值中等,TTP、ET、RSR、HWOT、HWSR诊断价值较高;TVS-CEUS对子宫内膜癌的术前分期诊断与病理诊断符合率均高于TVCDS,差异有统计学意义(P<0.05)。结论 TVS-CEUS在子宫内膜癌术前诊断中有一定的临床应用价值,优于TVSDS。

Objective To explore the clinical value of transvaginal contrast-enhanced ultrasound（TVS-CEUS） in clinical preoperative diagnosis of endometrial cancer. Methods Twenty-seven cases of endometrial cancer were examined by transvaginal color doppler sonography （TVCDS） and TVS-CEUS before operation to assess the size and scope of local lesions, the results were compared with those of the pathology, the shape and parameters of time-intensity curve（TIC ） for TVS-CEUS were analyzed. Results The enhancement pattern of endometrial cancer was whole rapid enhancement, the enhancement and wash- out were earlier than normal myometrium. The boundary and the size of the lesion was more clearly displayed by TVS-CEUS than TVCDS. The shape of time-intensity curve （TIC） was rapid up and rapid down,the peak was sharp. Enhancement intensity （EI） had no reference value, while arrive time（AT）, time to peak（TTP）, enahncement time（ET）, rising-slope rate（RSR）, half wash-out time （HWOT）, half washed slope rate （HWSR） had diagnosis value by analyzing the receiver operator characteristic （ROC） curve （P〈0.05）. A z data indicated that TTP, ET, RSR, HWOT and HWSR appeared to be superior to AT. The accuracy of TVS-CEUS in diagnosis and preoperative staging of endometrial cancer was advanced than TVCDS, there was significant difference （P〈0.05）. Conclusion TVS-CEUS has considerable clinical value in preoperative diagnosis of endometrial cancer, which is better than TVCDS.