子宫内膜息肉经阴道三维超声检查的图像表现及漏诊原因分析

IMAGE FEATURES AND ANALYSIS OF MISDIAGNOSIS OF ENDOMETRIAL POLYP THROUGH THREE- DIMENTIONAL TRANSVAGINAL ULTRASOUND INSPECTION

目的研究子宫内膜息肉经三维阴道超声检查的图像特征,寻找漏诊的原因,提高诊断可靠性。方法回顾性分析2012年6月～2013年12月的51例经宫腔镜术并病理证实为子宫内膜息肉的阴道三维超声的图像特征。结果 51例子宫内膜息肉的患者中,经阴道三维超声诊断的子宫内膜息肉47例,检出率92.16%；漏诊4例,漏诊率7.84%,2例由于剖宫产后子宫底与前腹壁粘连,1例子宫增大合并子宫多发性肌瘤、1例为子宫腺肌病合并子宫肌瘤。结论经阴道三维超声在子宫内膜息肉诊断方面存在特征性图像,同时较二维阴道彩超具有更好的空间分辨率。漏诊原因是二维图像质量的不清晰,当因各种原因出现二维图像质量欠佳时应提示临床医师行宫腔镜检查,避免漏诊。

Objective To study the image characteristics of endometrial polyp by three- dimensional vaginal ultrasound and to investigate the causes of missed diagnosis in order to improve the diagnostic reliability. Methods The three-dimensional transvaginal ultrasound image characteristics of 51 endometrial polyp cases confirmed by pathology and hysteroscopy surgery during June 2012 and December 2013 were retrospectively analyzed. Results In 51 cases of endometrial polyp,47 were diagnosed by three- dimensional transvaginal ultrasound with the detection rate of 92. 16%;4 were missed diagnosis with the rate of 7. 84%,in which 2 were due to adhesion of abdominal wall and uterus bottom after cesarean section,1 due to uterus increases and multiple uterine fibroids,and the last one due to adenomyosis of uterus and uterine fibroids. Conclusion Three- dimensional transvaginal ultrasound presents characteristic images in the diagnosis of endometrial polyp and better spatial resolution ratio compared to two- dimensional transvaginal ultrasound. The reason of misdiagnosis is the obscure quality of two- dimensional image. Therefore when two- dimensional image quality is poor due to various reasons,hysteroscopy should be performed to avoid missed diagnosis.