超声造影对附件区良恶性包块的鉴别诊断价值

THE VALUE OF CONTRAST-ENHANCED ULTRASOUND IN THE DIFFERENTIAL DIAGNOSIS OF BENIGN AND MALIGNANT MASS IN ANNEX REGION

目的探讨超声造影在附件区良恶性包块鉴别诊断中的应用价值。方法对32例附件区囊性、囊实性混合包块或实性包块病人行经阴道常规超声及经腹部超声造影检查,观察包块的造影灌注强度和灌注模式,制作时间-强度曲线(TIC)。依据手术病理结果将病人分为良性组及恶性组,分析比较两组TIC形态及造影参数的差异。结果 32例附件区包块中,良性组21例,恶性组11例。以正常子宫肌层作为参照,良性组造影剂呈缓慢低或等增强,多由周边向内部灌注,血管走行规则,TIC表现为"缓升缓降"型;恶性组呈不均质快速高增强,多由包块内部向周边灌注,血管迂曲,走行不规则,TIC表现为"速升缓降"型。恶性组造影剂峰值强度和曲线下面积显著高于良性组(t=5.95、3.85,P<0.01);而两组达峰时间及平均渡越时间比较差异无统计学意义(P>0.05)。结论超声造影能够更好显示病灶内血流灌注情况,分析包块的超声造影增强模式、TIC形态及各参数值,有助于附件区良恶性肿瘤的诊断及鉴别诊断。

Objective To explore the value of contrast-enhanced ultrasonography in differential diagnosis of benign and malignant mass in annex region. Methods Thirty-two patients with cystic-solid or solid mass in annex region underwent transvaginal sonography and abdominal contrast-enhanced ultrasonography,the enhanced patterns and intensity were observed and the time-intensity curve（TIC）made.The patients were divided into two groups-benign and malignant-according to the pathology.The differences of TIC and contrast parameters were compared between the two groups. Results Among the 32 cases,21in the benign group,and 11 in the malignant group.Taking normal myometrium as a reference,in the benign group,the contrast media showed slowing low or equal enhancement,perfusion from surrounding to the interior,vessels arranged regularly,TIC manifested as slow-up-and-slow-down type;in the malignant group,masses exhibited heterogeneous and rapidly high enhancement,mostly from inside to periphery,with tortuosity and un-regularity of blood vessels,the TIC appeared as speed-up-and-slow-down type.The peak intensity（PI）of contrast media and the area under the curve（AUC）in the malignant group were higher than that in the benign group（t=5.95,3.85;P〈0.01）,while there was no significant differences of time to top（TTP）and mean transit time（MTT）between benign and malignant groups（P〉0.05）. Conclusion Contrast-enhanced ultrasonography can better demonstrate the blood perfusion inside the lesions,analyze the mode of mass enhancement,TIC modality and each parameter value,which is conducive to improving the ability of differential diagnosis of benign and malignant tumors in annex region.